Induction of total laparoscopic hysterectomy adopted the marionette technique in peri-menopausal and post-menopausal CIN3 patients

Objective:When performing cervical conization in post-menopausal cervical intraepithelial neoplasia 3(CIN3)patients,the positive rate of endocervical cone margin and the incidence of postoperative cervical stenosis increase.This study summarized a 4-year experience of total laparoscopic hysterectomy as a treatment option for peri-menopausal and post-menopausal CIN3 patients at a single institution.Furthermore,it shared the refinement strategies used during the surgery.Methods:This study retrospectively analyzed the medical records of CIN3 patient aged45 years and who underwent open or laparoscopic hysterectomy at our institution from January 1,2017 to December 31,2020.Totally,30 CIN3 patients were enrolled and divided into abdominal hysterectomy group and laparoscopic hysterectomy based on surgery method,with 5 patients and 25 patients respectively.Results:Compared to the abdominal hysterectomy group,the perioperative blood loss(20 mL vs.220 mL,p=0.004)was less and the duration of in-hospital stay(7 d vs.11 d,p<0.001)were significantly shorter in the laparoscopic hysterectomy group.However,no significant differences in age at hysterectomy(53 y vs.77 y,p=0.054)and operative time(154.4±27.8 min vs.161.0±62.4 min,p=0.826)were observed between them.Diagnostic conization was performed in advance for 12 patients,and among them,10(83.3%)patients had positive endocervical cone margin.Postoperative intestinal obstructionwas noted in one abdominal hysterectomy patient,no other complications were observed in the remaining patients.Conclusion:Compared to conization,hysterectomy is more invasive;however,it is an acceptable treatment option for peri-menopausal and post-menopausal CIN3 patients.In such cases,opting for total laparoscopic hysterectomy adopted the marionette technique might be preferable because the procedure is less invasive.

An old uterine rupture repaired 2 months postpartum using laparoscopy aided by hysteroscopy: A case report

With an incidence of 0.005%,unscarred uterine rupture is extremely rare.It is difficult to diagnose uterine rupture because of the absence of characteristic clinical symptoms.Here,we report a rare case of a 31-year-old woman with a uterine rupture that was accurately diagnosed and repaired by laparoscopy and hysteroscopy on postpartum day 69.The patient recovered uneventfully and was discharged on postoperative day 4.Three months after surgery,pelvic magnetic resonance imaging was performed,which confirmed wound repair.In women with a stable condition,laparoscopy with hysteroscopy could be an alternative choice for the diagnosis and treatment of suspected uterine rupture;however,more substantial studies are needed to confirm this surgical approach.

Factors associated with surgical-site infection after total laparoscopic hysterectomy

Objective:In recent years,minimally invasive surgery has been emphasized in gynecological surgery,and total laparoscopic hysterectomy has been increasingly reported.In this retrospective single-center study,the main objective was to identify risk factors for the development of surgical-site infection(SSI)after total laparoscopic hysterectomy.The secondary objective was to investigate the efficacy of transvaginal drainage as a treatment for SSI.Methods:This retrospective study investigated 377 patients who underwent total laparoscopic hysterectomy in the Department of Obstetrics and Gynecology at the Saitama Medical Center,Saitama Medical University,Japan between January 1,2015 and December 31,2019.Patients were divided into the SSI group and non-SSI group based on whether they suffered from SSI.The data of preoperative,intraoperative,and postoperative risk factors for SSI were collected and analyzed.Results:Of the 377 patients who underwent total laparoscopic hysterectomy,21 patients were in the SSI group and 356 patients were in the non-SSI group.After the comparison between the two groups and the multivariate analysis,only the C-reactive protein level on postoperative day 3(OR¼1.556,95%CI:1.233 e1.964,p<0.001)showed a significant correlation with SSI.The receiver operating characteristic curve revealed that the C-reactive protein level>7.6 mg/dL on postoperative day 3 could detect the SSI onset early.In the SSI group,the hospital stay was longer for patients with transvaginal drainage than for patients without(17.40±3.21 d vs.10.90±2.39 d,p¼0.0027).However,none required reoperation.Conclusions:Patients with a high postoperative C-reactive protein level may be experiencing SSI,and ultrasonography and other imaging procedures should be performed immediately.If a vaginal abscess is confirmed on imaging,transvaginal drainage should be performed early,which may prevent reoperation.