IntroduçãoDesde o início do século passado, os procedimentos do tipo sling têm sido descritos no tratamento da incontinência urinária de esforço (IUE), sendo utilizada grande variedade de materiais, como: músculo piramidal, fáscia lata, músculo grácil e bulbocavernoso Apesar das várias modificações técnicas, a cirurgia de sling consiste na utilização de uma faixa posicionada inferiormente à uretra ou colo vesical e fixada superiormente na parede abdominal. Apresenta taxas de cura objetiva de 61 a 100% e de cura subjetiva de 73 a 93% no tratamento da IUE feminina 1 . As altas taxas de sucesso do sling suburetral no tratamento da IUE, associadas aos novos conceitos na fisiopatologia da IUE e ao desenvolvimento de técnicas menos invasivas com material sintético, têm ocasionado um ressurgimento do interesse pelo sling no tratamento da IUE feminina.A utilização de tecido não autólogo no sling pubovaginal tem como vantagens a diminuição do tempo operatório, a possibilidade de utilização de anestesia local, além de menor tempo de internação e convalescência das pacientes 1,3 . Dessa forma, existe grande interesse por materiais
Objective Gonadotropin-releasing hormone analogues (GnRH-a) have been used preoperatively before hysteroscopic myomectomy to decrease the size and vascularization of the myomas, but evidence to support this practice is weak. Our objective was to analyze the use of GnRH-a in the reduction of submucous fibroid as a facilitator for surgical hysteroscopy from published clinical trials. Data sources Studies from electronic databases (Pubmed, Scielo, EMBASE, Scopus, PROSPERO), published between 1980 and December 2018. The keywords used were fibroid, GnRH analogue, submucous, histeroscopy, histeroscopic resection and their correspondents in Portuguese. Study selection The inclusion criteria were controlled trials that evaluated the GnRH-a treatment before hysteroscopic resection of submucous myomas. Four clinical trials were included in the meta-analysis. Data collection Two review authors extracted the data without modification of the original data, using the agreed form. We resolved discrepancies through discussion or, if required, we consulted a third person. Data synthesis The present meta-analysis included a total of 213 women and showed no statistically significant differences in the use of GnRH-a compared with the control group for complete resection of submucous myoma (relative risk [RR]: 0.94; 95% confidence interval [CI]: 0.80–1.11); operative time (mean difference [MD]: - 3.81; 95%CI : - 3.81–2.13); fluid absorption (MD: - 65.90; 95%CI: - 9.75–2.13); or complications (RR 0.92; 95%CI: 0.18–4.82). Conclusion The present review did not support the routine preoperative use of GnRH-a prior to hysteroscopic myomectomy. However, it is not possible to determine its inferiority when compared with the other methods due to the heterogeneity of existing studies and the small sample size.
Placenta accreta spectrum is a serious obstetric condition related to abnormal adherence of placental tissue to the myometrium and high maternal and fetal morbidity. In order to achieve the best outcome, the management of this condition must be carried out by an experienced multidisciplinary team and the individual characteristics of the patient must be taken into consideration, such as comorbidities and desire for reproductive preservation. This case report presents the conservative surgical management of placenta accreta spectrum in a 23-year-old patient who underwent an elective caesarean section with uterine preservation because of anterior placenta increta. The authors performed a transverse uterine incision at the fundus with transitory uterine devascularisation of the lower uterine segment with partial myometrial removal. This technique was successful for controlling the haemorrhage and preserving the uterus, with no complications.
Background: Single-incision laparoscopic surgery (SILS) was developed with the aim of reducing the invasiveness of conventional laparoscopy (ranging from 3-5 incisions). Objective: The aim of this research was to evaluate surgical findings, postoperative features, and complications in a series of 64 cases of benign adnexal mass that was approached in each case with single incision laparoscopic surgery (SILS). Materials and Methods: In a tertiary medical center in Brazil, 64 patients with presurgery diagnoses of benign adnexal masses underwent laparoscopic surgery using the SILS technique. Each patient's adnexal mass was presumed to be benign, based on each patient's echography features, patient's age, C-125 level, and menopausal status. Results: Hystologic results of all the recruited patients showed benign lesions. Benign cysts (28; 43,8%), solid teratomas (10; 15,6%), and endometriosis (8; 12,5%) were the most prevalent results. There was 1 case of an incisional hernia, the only postoperative complication that required new hospital admission. The average length of stay in the hospital was 22 hours (range: 17-28). Conclusions: SILS is a feasible approach for benign adnexal masses, presenting low rates of postoperative complications and short hospital stays. ( J GYNECOL SURG 31:83)
Objective: to describe the initial experience of a gynecology team, at a tertiary care center, when performing single-port laparoscopic surgery. Method: this is a retrospective study reviewing the medical records of 50 patients treated at the outpatient gynecology clinic of our institution between June 2012 and July 2013 who underwent single-port laparoscopic surgery. This study was approved by the institution's Ethics in Research Committee. Result: the mean age of patients is 37.8 years, ranging from 18 to 70 years, and the most frequent surgical indications were adnexal mass (72%) and chronic pelvic pain (24%). The mean operative time was 94.4 minutes with a mean hospital stay of 25.8 hours. There were no perioperative complications. We recorded two conversions to laparotomy due to technical difficulties during the procedure. All cases of conversion had pelvic adhesions. All operative complications were successfully treated and none were considered severe. Conclusion: this is one of the largest case series in the literature regarding surgical treatment by single-port laparoscopy in gynecology and presents evidence on reduction of surgical morbidity and satisfactory cosmetic results. We conclude that single-port laparoscopy is a viable minimally invasive technique, and that it contributes to the construction of a new scenario in modern gynecological surgery.
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