Operative laparoscopy was initially developed in the field of gynecology earlier on and the advent of laparoscopic surgery led to advances in general surgery as well. In the last few years, a number of articles have been published on the performance of surgical procedures using the robot-assisted laparoscopy. The shortcomings of conventional laparoscopy have led to the development of robotic surgical system and future of telerobotic surgery is not far away, enabling a surgeon to operate at a distance from the operating table. The complete loss of tactile sensation is often quoted as a big disadvantage of working with robotic systems. Although the first generation da Vinci robotic surgical system provides improved imaging and instrumentation, the absence of tactile feedback and the high cost of the technology remain as limitations. New generations of the robotic surgical systems have been developed, allowing visualization of preoperative imaging during the operation. Though the introduction of robotics is very recent, the potential for robotics in several specialties is significant. However, the benefit to patients must be carefully evaluated and proven before this technology can become widely accepted in the gynecologic surgery.
Female ; Gynecologic Surgical Procedures/instrumentation/*methods ; Humans ; Hysterectomy/instrumentation/methods ; Robotics/instrumentation/*methods

OBJECTIVETo compare the therapeutic effect of laparoscopy-assisted Vechitti vaginoplasty and vaginoplasty with peritoneum.

METHODSFrom Jan. 2005 to Mar. 2011, 43 cases of congenital absence of vagina were treated by laparoscopy-assisted modified Vechitti vaginoplasty (n = 26) and by laparoscopy-assisted vaginoplasty with peritoneum (n = 17). The duration of operation, the intraoperative blood loss, and the length, appearance of reconstructed vagina were compared between the two groups.

RESULTSAll the patients were successfully treated with no complication. The mould fell out in one case in Vechitti group one month after operation, which was put back after 3 days of expansion with a smaller mould. The perineum appearance was not affected. The reconstructed vagina in both groups were wide with pink mucosa, good elasticity and smoothness. The intercourse process was satisfied. The duration of operation and intraoperative blood loss were less in Vechitti group than those in peritoneum group, but the reconstructed vagina length was (7.8 +/- 0.4) cm in Vechitti group, and (8.8 +/- 0.6) cm in peritoneum group, showing a significant difference (t = 6.45, P < 0.01).

CONCLUSIONSCompared with Vechitti vaginoplasty, the laparoscopy-assisted vaginoplasty with peritoneum is comparatively complicated with longer operative duration, but the reconstructed vagina is longer with better long-term effect.

Adult ; Female ; Gynecologic Surgical Procedures ; methods ; Humans ; Laparoscopy ; Peritoneum ; surgery ; Reconstructive Surgical Procedures ; methods ; Vagina ; abnormalities ; surgery ; Young Adult

Quality of life is adversely affected by pelvic organ prolapse, the prevalence of which is increasing because of the persistently growing older population. Today, the tension-free vaginal mesh kit has grown in popularity owing to its comparable cure rate to traditional reconstructive surgery and the feasibility of an early return to normal life. However, significant debate remains over the long-term cure rate and the safety of tension-free vaginal mesh in the United States. The U.S. Food and Drug Administration recommends obtaining informed consent about the safety and cure rate when the patient chooses surgery using the tension-free vaginal mesh kit or meshes before surgery. The goal of surgery for pelvic organ prolapse is the restoration of anatomic defects. This review article provides an overview of basic surgical techniques and the results, advantages, and disadvantages of surgery for pelvic organ prolapse.
*Disease Management ; Female ; Gynecologic Surgical Procedures/*methods ; Humans ; Pelvic Organ Prolapse/*surgery ; Quality of Life

OBJECTIVETo evaluate the effect of combined electroacupuncture (EA) and epidural anesthesia in gynecological operation by bispectral index (BIS).

METHODSSixty patients of ASA grade I-II, 20-60 years old, being scheduled to receive gynecological operation with epidural anesthesia were randomly assigned to 3 groups equally. Group A was anesthetized with epidural infusion of midazolam in dosage of 0.04 mg/kg, Group B with continuous EA in 30-100 Hz on Zusanli (ST36) and Sanyinjiao (SP6) acupoints, and Group C with both epidural infusion and EA same as those applied in Groups A and B. BIS, blood pressure (BP), heart rate (HR), and blood oxygen saturation (SPO2) were monitored during peri-operative stage, and the post-operation visual analogue scores (VAS) was measured as well.

RESULTSBIS decreased after operation in all groups (P < 0.05), the highest value was shown in Group B (P < 0.05) and the lowest was seen in group C at time of skin incising; while at time of gauze plugging, it was higher in Group B than in other two groups (P < 0.05). Besides, VAS in Group A at 8 h and 24 h after operation was higher than that in the other two groups respectively (P < 0.05).

CONCLUSIONBIS can be taken as an index for objectively evaluating the effect of combined EA and epidural anesthesia in gynecological operation. EA anesthesia has certain analgesic and sedative effects, could effectively release postoperative pain.

Adult ; Anesthesia, Epidural ; Electroacupuncture ; Electroencephalography ; Female ; Gynecologic Surgical Procedures ; methods ; Humans ; Middle Aged ; Young Adult

Radical trachelectomy (RT) is a fertility-sparing treatment for young women with early-stage cervical cancer. We report here a case of a 30-year-old nulliparous woman who presented with stage IA2 cervical squamous cancer. She was treated with total laparoscopic radical trachelectomy (TLRT) and laparoscopic pelvic lymphadenectomy (LPL). During this procedure, the ascending branches of uterine arteries were preserved. No metastasis was identified after fourteen months of follow-up. The menstrual pattern normalized and the patient has been attempting to conceive for two months. TLRT might be a safe fertility-preserving procedure for early-stage cervical cancer, due to its minimally invasive nature and shorter recovery time. However, more data are required on recurrence rate, fertility rate and pregnancy outcome in order to fully evaluate the therapeutic efficacy of TLRT.
Adult ; Female ; Gynecologic Surgical Procedures ; methods ; Humans ; Laparoscopy ; Uterine Cervical Neoplasms ; surgery

The magnamosis device for stage-one repair of the rectovaginal tistula consists of two arc magnets. Drawing the interrupting thread along the fistula margin via the vaginal side, and pulling the string to arrange the magnets at the fistula base along the long axis of the vagina, we made the magnamosis device automatically clipped to seal the fistula. After removing the threads we kept the device for 2-4 weeks till the natural detachment of it when the compressed tissue in between healed after vascular necrosis. This device utilizing the unique ability of magnamosis to fulfill anastomosis under inflammatory infected state reduces the current high relapse rate and colostomy drawbacks of the conventional rectovaginal neoplasty.
Female ; Gynecologic Surgical Procedures ; instrumentation ; methods ; Humans ; Magnetics ; Magnets ; Pressure ; Rectovaginal Fistula ; surgery ; Wound Healing

The development of robotic technology has facilitated the application of minimally invasive techniques for the treatment and evaluation of patients with early, advanced, and recurrent cervical cancer. The application of robotic technology for selected patients with cervical cancer and the data available in the literature are addressed in the present review paper. The robotic radical hysterectomy technique developed at the Mayo Clinic Arizona is presented with data comparing 27 patients who underwent the robotic procedure with 2 matched groups of patients treated by laparoscopic (N = 31), and laparotomic radical hysterectomy (N = 35). A few other studies confirmed the feasibility and safety of robotic radical hysterectomy and comparisons to either to the laparoscopic or open approach were discussed. Based on data from the literature, minimally invasive techniques including laparoscopy and robotics are preferable to laparotomy for patients requiring radical hysterectomy, with some advantages noted for robotics over laparoscopy. A prospective randomised trial is currently being perfomred under the auspices of the American Association of Gyneoclogic Laparoscopists comparing minimally invasive radical hysterectomy (laparoscopy or robotics) with laparotomy. For early cervical cancer radical parametrectomy and fertility preserving trachelectomy have been performed using robotic technology and been shown to be feasible, safe, and easier to perform when compared to the laparoscopic approach. Similar benefits have been noted in the treatment of advanced and recurrent cervical cancer where complex procedures such as extraperitoneal paraortic lymphadenectomy and pelvic exenteration have been required. CONCLUSION: Robotic technology better facilitates the surgical approach as compared to laparoscopy for technically challenging operations performed to treat primary, early or advanced, and recurrent cervical cancer. Although patient advantages are similar or slightly improved with robotics, there are multiple advantages for surgeons.
Female ; Gynecologic Surgical Procedures/*methods ; Humans ; Hysterectomy/methods ; Lymph Node Excision/methods ; Pelvic Exenteration/methods ; Robotics/*methods ; Surgical Procedures, Minimally Invasive/methods ; Uterine Cervical Neoplasms/*surgery

BACKGROUNDDuring the past decade, graft materials have been widespread used in the vagina in order to correct pelvic organ prolapse. The aim of this study was to describe and compare the exact anatomical position of the puncture devices and their relations to the relevant anatomical structures in the Prolift(TM) and a modified pelvic reconstructive surgery with mesh.

METHODSTwelve fresh cadavers were allocated randomly to either the Prolift(TM) or the modified pelvic reconstructive surgery group. Each group had six fresh cadavers. Relevant distances between the puncture devices and anatomical structures were recorded in both minimally invasive puncture surgeries.

RESULTSThe mean distances from the posterior puncture points of the obturator membrane to the posterior branch of obturator arteries were shorter ((0.60 ± 0.36) cm and (0.78 ± 0.10) cm) when compared with the distances to the anterior branch of obturator arteries ((1.53 ± 0.46) cm and (1.86 ± 0.51) cm) for the reconstruction of the anterior compartment in both surgeries (all P < 0.05). The distance from the puncture points of the pelvic floor through the ischiorectal fossa to the coccygeal and inferior gluteal arteries in the Prolift(TM) technique ((0.88 ± 0.10) cm) and ((1.59 ± 0.36) cm)) were much shorter than that in the modified pelvic reconstructive surgery ((2.95 ± 0.09) cm) and ((3.40 ± 0.36) cm)) for the reconstruction of the middle and posterior compartments (all P < 0.05).

CONCLUSIONSCompared with the Prolift(TM) technique, the modified pelvic reconstructive surgery with mesh would be safer not to cause great damage to the inferior gluteal arteries and the coccygeal arteries. The posterior branch of obturator arteries would be easier to be injured than the anterior branch of obturator arteries during anterior compartment reconstruction in both surgeries.

Aged ; Aged, 80 and over ; Cadaver ; Female ; Gynecologic Surgical Procedures ; methods ; Humans ; Pelvic Organ Prolapse ; surgery ; Postoperative Complications ; Reconstructive Surgical Procedures ; methods ; Surgical Mesh ; Treatment Outcome

Female ; Gynecologic Surgical Procedures ; instrumentation ; methods ; Gynecology ; instrumentation ; Humans ; Robotics ; instrumentation ; methods ; Singapore ; Surgery, Computer-Assisted ; instrumentation ; methods

OBJECTIVETo evaluate a pudendal-thigh island flap for vaginal reconstruction.

METHODSForty-seven patients with congenital absence of vagina were undergoing the treatment. Based on the pedicle including the posterior labial neurovascular bundle, a pudendal-thigh island flap was designed and raised in the groin crease just lateral to the labia majora under the deep fascia. It was then transferred to the tunnel between the urethra and the anus for reconstruction of the vagina.

RESULTSFrom May of 1993 to July of 2001, 47 patients were successfully treated for the vaginal reconstruction with the flap. The results were satisfactory without complications.

CONCLUSIONThe above mentioned technique could be a safe and effect method for vaginal reconstruction with the advantages of reliable blood supply, good sensation and few complications. The areaes with the bilateral pudendal-thigh could be large enongh for the vaginal reconstruction without problem of the donor closure.

Fasciotomy ; Female ; Groin ; Gynecologic Surgical Procedures ; methods ; Humans ; Male ; Surgical Flaps ; Thigh ; Urethra ; Vagina ; abnormalities ; surgery ; Vulva ; abnormalities ; surgery