Application of ultrasonic scalpel in gynecologic operative laparoscopy

Objective To investigate the applied value of the ultrasonic scalpel in gynecologic operative laparoscopy. Methods Gynecologic operations were performed using the ultrasonic scalpel under laparoscopy. Operative bleeding and time, perioperative body temperature and hemogram, and tissue damage were observed.Results Forty-two cases of benign gynecologic diseases were treated with the ultrasonic scalpel under laparoscopy. Among them, there were 4 hysterectomies, 9 ovarian cystectomies, 18 salpingotomies, 4 ectopic pregnancies, 3 myomectomies, 3 adhesiolysis and 1 adnexectomy. The amount of operative bleeding, operating time and the tissue injury were related to the type of operation. The minimual operative bleeding amount, operating time, depth of tissue necrosis, tissue injury score and fibrin deposition score were 24.77±4.71ml, 23.39±3.01 min, 0.22±0.10mm, 0.98±0.21 and 0.38±0.26, respectively. The maximal operative bleeding amount, operating time, depth of tissue necrosis, tissue injury score and fibrin deposition score were 166.7±47.18ml, 127.2±16.99 min, 0.35±0.20mm, 1.25±0.20 and 0.81±0.29, respectively. The levels of body temperature, white blood cells and hemoglobin before and after the operations were not statistically different (P>0.05) except for hysterectomy (P<0.05). Conclusion The ultrasonic scalpel can be safely applied for gynecologic operative laparoscopy and should be used widely.

Comparison of the Efficacy and Safety of Different Surgical Strategies for Patients with Type Ⅱ Cesarean Scar Pregnancy

Objective:To compare the efficacy and safety of four surgical strategies currently used for the management of deep implantation cesarean scar pregnancy(CSP-Ⅱ).Methods:This was a retrospective clinical cohort study,and,in total,131 women diagnosed with CSP-Ⅱ and primarily treated in our hospital were recruited.Women treated using laparoscopy assisted by operative hysteroscopy(LAOH;Group A,n=25),uterine artery embolization(UAE)followed by LAOH(Group B,n=21),ultrasound-guided dilatation and curettage(D&C;Group C,n=24),and UAE followed by D&C(Group D,n=61)were evaluated.Univariate and multiple logistic analyses were performed to identify the risk factors.Results:No statistically significant difference was found in patient age,gestational age,size of lesion,and pretreatment serumβ-human chorionic gonadotropins(β-hCG)level.Operation time was longer(P<0.001)and the success rate was higher(P=0.01)in both Group A and Group B than in Group C and Group D.When the cohort was further analyzed regarding patients with myometrial thickness≤3 mm(n=75,defined as CSP-IIb),a lower rate of perioperative complications(P=0.036)and a higher success rate(P<0.001)remained in Group A(n=15)and Group B(n=15)but not in Group C(n=11)or Group D(n=34).In multiple logistic regression analysis,the risk factors related to lower treatment efficacy for patients with CSP-Ⅱ were thinner myometrial thickness of cesarean scar(CS)(≤3 mm)(odds ratio[OR]=5.470,P=0.062),number of cesarean sections(a2)(OR=8.877,P=0.013),mass protruding into the bladder or abdominal cavity(OR=25.507,P<0.001),and direct D&C modality(OR=38.247,P=0.010).Conclusions:Compared with D&C±UAE,LAOH±UAE showed a higher success rate for patients with CSP-Ⅱ,especially when the zygote was more deeply implanted with a myometrial thickness of CS≤3 mm.CSP-Ⅱ treatment should be individualized on the basis of many risk factors.