Obstetrics and Gynecology
Minoo Gharouni; Abolfazl Mehdizadeh Kashi; Shahla Chaichian; Zahra Azizian; Kobra Tahermanesh; Samaneh Rokhgireh
Volume 8, Issue 1 , November and December 2022, , Pages 57-62
Abstract
Background & Objective: Fast-track surgery (FTS) consists of different pathways to decrease surgical complications and improve outcomes and patient satisfaction. FTS in an elective gynecologic laparoscopic surgery has not been well assessed. No consensus guidelines have been developed for gynecologic ...
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Background & Objective: Fast-track surgery (FTS) consists of different pathways to decrease surgical complications and improve outcomes and patient satisfaction. FTS in an elective gynecologic laparoscopic surgery has not been well assessed. No consensus guidelines have been developed for gynecologic laparoscopic surgeries. The purpose of this study is to evaluate enhanced recovery after surgery (ERAS) for total laparoscopic hysterectomy.Materials & Methods: 260 patients underwent for laparoscopic hysterectomy surgery. All patients were divided into two groups as follows: one group received traditional laparoscopic hysterectomy surgery and the intervention group was treated under ERAS protocol. ERAS protocol includes not receiving preoperative mechanical bowel preparation and laxatives as well as fasting 6 h and not drinking liquids 2h before surgery. The patients were allowed to resume the ordinary diet 6h post-operation. Ondansetron 4 mg were prescribed after surgery for nausea and vomiting, pain was controlled with non-narcotic analgesics diclofenac suppository 100 mg/q12 h and paracetamol 1000 mg/q6 h until discharge. Urinary catheter was removed whenever possible and early ambulation occurred 6h after the surgery.Results: A total of 260 patients were studied. Regarding the length of hospitalization, significant differences were shown between the groups (P<0.001). Return to daily functions was occurred earlier in the fast-track surgery group than another group. Complications and VAS pain scores showed no significant differences between the groups.Conclusion: Our results show that ERAS surgery has fewer side effects and better outcomes which make it more suitable for patients undergoing laparoscopic hysterectomy.
Gynecology Oncology
Behnaz Nouri; Mohadese Alemi; Ahmad Reza Baghestani
Volume 7, Issue 5 , July and August 2022, , Pages 429-436
Abstract
Background & Objective: Endometriosis is associated with the increased risk of coronary heart disease and immune alterations, which may be attributed to the altered lipid profile and decreased serum level of 25–hydroxyl vitamin D (25(OH)D). The present study aimed to evaluate the effect of ...
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Background & Objective: Endometriosis is associated with the increased risk of coronary heart disease and immune alterations, which may be attributed to the altered lipid profile and decreased serum level of 25–hydroxyl vitamin D (25(OH)D). The present study aimed to evaluate the effect of radical laparoscopic surgery of endometriosis on serum lipid profile and 25(OH)D.Materials & Methods: This cross-sectional study was performed on 47 women aged 15 to 45, with body mass index <30kg/m2, who were referred to Shohaday-eTajrish Hospital, from May 2018 until Jan 2020, for surgical treatment of endometriosis and did not have a systemic disease and did not use oral contraceptives and/or other hormonal therapies three months before surgery were enrolled into the study. The serum lipid profile and 25(OH)D levels of patients two months after surgery were compared with presurgical levels. The results were analyzed by using paired t-test.Results: A total of 47 patients completed the study (mean age: 32.8±7.5years). About half had no pregnancies (49.1%). Comparing the serum lipid profile of patients before and two months after surgery showed a significant decrease in triglyceride from 108.4±46.2 to 86.4±51.1 mg/dL (P < /i>=0.001), ], total cholesterol from 172.5±26.5 to 160.0±28.3mg/dl (P < /i>=0.002), and low-density lipoprotein levels from 97±28.3 to 89.8±26.1 mg/dL (P < /i>=.003); however, high-density lipoprotein and 25(OH)D levels did not show a significant difference (P < /i>>0.05). Conclusion: the results of the current study showed that laparoscopic resection of endometriotic lesions resulted in a significant reduction of the unfavorable lipid profile after two months, but not 25(OH)D levels.
Reproductive Medicine
Ayman S. Dawood; Walid M. Atallah; Tamer M. Assar
Volume 7, Issue 5 , July and August 2022, , Pages 437-444
Abstract
Background & Objective: Secondary infertility resulting from tubal adhesions following cesarean section are not uncommon. The decision to do adhesiolysis or direct IVF/ICSI is to some extent difficult. This study was conducted to evaluate the benefits/risks of either adhesiolysis or direct IVF/ICSI ...
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Background & Objective: Secondary infertility resulting from tubal adhesions following cesarean section are not uncommon. The decision to do adhesiolysis or direct IVF/ICSI is to some extent difficult. This study was conducted to evaluate the benefits/risks of either adhesiolysis or direct IVF/ICSI for patients with secondary infertility due to post-cesarean tubal adhesions.Materials & Methods: Three hundred infertile women with post-cesarean adhesion were recruited and divided into 2 groups either laparoscopic adhesiolysis or ICSI procedure.Results: Demographic data of enrolled patients in both groups were comparable. Regarding types of adhesions, mild adhesions were found in (47.65%) cases, moderate adhesions in (24.83%) cases and severe adhesions in (27.52%) cases. Pregnancy rates were found to be higher in cases with mild adhesions (62.67%) when compared to cases with moderate or severe adhesions (28.00%) and (9.33%) respectively. The overall pregnancy rate in group 1 was 67 (44.97%), while it was 83 (55.70%) in group 2. The pregnancy rate was higher in group 2 but didn't reach statistical significance. The cost of the procedure was significantly higher in group 2 but with significantly lower complication rates. Conclusion: Although assisted reproduction gives the patient higher pregnancy rates with less possibility of complications, it should not be considered the first-choice treatment for patients with post-cesarean adhesions, especially in mild and moderate cases.
Radiology
Behnaz Moradi; Masoumeh Gity; Fatemeh Davari Tanha; Masoumeh Golestani Jahromi; Shahrzad Fayyazi
Volume 7, Issue 4 , March and April 2022, , Pages 272-278
Abstract
Diagnosis of endometriosis according to TVS may be an appropriate alternative method for laparoscopy. Hence in this study, the role of TVS was investigated compared with laparoscopic assessment in cases with pelvic endometriosis attending to imaging center of Imam-Khomeini and Yas Hospital in Tehran ...
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Diagnosis of endometriosis according to TVS may be an appropriate alternative method for laparoscopy. Hence in this study, the role of TVS was investigated compared with laparoscopic assessment in cases with pelvic endometriosis attending to imaging center of Imam-Khomeini and Yas Hospital in Tehran in 2018. In this diagnostic study, 69 patients with pelvic endometriosis were assessed. The results of TVS were compared with laparoscopic assessment, and the sensitivity, specificity, and congruence rate were determined. According to the obtained results, it may be concluded that most sensitivity of TVS is related to the torus uterinus and dome of the bladder. Also, the most specificity is related to bladder, sigmoid colon, and peritoneal cyst. The most congruence rate between U/S and laparoscopy is at bladder trigon and sigmoid colon. However, in the end, multicenter studies with more cases and comparisons with the results of other diagnostic methods are recommended to achieve more accurate results.
Gynecology Oncology
Fariba Behnamfar; Safoura Rouholamin; Taj Sadat Allameh; Fahimeh Sabet; Leila Mousavi Seresht; Maryam Nazemi
Volume 7, Issue 1 , September and October 2021, , Pages 32-37
Abstract
Background & Objective: Comparative study between laparoscopic and laparotomy scoring in patients with advanced ovarian cancer.Materials & Methods: This prospective study included 27 patients with advanced ovarian cancer who underwent laparoscopy and laparotomy scoring at hospitals affiliated ...
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Background & Objective: Comparative study between laparoscopic and laparotomy scoring in patients with advanced ovarian cancer.Materials & Methods: This prospective study included 27 patients with advanced ovarian cancer who underwent laparoscopy and laparotomy scoring at hospitals affiliated with Isfahan University of Medical Sciences (IUMS) during 2020 and 2021. The laparoscopic predictive index value (PIV) score (range: 0-14) was calculated for all patients. In patients with PIV scores <8, primary cytoreductive surgery (PCS) was performed, and patients with scores ≥8 were candidates for neoadjuvant chemotherapy (NACT). In the PCS group, laparotomy scoring and surgical findings for each anatomical area were registered for all patients, and concordance between laparoscopy and laparotomy findings was compared. Residual disease following PCS was documented for all patients.Results: A total of 27 patients underwent laparoscopic scoring surgery; 25 patients (92/5%) had a PIV score <8, and two patients (7/5%) had a PIV score ≥8. There was 92% agreement between PIV scores at laparoscopy and laparotomy. Agreements in different anatomical regions in laparoscopy and laparotomy were as follows: involvement of the bowel 76%, mesenteric 92%, liver 96%, omental 92%, diaphragm 96%, stomach 100%, peritoneal carcinomatosis 96%. A laparoscopic PIV score of <8 had a PPV of 84% at predicting R0 at PCS.Conclusion: Laparoscopic scoring is a precise approach in the management of patients with advanced ovarian cancer. Laparoscopic scoring is a screening method of selecting patients for primary surgery or NACT and improved R0 resection at PCS. The present study was designed to assess patients who would gain the maximum benefits from primary surgery.
Obstetrics and Gynecology
Zahra Rezaei; Mehrnaz Valadan; Elahe Zabihi Soltani
Volume 5, Issue 2 , October 2020, , Pages 44-48
Abstract
Background & Objective: Laparoscopic ovarian drilling (LOD) is a method for ovulation induction in polycystic ovary syndrome (PCOS) patients. The aim of this study was to evaluate the serum levels of anti-Mullerian hormone (AMH) and follicle-stimulating hormone (FSH) before and after LOD in one or ...
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Background & Objective: Laparoscopic ovarian drilling (LOD) is a method for ovulation induction in polycystic ovary syndrome (PCOS) patients. The aim of this study was to evaluate the serum levels of anti-Mullerian hormone (AMH) and follicle-stimulating hormone (FSH) before and after LOD in one or two ovaries in women with PCOS.Materials & Methods: This study was a prospective cohort study. The study population included infertile women with PCOS resistant to clomiphene referred to the Infertility Clinic of Yas Hospital. They were candidates for LOD in 2016–2017. The serum levels of AMH and FSH were measured before and after three months in two groups of unilateral and bilateral LOD. Data were analyzed using Stata software.Results: A total of 35 female patients were enrolled in the study, 18 (51.4%) in bilateral and 17 (46%) in unilateral LOD groups; the average age of patients was 27 ± 3.4 years old. AMH levels significantly (P < /em><0.001) decreased in both unilateral and bilateral groups after LOD. FSH levels significantly (P < /em><0.001) increased in both groups after LOD, but this increase was higher in the unilateral group than in the bilateral group, and this difference was statistically significant (P < /em><0.001).Conclusion: It seems women with clomiphene-resistant PCOS when underwent unilateral or bilateral ovarian drilling experienced a significant decrease in AMH and a significant increase in FSH, indicating a decrease in their ovarian reserve.
Firoozeh Sadat Hashemi
Volume 4, Issue 1 , March and April 2019, , Pages 1-4
Abstract
Laparoscopy is a surgical procedure which has been used in gynecologic cancer since 1994. With technology progressing during years, there are so many kinds of minimally invasive surgeries in gynecologic malignancies. Regarding the importance of overall survival and progression of free survival in cancerous ...
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Laparoscopy is a surgical procedure which has been used in gynecologic cancer since 1994. With technology progressing during years, there are so many kinds of minimally invasive surgeries in gynecologic malignancies. Regarding the importance of overall survival and progression of free survival in cancerous patients, we should consider this type of surgery very wisely not to compromise patient's prognosis. Considering all the points above, a review was performed to study the role of laparoscopy in gynecologic oncology including endometrial and cervical cancer. It can be concluded that laparoscopy is not safe in a disease with high risk of tumor spread. Also a good prognosis of cancer patients should not be jeopardized by doing incomplete laparoscopic surgery.
maliheh Arab; shahla Noori Ardabili; poria Ganji
Volume 3, Issue 1 , March and April 2018, , Pages 39-44
Abstract
Introduction Endometrial cancer is one of the most common malignancies in women globally. The laparoscopic approach from endometrial cancer is suggested in the medical literature. The aim of the present review is to clarify clinical points of laparoscopic operation in endometrial cancer. A search using ...
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Introduction Endometrial cancer is one of the most common malignancies in women globally. The laparoscopic approach from endometrial cancer is suggested in the medical literature. The aim of the present review is to clarify clinical points of laparoscopic operation in endometrial cancer. A search using keywords included endometrial carcinoma, and treatment and laparoscopy were conducted on PubMed, Up-To-Date, Ovid and Clinical Key databases up to 2016.
Conclusion This present review research showed over 1600 full-text manuscripts, of which, 18 were relevant to this article. The laparoscopic approach to endometrial cancer is categorized as follows: 1) Comparison of complications and advantages of laparoscopy and laparotomy in endometrial cancer; 2) Hospitalization days; 3) Blood transfusion and blood loss; 4) Comparison of the operation time of laparoscopy versus laparotomy; 5) Conversion of laparoscopy to laparotomy; 6) Comparison of endometrial cancer lymphadenectomy in laparoscopy with laparotomy; 7) Laparoscopy of endometrial cancer in old age; 8) Surgical experience and learning curve; 9) Technical points in laparoscopic endometrial cancer surgery; 10) Comparison of endometrial cancer survival in laparoscopy and laparotomy methods; 11) Cost issues.
Atefeh Moridi; Maliheh Arab; Ghazaleh Fazli; Maryam Khayamzadeh
Volume 1, Issue 3 , November and December 2016
Abstract
Dermoid cyst is a benign and common ovarian neoplasm affecting women. Sources for this review article were taken from PubMed and other up-to-date databases covering the period from Jan 2010 to Jan 2016. Keywords for the search were “dermoid cyst” and “treatment”. A search of the ...
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Dermoid cyst is a benign and common ovarian neoplasm affecting women. Sources for this review article were taken from PubMed and other up-to-date databases covering the period from Jan 2010 to Jan 2016. Keywords for the search were “dermoid cyst” and “treatment”. A search of the literature revealed 113 full text manuscripts, from which 21 were relevant. In addition, another 56 relevant manuscripts identified in the reference lists of the above-mentioned 21 manuscripts were included in the study, although they had been published before 2010. Clinical considerations for dermoid cyst management are categorized as follows: 1) selection of the best choice of surgical treatment in dermoid cyst: laparoscopy or laparotomy; 2) procedure to exteriorize a dermoid cyst in laparoscopy; 3) selection of oophorectomy or cystectomy; 4) spillage of the cyst contents: prevention and treatment of the consequences if it does happen; 5) necessity of surgical treatment in dermoid cyst management; 6) ovarian torsion and other complications; 7) Probability of malignancy in dermoid cyst.
