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Category: Journal Spotlight

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    AAGL Announces The Journal of Minimally Invasive Gynecology (JMIG) for Tablet/Smartphone

    AAGL is pleased to announce the immediate availability of The Journal of Minimally Invasive Gynecology App for iPhone, iPad, Android, and Kindle Fire. The app is available for free as a benefit of membership in the AAGL, and can be downloaded from all of the major app stores today. AAGL members can unlock the app by tapping on “Existing Subscriber” and entering their AAGL username and password once they have launched the app.

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  • May 2013 JMIG Cover

    JOURNAL SPOTLIGHT: Robotic-Assisted, Ultrasound-Guided Abdominal Cerclage During Pregnancy: Overcoming Minimally Invasive Surgery Limitations?

    Authors: Teresa M. Walsh, Mostafa A. Borahay, Karin A. Fox, Gokhan S. Kilic
    Citation: The Journal of Minimally Invasive Gynecology, Volume 20, Issue 3, Page 398-400
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    Abstract: Herein, we report robotic abdominal cerclage placement under ultrasound guidance. The da Vinci Si system (Intuitive Surgical, Sunnyvale, CA) allows a simultaneous display of the operative field and transvaginal ultrasound images. Additionally, the vaginal ultrasound probe assisted in the manipulation of the uterus to improve visualization without placing excessive pressure on the gravid uterus. Ultrasound guidance improves needle placement accuracy and reduces potential for injuries.

  • May 2013 JMIG Cover

    JOURNAL SPOTLIGHT: Economics and Energy Sources

    Authors: Malcolm G. Munro
    Citation: The Journal of Minimally Invasive Gynecology, Volume 20, Issue 3, Page 319-327
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    Abstract: Energy-based instrumentation has not only facilitated the rapid adoption of laparoscopic surgery, but could be considered essential for the completion of abdominal and pelvic procedures under endoscopic guidance. For decades, relatively simple and generic reusable monopolar and bipolar systems were the only options available. More recently, the available options for energy-based surgical instrumentation have become more crowded with the introduction of ultrasound-based cutting and sealing instruments and proprietary, impedance monitoring radiofrequency coagulation devices. Such instrumentation is presented as being easier to use as well as providing greater safety and efficacy. However, these new instruments typically require the expenditure of capital for proprietary energy generators and are usually designed to be for single use, a circumstance that increases per case costs, a circumstance that begs the question of value. Do the additional costs expended for the more expensive devices translate into reduced complications, faster operating time, or even wider access to minimally invasive procedures because they enable more surgeons to offer the service? Herein is explored the complex economic issues associated with the use of energy-based surgical devices as they apply to minimal access surgery in general and to laparoscopic procedures specifically.

  • May 2013 JMIG Cover

    JOURNAL SPOTLIGHT: Symptomatic Subserous Multicystic Uterus

    Authors: George Pados, Anastasios Makedos, Konstantina Diamanti, Zaharoula Ntinou, Thomas Zaramboukas, Basil Tarlatzis
    Citation: The Journal of Minimally Invasive Gynecology, Volume 20, Issue 3, Page 328
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    Abstract: A 39-year-old woman of western European origin came to the gynecologic outpatient clinic with urinary urgency for the past 3 months. At examination, no symptoms were reported. Transvaginal ultrasonography revealed multiple cystic hypoechogenic structures around the uterus, with diameter ≤2 cm, and a single cyst of 3.5-cm diameter on the anterior wall, in contact with the urinary bladder. The ovaries and endometrium appeared anatomically normal. During elective laparoscopy, multiple small subserous cysts were noted all over the uterine body, and a single cyst ∼4 cm in diameter was found on the anterior uterine wall. The cysts were removed, and the histopathologic analysis was endometrioid cystadenomas without atypia. Cytologic analysis was negative for endometriosis or adenomyosis, as was the microbiologic culture. The patient’s symptom resolved after surgery. Uterine cysts at other locations have been reported 12; however, subserous uterine cysts occur rarely.

  • May 2013 JMIG Cover

    JOURNAL SPOTLIGHT: Chronic Subtorsion of the Ovary With Subsequent Ovarian Hypoplasia

    Authors: Carlo De Cicco Nardone, Corrado Terranova, Ester Valentina Cafa, Nella Dugo, Paolo Gennari, Francesco Plotti, Roberto Angioli
    Citation: The Journal of Minimally Invasive Gynecology, Volume 20, Issue 3, Page 330-331
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    Abstract: A 20-year-old woman was referred to our department because of a suspected dermoid ovarian cyst. She reported having chronic pelvic pain for 2 years. A preoperative pelvic ultrasound examination revealed the presence of a 4-cm cyst on the right ovary; however, it was not possible to detect the left ovary. Doppler evaluation of the pelvic vessels was not attempted. Operative laparoscopy confirmed the presence of the 4-cm cyst on the right ovary. The left adnexa was anatomically subverted. The left salpinx and infundibolopelvic ligament were twisted on themselves (torsion 180 degrees) and adherent to the uterine posterior surface. The left ovary was poorly recognized and deeply attached to the right uterosacral ligament.

  • May 2013 JMIG Cover

    JOURNAL SPOTLIGHT: Laparoscopic Management of Sacral Nerve Root Schwannoma With Intractable Vulvococcygodynia: Report of Three Cases and Review of Literature

    Authors: Marc Possover, Plamen Kostov
    Citation: The Journal of Minimally Invasive Gynecology, Volume 20, Issue 3, Page 394-397
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    Abstract: Herein we report the feasibility of laparoscopic resection of schwannomas of the sacral nerves roots in 3 women with intractable vulvodynia and coccygodynia. Laparoscopic en bloc resection of the sacral schwannomas was performed, with primary control of the tumor blood supply and with exposure and sparing of the sacral nerve roots. In all 3 patients, laparoscopy was successful, with minimal blood loss and without complications. Histologic examination confirmed the diagnosis of schwannoma without malignant transformation in all 3 women. At mean follow-up of 27.66 months, no patient reported recurrence or worsening of symptoms. All patients are able to walk normally without gait aids. Primary control of the tumor blood supply during laparoscopic surgery to resect deep sacral masses reduces considerably the risk of operative hemorrhage. Compared with classic neurosurgical approaches, laparoscopic exposure of the rectum, ureters, and sacral nerve roots renders the procedure safer and easier, with less risk of postoperative functional morbidity.

  • May 2013 JMIG Cover

    JOURNAL SPOTLIGHT: Robotic-Assisted Laparoscopic vs Abdominal and Laparoscopic Myomectomy: Systematic Review and Meta-Analysis

    Authors: Jyotsna Pundir, Vishal Pundir, Rajalaxmi Walavalkar, Kireki Omanwa, Gillian Lancaster, Salma Kayani
    Citation: The Journal of Minimally Invasive Gynecology, Volume 20, Issue 3, Page 335-345
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    Abstract: Herein is presented a systematic review and meta-analysis of evidence related to operative outcomes associated with robotic-assisted laparoscopic myomectomy (RLM) compared with abdominal myomectomy (AM) and laparoscopic myomectomy (LM). Outcome measures included estimated blood loss (EBL), blood transfusion, operating time, complications, length of hospital stay (LOHS), and costs. Meta-analysis 1 compared RLM vs AM, and meta-analysis 2 compared RLM vs LM. Studies scored moderately well on the Newcastle-Ottawa Quality Assessment Scale. No significant differences were found in age, body mass index, or number, diameter, and weight of myomas. In meta-analysis 1, EBL, blood transfusion, and LOHS were significantly lower; risk of complications was similar; and operating time and costs were significantly higher with RLM. In meta-analysis 2, no significant differences were noted in EBL, operating time, complications, and LOHS with RLM; however, blood transfusion risk and costs were higher. It was concluded that insofar as operative outcomes, RLM has significant short-term benefits compared with AM and no benefits compared with LM. Long-term benefits such as recurrence, fertility, and obstetric outcomes remain uncertain.

  • May 2013 JMIG Cover

    JOURNAL SPOTLIGHT: Laparoscopic Transvesical Approach for Vesicovaginal Fistula Repair

    Authors: Shailesh P. Puntambekar, Riddhi Desai, Amit Galagali, Geetanjali Agarwal Joshi, Saurabh Joshi, Rahul Kenawadekar, Archit Pandit, Anup Aitwade, Seema S. Puntambekar
    Citation: The Journal of Minimally Invasive Gynecology, Volume 20, Issue 3, Page 334-334
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    Abstract: Study Objective: To access the technical feasibility of performing laparoscopic repair of vesicovaginal fistula.Material and Methods: We attempted a laparoscopic repair of vesicovaginal fistula in five women with a history of urinary leakage via the vagina after vaginal hysterectomy. Five pelvic ports were used. The surgical procedure was performed using the same principles as for open surgery, i.e., separation of the vaginal wall from the bladder wall, repair of the fistula, and interposition of the omentum.Results: There was early recovery of the patients in terms of continence, with less chance of recurrence. Results were comparable to those with the vaginal approach.Conclusion: The use of minimally invasive surgery for vesicovaginal fistula repair helps to ease the suturing deep in the pelvis, and the magnification facilitates good identification of tissues planes and thus better mobilization of the vaginal and bladder walls and decreases postoperative morbidity.

  • May 2013 JMIG Cover

    JOURNAL SPOTLIGHT: CO2 Laser Treatment for Bartholin Gland Abscess: Ultrasound Evaluation of Risk Recurrence

    Authors: Violante Di Donato, Filippo Bellati, Assunta Casorelli, Margherita Giorgini, Giorgia Perniola, Claudia Marchetti, Innocenza Palaia, Pierluigi Benedetti Panici
    Citation: The Journal of Minimally Invasive Gynecology, Volume 20, Issue 3, Page 346-352>
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    Abstract: Study Objective: To evaluate the efficacy of CO2 laser treatment and parameters correlated with recurrence in patients with Bartholin gland abscesses treated using this approach.Design: Prospective study (Canadian Task Force classification II-2).Setting: University hospital.Patients: One hundred forty-seven patients who met eligibility criteria.Intervention: Preoperative ultrasound evaluation of Bartholin gland lesions and CO2 laser treatment.Measurements and Main Results: All patients received CO2 laser therapy, with median operative time 15 minutes (range, 12

  • May 2013 JMIG Cover

    JOURNAL SPOTLIGHT: Prospective Evaluation of the Incidence of Uterine Vascular Malformations Developing After Abortion or Delivery

    Authors: Hiroyuki Yazawa, Syu Soeda, Tsuyoshi Hiraiwa, Masayo Takaiwa, Sumiko Hasegawa-Endo, Manabu Kojima, Keiya Fujimori
    Citation: The Journal of Minimally Invasive Gynecology, Volume 20, Issue 3, Page 360-367
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    Abstract: Study Objective: To describe the incidence of uterine vascular malformations (UVMs) including uterine arteriovenous malformations (AVMs) in patients after abortion or delivery and in outpatients.Design: Prospective study (Canadian Task Force classification II-3).Setting: Fukushima Red Cross Hospital.Patients: Six patients with a UVM including 1 with an AVM.Interventions: Clinical screening of patients using transvaginal color Doppler ultrasonography between April 2010 and March 2012.Measurements and Main Results: The incidence of UVM developing after abortion or delivery or in outpatients was prospectively evaluated using transvaginal color Doppler ultrasonography. From 959 patients, we identified 6 (0.63%) with UVMs, including 1 (0.10%) with a uterine AVM. Specifically, we detected UVMs in 4 of 77 patients (5.2%) after abortion, 1 of 458 patients (0.22%) after delivery, and 1 of 424 outpatients (0.24%). Four patients after abortion and 1 after delivery reported mild symptoms, which were treated conservatively; however, the outpatient had a severe uterine AVM, which was confirmed via 3-dimensional computed tomography angiography.Conclusion: The incidence of UVMs was relatively higher, in particular in the patients after abortion, and was significantly higher than that in postpartum or outpatient groups. Therefore, it is important to consider the possibility of UVMs in any patient with episodes of unexplained uterine bleeding and to perform follow-up analysis using color Doppler ultrasonography. Such an approach will facilitate accurate diagnosis and lead to appropriate clinical management to prevent unnecessary dangerous repeat curettage, which might induce profuse uterine bleeding.

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