The Retroperitoneal Approach to Endometriosis.

Study Objective: To demonstrate principles of laparoscopic management of deeply infiltrating endometriosis requiring retroperitoneal entry.

Design: Step-by-step demonstration and explanation of technique using videos from patients with deeply infiltrating stage IV endometriosis who failed medical management (Canadian Task Force classification IIIB). This study was exempt from Institutional Review Board review.

Multidisciplinary team learning in the management of the morbidly adherent placenta: outcome improvements over time.

Background: Morbidly adherent placenta (MAP) is a serious obstetric complication causing mortality and morbidity.

Objective: To evaluate whether outcomes of patients with MAP improve with increasing experience within a well-established multidisciplinary team at a single referral center.

Study Design: All singleton pregnancies with pathology-confirmed MAP (including placenta accreta, increta, or percreta) managed by a multidisciplinary team between January 2011 and August 2016 were included in this retrospective study.

Transvaginal uterosacral ligament suspension for posthysterectomy vaginal vault prolapse repair.

Introduction And Hypothesis: Posthysterectomy vaginal vault prolapse repair represents a challenge for urogynecologists. Surgical management can be successfully achieved with native tissue using a vaginal approach with uterosacral ligament (USL) suspension. However, severe complications have been described, mainly related to ureteral injury.

Urologic injuries during gynecologic surgery, a 10-year review.

Aims: The study was conducted to evaluate the incidence of urologic injuries during gynecologic surgery, study the management and outcome of such injuries, and identify risk factors that may be associated with urologic injuries.

Methods: A case-control study was conducted in patients who underwent gynecologic surgery from 2005 to 2014 in the university hospital. The study cases referred to patients who had urologic injury during gynecologic surgery and the control cases referred to patients who had gynecologic surgery matching the same period, type of procedure, and etiological disease leading to surgery.

A comparison of sentinel lymph node biopsy to lymphadenectomy for endometrial cancer staging (FIRES trial): a multicentre, prospective, cohort study.

Background: Sentinel-lymph-node mapping has been advocated as an alternative staging technique for endometrial cancer. The aim of this study was to measure the sensitivity and negative predictive value of sentinel-lymph-node mapping compared with the gold standard of complete lymphadenectomy in detecting metastatic disease for endometrial cancer.

Methods: In the FIRES multicentre, prospective, cohort study patients with clinical stage 1 endometrial cancer of all histologies and grades undergoing robotic staging were eligible for study inclusion.

An evaluation of laparoscopic hysterectomy alone versus in combination with laparoscopic myomectomy for patients with uterine fibroids.

Objective: The purpose of this study was to compare surgical outcomes following conventional laparoscopic hysterectomy (LH) (C-LH) versus the combination method of LH plus laparoscopic myomectomy (LM) (LH+LM) for the treatment of large uterine fibroids.

Study Design: This study was performed in 56 patients (uterine weights ≥500g) who underwent either C-LH or LH+LM performed by the same surgeon between May 2010 and May 2016. LH+LM was performed when C-LH was problematic because of poor visibility and/or mobility due to uterine fibroids.

Laparoscopic management of ureteral endometriosis: A systematic review.

The optimal management of ureteral endometriosis (UE) is not yet well defined. The choice on surgical approach and type of procedure has been based both on surgeons' experience and the location and depth of the lesion. The aim of this study was to review evidence about laparoscopic management of ureteral endometriosis, including preoperative evaluation, surgical details and postoperative follow-up.

Evolution in the approach to overlooked ureteral injuries after gynecological surgery.

Objectives: To analyzed the therapeutic results for patients with overlooked iatrogenic ureteral injuries after gynecological surgery, treated at the department since 1990. Before the era of endourology, ureteral injuries were operated on immediately after making a diagnosis. This approach was changed after the popularization of percutaneous nephrostomy (PN) and ureteral stenting using a JJ stent.

Safety of total laparoscopic hysterectomy in patients with prior cesarean section.

Aim: Patients who have undergone a cesarean section (CS) prior to hysterectomy are at a higher perioperative risk of complications. The purpose of this study was to evaluate the safety of total laparoscopic hysterectomy (TLH) in patients with prior CS.

Methods: We enrolled 482 patients treated with TLH.

Total Laparoscopic Hysterectomy Versus Vaginal Hysterectomy: A Systematic Review and Meta-Analysis.

Hysterectomies performed laparoscopically have greatly increased within the last few decades and even exceed the number of vaginal hysterectomies (VHs). This systematic review, conducted according to the Meta-analysis of Observational Studies in Epidemiology guidelines, compares surgical outcomes of total laparoscopic hysterectomy (TLH) and VH to evaluate which approach offers the most benefits. A literature search was performed in PubMed, Embase, and Web of Science for all relevant publications from January 2000 to February 2016.

Current concepts and practical techniques of nerve-sparing laparoscopic radical hysterectomy.

Laparoscopic radical hysterectomy has been widely performed for patients with early-stage cervical cancer. The operative techniques for nerve-sparing to avoid bladder dysfunction have been established during the past three decades in abdominal radical hysterectomy, but how these techniques can be applied to laparoscopic surgery has not been fully discussed. Prolonged operation time or decreased radicality due to less accessibility via a limited number of trocars may be a disadvantage of the laparoscopic approach, but the magnified visual field in laparoscopy may enable fine manipulation, especially for preserving autonomic nerve tracts.

Intraoperative Cystoscopic Evaluation of Ureteral Patency: A Randomized Controlled Trial.

Objective: To compare different modalities to aid in the evaluation of intraoperative ureteral patency on cystoscopy in the postindigo carmine era.

Methods: In a randomized controlled trial, participants undergoing pelvic surgery were randomized into one of four groups: saline distention (control), 10% dextrose distention, oral phenazopyridine, or intravenous sodium fluorescein. Our primary outcome was visibility of the ureteral jets.

Feasibility and Safety of Laparoscopic Total Mesometrial Resection in Early-stage Cervical Cancer.

Aim: In this study we aimed to analyze the safety and feasibility of total mesometrial resection (TMMR) using the laparoscopic approach.

Patients And Methods: Laparoscopic TMMR and pelvic lymphadenectomy (LNE) was carried out in 34 patients with cervical cancer FIGO IA-IIB from April 2012-April 2016 at our tertiary center. Para-aortic LNE was performed when indicated.

Laparoscopic fixation of the vaginal cuff to the uterosacral ligaments at the time of hysterectomy.

Introduction And Hypothesis: Transvaginal ipsilateral uterosacral ligament colpopexy for pelvic organ prolapse (POP), which was reported by Shull et al. (Shull's colpopexy) in 2000, is one of the most frequently performed non-mesh pelvic floor reconstructive surgical procedures. Despite its excellent anatomical outcomes, ureteral injury and difficulty in uterosacral ligament detection (especially in patients with severe POP) are typical issues with this procedure.

[Anatomical consideration for the technique of nerve-sparing during radical hysterectomy for cervical cancer].

Radical hysterectomy (RH) is an effective treatment for early-stage cervical cancer IA2 to IIA1 but RH is often associated with several significant complications such as urinary, anorectal and sexual dysfunction due to pelvic nerve injuries. Pelvic autonomic nerves including the superior hypogastric plexus (SHP), hypogastric nerves (HN), pelvic splanchnic nerves (PSN), sacral splanchnic nerves (SSN), inferior hypogastric plexus (IHP) and efferent branches of the IHP. We aimed to precise the neuroanatomy of the female pelvis in order to provide key-points of surgical anatomy to improve NSRH for cervical cancer.

Vaginal hysterectomy, vaginal salpingoophorectomy and uterosacral ligament colpopexy: a view from above (in English and Spanish).

Aim Of The Video: The aim of this video is to make vaginal hysterectomy (TVH), vaginal salpingoophorectomy and uterosacral ligament (USL) colpopexy approachable by showing the key procedural steps from both the vaginal and abdominal perspectives.

Methods: This production shows TVH with salpingoophorectomy and USL colpopexy that was performed on a cadaver and filmed simultaneously from the vaginal and abdominal views. The video begins with an anatomy overview from the open abdomen and proceeds with the TVH.

Peripartum hysterectomy in a Nigerian university hospital: An assessment of severe maternal outcomes with the maternal severity index model.

Background: Peripartum hysterectomy is life-saving and a life-threatening criterion of the World Health Organization (WHO) maternal near-miss concept. The maternal severity index (MSI) model was developed to assess the outcome of severe maternal morbidities. This study assessed severe maternal outcomes of peripartum hysterectomy using the MSI model and related maternal severity score with mortality.

Phenazopyridine for Evaluation of Ureteral Patency: A Randomized Controlled Trial.

Objective: To evaluate the usefulness of phenazopyridine for confirmation of ureteral patency during intraoperative cystoscopy.

Methods: We conducted a randomized controlled trial comparing use of phenazopyridine with no medications for evaluation of ureteral patency during intraoperative cystoscopy in women undergoing pelvic surgery. The primary study outcome was time to visualize ureteral urine efflux.

The Impact of Minimally Invasive Surgery on Major Iatrogenic Ureteral Injury and Subsequent Ureteral Repair During Hysterectomy: A National Analysis of Risk Factors and Outcomes.

Objective: To identify risk factors for ureteral injury during hysterectomy and to assess outcomes of concurrent minimally invasive vs converted to open repairs.

Methods: We queried the American College of Surgeons-National Surgical Quality Improvement Program database between 2005 and 2013 to identify abdominal hysterectomy (AH), minimally invasive hysterectomy (MIH), or vaginal hysterectomy. Ureteral injury was identified based on intraoperative or delayed management.