In this article, we present a method involving submucosal transvaginal ICG infiltration caudal to a vaginal endometriotic nodule, allowing for the visualization of the lower resection margin during laparoscopic surgery.
Employing submucosal ICG tattooing, we illustrate its use in precisely marking and outlining the caudal edge of an ultra-low, full-thickness vaginal nodule, aiding its laparoscopic removal.
A stepwise methodology for endometriosis excision employing the SOSURE surgical technique, further enhanced by ICG for accurate demarcation of the vaginal nodule's deepest extent is presented.
A 5-centimeter full-thickness vaginal nodule, invading the right parametrium and the superficial muscularis layer of the rectum, underwent complete laparoscopic excision.
Utilizing ICG tattooing, the lower margin of rectovaginal space dissection was effectively identified.
The implementation of indocyanine green (ICG) tattooing on the margins of full-thickness vaginal nodules in benign gynecology could potentially be a valuable tool for surgeons, aiding in their tactile and visual identification of the dissection's lower boundary.
ICG tattooing applied to the edges of full-thickness vaginal nodules might serve as an additional role for ICG in benign gynecological procedures, supplementing the surgeon's existing means for identifying the lower boundary of the dissection process.
Minimally invasive sacral colpopexy, a surgical approach for Pelvic Organ Prolapse (POP), is widely considered the gold standard, boasting both high success rates and a significantly reduced recurrence risk in comparison to other techniques. This is the first time robotic sacral colpopexy (RSCP) has been performed using the Hugo RAS robotic system, a revolutionary advancement.
By utilizing the Hugo RAS robotic system (Medtronic), the surgical steps of a nerve-sparing RSCP are presented in this article, followed by an evaluation of the technique's feasibility using this state-of-the-art robotic system.
In the Division of Urogynaecology and Pelvic Reconstructive Surgery at Fondazione Policlinico Universitario A. Gemelli IRCCS in Rome, Italy, a 50-year-old Caucasian woman with symptomatic pelvic organ prolapse (POP-Q) Aa +2, Ba +3, C +4, D +4, Bp -2, Ap -2, TVL10 GH 35 BP3, had a subtotal hysterectomy and bilateral salpingo-oophorectomy performed robotically, using the Hugo RAS system.
Intraoperative data, details of the docking procedure, and objective and subjective outcomes at the three-month follow-up.
The surgical procedure was performed flawlessly, experiencing no intraoperative issues; operative time was 150 minutes, and docking time was a concise 9 minutes. No system errors or failures were noted regarding the robotic arms' functioning. A thorough urogynaecological examination three months post-procedure confirmed the complete resolution of the prolapse.
The Hugo RAS system, coupled with RSCP, appears to be a viable and successful method, judging by metrics including operating time, aesthetic outcomes, post-operative discomfort, and hospital stay duration. Extended follow-up and numerous case reports are paramount to clearly defining the benefits, advantages, and costs.
Results from the use of RSCP in conjunction with the Hugo RAS system suggest a practical and effective methodology concerning operative time, cosmetic results, postoperative pain, and length of hospital stay. A greater understanding of the benefits, advantages, and costs of this subject requires a substantial volume of case reports and longer observation periods.
Young women account for 4% of endometrial cancer diagnoses, and a significant 70% of these cases involve women who have not given birth. oncolytic immunotherapy The fertility of these patients requires careful attention and preservation. A complete response rate of 953% is observed following hysteroscopic resection of focal, well-differentiated endometrioid adenocarcinoma and subsequent progestin administration. A fertility-sparing treatment protocol is now suggested in the instance of moderately differentiated endometrioid tumors, yielding a rather high remission rate, as of late.
To present a novel hysteroscopic strategy for conserving fertility in patients with diffuse endometrial G2 endometrioid adenocarcinoma.
Visualizing the technique for fertility-sparing management of diffuse endometrial G2 endometrioid adenocarcinoma, with a detailed, step-by-step demonstration, using a 15 Fr bipolar miniresectoscope and a three-step resection method (Karl Storz, Tuttlingen, Germany) and a Tissue Removal Device (TRD) (Truclear Elite Mini, Medtronic).
Hysteroscopic assessment, revealing no abnormalities, and endometrial biopsies were taken at three and six months respectively.
The endometrial cavity was found to be normal, and the biopsies were negative.
Hysteroscopic procedures, when combined with dual progestin therapy (Levonorgestrel-releasing intrauterine device plus 160 mg of Megestrole Acetate daily), may exhibit increased complete response rates in cases of diffuse G2 endometrioid adenocarcinoma; the application of TRD to complete resection near the tubal ostia could potentially decrease the occurrence of post-operative intrauterine adhesions and positively impact reproductive prospects.
A new, fertility-preserving surgical procedure for diffuse endometrial G2 endometroid adenocarcinoma.
In managing diffuse endometrial G2 endometroid adenocarcinoma, a novel, fertility-sparing surgical approach is introduced.
A novel surgical technique in minimally invasive surgery, transvaginal natural orifice transluminal endoscopic surgery (V-NOTES), is gaining traction as a leading-edge procedure. Endoscopic control, when combined with vaginal access, permits the execution of many types of surgical procedures using this technique. Vaginal surgery, coupled with laparoscopy, presents numerous benefits, including the avoidance of abdominal wall incisions and enhanced visualization of the abdominal cavity.
This report details our initial observations of V-NOTES during benign gynecological surgery, focusing on a series of 32 consecutive procedures.
Over the duration of June 2020 to January 2022, a total of 32 gynaecological procedures were performed by one surgeon using the V-NOTES system, all within a university hospital. The perioperative outcomes were assessed using a retrospective approach.
Laparoscopic versus open surgical approaches, and their related complications both before, during, and after the intervention.
All 32 V-NOTES procedures were conducted without the need for alteration to standard laparoscopic or open surgical techniques. Two intraoperative complications were observed during the procedure and resolved using the V-NOTES technique; in addition, two post-operative complications, categorized as Clavien-Dindo Grade 2, were noted.
Similar patterns observed in earlier research are echoed in our results, which demonstrate promising outcomes concerning both the efficacy and safety of the procedures. We are certain that a brief period of training leads to safely obtainable advantages. For a comprehensive evaluation, prospective multicenter randomized trials examining the effectiveness of V-NOTES relative to both total laparoscopic and vaginal hysterectomy approaches are essential.
V-NOTES extends the permissible scenarios for vaginal hysterectomies by dispensing with constraints including a large uterus, the lack of prolapse, and a past history of cesarean surgery. This method further allows for adnexal surgery performed via the vaginal route.
V-NOTES broadens the scope of procedures for vaginal hysterectomies, eliminating constraints traditionally linked to large uterine sizes, the absence of prolapse, and prior cesarean sections. This method, in addition, permits adnexal surgery through a vaginal route.
No published work in the current literature has undertaken a study on the effects of externally supplied steroids in relation to hysteroscopic image quality.
To analyze the hysteroscopic properties of the endometrium in women on hormone medication.
Video records of hysteroscopies in women receiving estro-progestin (EP), progestogen (P), and hormonal replacement therapy (HRT) were reviewed by us. Biopsies were performed on all women, yielding pathological reports categorized as atrophic, functional, or dysfunctional.
Documentation of hysteroscopic images, corresponding to each therapy schedule.
The subjects of the study consisted of 117 women. biologic DMARDs The 82 women receiving EP treatment, along with 24 women treated by P and 11 women who received HRT treatment, were part of the evaluation. A remarkable finding in EP users was that imaging was identical to physiological pictures when high oestrogen dosages and low-potency progestogens such as 17-OH progesterone derivatives were administered. Through the augmentation of progestogen potency by 19-norprogesterone and 19-nortestosterone derivatives, we noted an enhancement of progestogen-driven differentiation, including polypoid-papillary pseudo-decidualization, spiral artery development, suppressed glandular proliferation, and endometrial shrinkage. In the case of P users, two scheduling patterns were discernible, distinguished by their continuous or sequential nature. Continuous treatment protocols resulted in atrophic or proliferative-secretory endometrial characteristics, unlike sequential treatments, which promoted endometrial overgrowth indicative of stromal pseudo-decidualisation. TAK875 Women on hormone replacement therapy, utilizing sequential schedules, displayed atrophic characteristics with concurrent combined continuous and polypoid overgrowth. Tibolone administration in women presented tissue images varying from atrophic displays to hyperplastic presentations.
Significant endometrial shaping is a consequence of exogenous steroid use. Depending on the timetable, the hysteroscopic view is frequently predictable, with the presence of overgrowths commonly resembling proliferative diseases. This case necessitates a biopsy; nonetheless, medical professionals should routinely become more knowledgeable in the use of hysteroscopic images resulting from hormone treatment.
A systematic approach to analyzing hysteroscopic images collected during estro-progestin intake.
Systematically interpreting hysteroscopic views gathered while patients were taking estro-progestins.