Adenosarcoma/surgery* ; Female ; Heart Neoplasms ; Humans ; Neoplasm Metastasis ; Uterine Cervical Neoplasms ; Uterine Neoplasms/surgery*

OBJECTIVETo assess the prognosis and reproductive outcomes of laparoscopic intracapsular myomectomy.

METHODSA total of 673 women received subserosal and intramural intracapsular laparoscopic myomectomy between March, 2007 and March, 2012, and their post-operative complications, the need for subsequent surgery, symptomatic relief and reproductive outcomes were analyzed.

RESULTSOf these patients, 42.4% had subserosal myomas and 57.6% had intramural myomas. The mean total operative time was 96∓41 min with a mean blood loss of 128∓46.2 ml, and 82.3% of the patients were discharged 48 h after the operation without early complications. A small fraction (2.3%) of the patients had a second laparoscopic myomectomy for recurrent fibroids. Of the fertility-demanding women who underwent myomectomy, 71% achieved pregnancy, 49.8% underwent caesarean section, 8% had operative vaginal deliveries, and 42.2% had spontaneous deliveries; uterine rupture occurred in none of the cases.

CONCLUSIONLaparoscopic intracapsular myomectomy, by preserving the fibroid pseudocapsule and myometrial integrity, has no early postoperative complications and ensures good fertility rates and reproductive outcomes.

Adult ; Female ; Fertility ; Humans ; Laparoscopy ; Leiomyoma ; surgery ; Prognosis ; Retrospective Studies ; Uterine Myomectomy ; Uterine Neoplasms ; surgery

No abstract available.
Female ; Humans ; Hysterectomy/*methods ; *Time-to-Treatment ; Uterine Cervical Neoplasms/*surgery

Objective: To evaluate the effect of postoperative radiotherapy and high-risk pathological factors on the prognosis of early-stage neuroendocrine carcinoma of cervix (NECC). Methods: A single-center retrospective cohort study of early-stage NECC in Peking Union Medical College Hospital from January 2011 to April 2022 were enrolled. The patients were treated with radical hysterectomy±adjuvant treatment. They were divided into postoperative non-radiation group and postoperative radiation group. The possible postoperative recurrence risk factors identified by univariate analysis were assessed using multivariate logistic regression. The Kaplan-Meier method was used to analyze the progression free survival (PFS), overall survival (OS), recurrence rate, and mortality rate. Results: (1) Sixty-two cases were included in the study, including 33 cases in postoperative non-radiation group and 29 cases in postoperative radiation group. (2) The median follow-up time was 37 months (ranged 12-116 months), with 23 cases (37%) experienced recurrences. There were 7 cases (11%) pelvic recurrences and 20 cases (32%) distant recurrences, in which including 4 cases (6%) both pelvic and distant recurrences. Compared with postoperative non-radiation group, the postoperative radiation group had a lower pelvic recurrence rate (18% vs 3%; P=0.074) but without statistic difference, a slightly elevated distant recurrence rate (24% vs 41%; P=0.150) and overall recurrence rate (33% vs 41%; P=0.513) without statistically significances. Univariate analysis showed that lymph-vascular space invasion and the depth of cervical stromal invasion≥1/2 were risk factors for postoperative recurrence (all P<0.05). Multivariate analysis showed lymph-vascular space invasion was an independent predictor for postoperative recurrence (OR=23.03, 95%CI: 3.55-149.39, P=0.001). (3) During the follow-up period, 18 cases (29%, 18/62) died with tumor, with 10 cases (30%, 10/33) in postoperative non-radiation group and 8 cases (28%, 8/29) in postoperative radiation group, without significant difference (P=0.814). The postoperative 3-year and 5-year survival rate was 79.2%, 60.8%. The depth of cervical stromal invasion≥1/2 was more common in postoperative radiation group (27% vs 64%; P=0.011), and postoperative radiation in such patients showed an extended trend in PFS (32.3 vs 53.9 months) and OS (39.4 vs 73.4 months) but without statistic differences (P=0.704, P=0.371). Compared with postoperative non-radiation group, the postoperative radiation did not improve PFS (54.5 vs 37.3 months; P=0.860) and OS (56.2 vs 62.4 months; P=0.550) in patients with lymph-vascular space invasion. Conclusions: Postoperative radiation in early-stage NECC patients has a trend to reduce pelvic recurrence but not appear to decrease distant recurrence and overall recurrence, and has not improved mortality. For patients with the depth of cervical stromal invasion≥1/2, postoperative radiation has a trend of prolonging OS and PFS but without statistic difference. Lymph-vascular space invasion is an independent predictor for postoperative recurrence, but postoperative radiation in such patients does not seem to have any survival benefits.
Female ; Humans ; Cervix Uteri/surgery* ; Prognosis ; Retrospective Studies ; Uterine Cervical Neoplasms/surgery* ; Carcinoma, Neuroendocrine/surgery* ; Recurrence

OBJECTIVETo report the first case of laparoendoscopic single-site surgery (LESS) for gynecologic malignancy in China and discuss the application of LESS in minimally invasive gynecologic surgery.

METHODSA 57-year-old postmenopausal woman presented with vaginal bleeding for 5 years and diagnostic curettage revealed endometrial cancer. Staged LESS for endometrial cancer was performed using a single multiple-channel port (Tri-port) inserted through a solitary 2.5 cm upper umbilicus incision.

RESULTSThe operation was completed successfully. The total operative time was 4.5 h, the duration of the LESS procedure was 4.0 h, and the establishment of the operative access took 1.0 h. No other port incision or transfer to open procedure was needed. The intraoperative blood loss was 100 ml. Bowel peristalsis and micturition recovered 2 days after the operation, and the peritoneal drainage tube was removed 4 days after the operation without vaginal bleeding. No obvious scar was left on the surface of umbilicus.

CONCLUSIONLESS can be a promising minimally invasive approach to effective management of benign and malignant gynecological diseases.

China ; Endometrial Neoplasms ; surgery ; Female ; Humans ; Laparoscopy ; methods ; Middle Aged ; Uterine Neoplasms ; surgery

Adult ; Female ; Humans ; Hysterectomy ; Leiomyoma ; diagnosis ; Middle Aged ; Muscle Neoplasms ; complications ; surgery ; Uterine Neoplasms ; complications ; surgery

OBJECTIVETo study the optimal position and method for ovarian transposition and its benefits and indications.

METHODSWe performed ovarian transposition in 34 patients from August 1989 to December 2000. Twelve patients were diagnosed with stage Ib to IIa cervical cancer, 4 had stage Ia endometrial carcinoma, 12 had stage III to IV endometriosis, 4 had myoma of uterus, 1 had dysfunctional uterine bleeding, and 1 had an ovarian granulosa cell tumor. Surgery went as follows: the ovary was dissociated by clamp, the skin was incised and a tunnel was made, then the ovary was translocated to the subcutaneous site. In the cases of benign lesions, the ovarian vessel pedicel went in through the abdominal cavity, but in malignant tumors, it went out through the peritoneum.

RESULTSIn both cases (benign lesions or malignant tumors), the short-term and long-term endocrine function of the translocated ovary remained normal. Furthermore, patients could supervise their translocated ovary themselves.

CONCLUSIONSSubcutaneous ovary transposition might prevent not only implantation of gastrointestinal cancer but also the extension of pelvic carcinoma to the ovary. Because of the shallow transposition and the incision scar, it is easy for patients to supervise themselves. Moreover, the site of the ovary is easy to locate for ultrasound examinations. Thus, it can obtain the goal of early prevention for cancer. Subcutaneous ovarian transposition with skin incision is the optimal selection and suitable for all patients with various gynecologic diseases in which ovary removal is not necessary.

Adult ; Endometrial Neoplasms ; surgery ; Endometriosis ; surgery ; Female ; Gynecologic Surgical Procedures ; methods ; Humans ; Hysterectomy ; Ovary ; surgery ; Prognosis ; Uterine Cervical Neoplasms ; surgery

Female ; Humans ; Leiomyomatosis ; diagnosis ; surgery ; Uterine Neoplasms ; diagnosis ; surgery ; Vascular Neoplasms ; diagnosis ; surgery ; Vascular Surgical Procedures ; methods ; Veins

This study was undertaken to evaluate the various gynecologic endoscopic surgical techniques including resectoscopic myomectomy, laparoscopic myomectomy, and laparoscopy assisted vaginal hysterectomy (LAVH) used in the treatment of uterine myomas. The medical records of 136 cases of uterine myomas treated using one or more of the gynecologic endoscopic surgical techniques in the Department of Obstetrics and Gynecology at Yonsei University were retrospectively reviewed from March 1997 to September 1998. Of the 136 cases reviewed, there were 40 submucosal myomas and 96 intramural and subserosal myomas. For statistical analysis, Student's t-test was used. Submucosal myomectomy using the resectosope was performed in 35 cases (mean age: 39 +/- 1.5 years), laparoscopic myomecotmy in 35 cases (mean age: 36 +/- 1.9 years), and LAVH in 66 cases (mean age: 42 +/- 1.1 years). In cases of huge myomas, the GnRH agonist was used prior to surgery, and in cases of heavy uterine bleeding, angioblock of the uterine artery was undertaken before the endoscopic procedures. The mean operating time was significantly shorter in resectoscopic myomectomy (41 +/- 12 min), followed by laparoscopic myomectomy (85.0 +/- 10.3 min) and LAVH (123 +/- 5.3 min). The mean hospital stay for resectoscopic myomectomy, laparoscopic myomectomy, and LAVH was 1.9 +/- 0.5, 2.5 +/- 0.5, and 3.4 +/- 0.8 days (p < 0.001), respectively. There were 3 cases of complications including pulmonary edema and uterine perforation in the resectoscopic myomectomy group, and 4 cases of complications including bladder, ureter, and epigastric vessel injury in the LAVH group. In conclusion, the therapeutic effect of various gynecologic endoscopic surgical techniques can be maximized in terms of shorter operation time, shorter hospital stay, faster recovery, and less blood loss by the appropriate management of uterine myoma in well-chosen patients.
Adult ; Female ; Human ; Hysterectomy, Vaginal* ; Laparoscopy* ; Leiomyoma/surgery* ; Uterine Neoplasms/surgery*

BACKGROUNDIn order to simplify the complicated procedure of nerve-sparing radical hysterectomy, a novel technique characterized by integral preservation of the autonomic nerve plane has been employed for invasive cervical cancer. The objective of this study was to introduce the nerve plane-sparing radical hysterectomy technique and compare its efficacy and safety with that of nerve-sparing radical hysterectomy.

METHODSFrom September 2006 to August 2010, 73 consecutive patients with International Federation of Gynecology and Obstetrics stage IB to IIA cervical cancer underwent radical hysterectomy with two different nerve-sparing approaches. Nerve-sparing radical hysterectomy was performed for the first 16 patients (nerve-sparing radical hysterectomy group). The detailed autonomic nerve structures were identified and separated by meticulous dissection during this procedure. After January 2008, the nerve plane-sparing radical hysterectomy procedure was developed and performed for the next 57 patients (nerve plane-sparing radical hysterectomy group). During this modified procedure, the nerve plane (meso-ureter and its extension) containing most of the autonomic nerve structures was integrally preserved. The patients' clinicopathologic characteristics, surgical parameters, and outcomes of postoperative bladder function were compared between the two groups.

RESULTSThere were no significant differences between the nerve plane-sparing radical hysterectomy and nerve-sparing radical hysterectomy groups regarding age, International Federation of Gynecology and Obstetrics stage, pathological type, preoperative treatment, or need for intraoperative blood transfusion. The nerve plane-sparing radical hysterectomy group had a higher body mass index than that of the nerve-sparing radical hysterectomy group (P = 0.028). The mean surgical duration in the nerve plane-sparing radical hysterectomy and nerve-sparing radical hysterectomy groups were (262 ± 46) minutes and (341 ± 36) minutes (P < 0.01). On the 8th postoperative day, 41 (71.9%) patients in the nerve plane-sparing radical hysterectomy group and nine (56.3%) patients in the nerve-sparing radical hysterectomy group had a postvoid residual urine volume of < 100 ml (P = 0.233). The median duration of catheterization was eight days (range 8 - 23 days) for the nerve plane-sparing radical hysterectomy group and eight days (range 8 - 22 days) for the nerve-sparing radical hysterectomy group (P = 0.509). Neither surgery-related injury nor pathologically positive margins were reported in either group.

CONCLUSIONNerve plane-sparing radical hysterectomy is a reproducible and simplified modification of nerve-sparing radical hysterectomy, and may be preferable to nerve-sparing radical hysterectomy for treatment of early-stage invasive cervical cancer.

Adult ; Aged ; Autonomic Pathways ; surgery ; Female ; Humans ; Hysterectomy ; methods ; Middle Aged ; Uterine Cervical Neoplasms ; pathology ; surgery