Journal of minimally invasive gynecology
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J Minim Invasive Gynecol · Jul 2017
Review Meta AnalysisLaparoscopic Excision Versus Ablation for Endometriosis-associated Pain: An Updated Systematic Review and Meta-analysis.
The aim of this study was to update the evidence on the surgical management of endometriosis-associated pain. Does laparoscopic excision offer any benefits over laparoscopic ablation? This is a systematic review and meta-analysis in which we searched MEDLINE, Embase, Institute for Scientific Information conference proceedings, the International Standard Randomised Controlled Trial Number registry, the Register and Meta-register for randomized controlled trials, the World Health Organization trials search portal, the Cochrane Library, and the British Library of electronic theses. Three randomized controlled trials were included, which enrolled 335 participants with a sample size per study ranging from 24 to 178 participants. ⋯ The symptoms of dyspareunia showed a nonsignificant benefit with excision (MD = 0.96; 95% CI, -0.07 to 1.99; p = .07). Data from 1 study showed a significant reduction in chronic pelvic pain (MD = 2.57; 95% CI, 1.27-3.87; p = .0001) and Endometriosis Health Profile-30 core pain scores (MD = 13.20; 95% CI, 3.70-22.70; p = .006) with the excision group compared with the ablation group. The limited available evidence shows that at 12 months postsurgery, symptoms of dysmenorrhea, dyschezia, and chronic pelvic pain secondary to endometriosis showed a significantly greater improvement with laparoscopic excision compared with ablation.
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J Minim Invasive Gynecol · Feb 2016
ReviewAdenomyosis: A Clinical Review of a Challenging Gynecologic Condition.
Adenomyosis is a heterogenous gynecologic condition. Patients with adenomyosis can have a range of clinical presentations. The most common presentation of adenomyosis is heavy menstrual bleeding and dysmenorrhea; however, patients can also be asymptomatic. ⋯ Two-dimensional TVUS and MRI have a respectable sensitivity and specificity; however, recent studies indicate that 3-dimensional TVUS is superior to 2-dimensional TVUS for the diagnosis of adenomyosis and may allow for the diagnosis of early-stage disease. Management options for adenomyosis, both medical and surgical, are reviewed. Currently, the only definitive management option for patients is hysterectomy.
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J Minim Invasive Gynecol · Jul 2015
Review Case ReportsResolution of Chronic Vulvar Pruritus With Replacement of a Neuromodulation Device.
Vulvar pruritus is typically associated with fungal, bacterial, and/or dermatological conditions that routinely resolve with the use of topical medications. Pruritus rarely becomes chronic in nature without a definable pathological diagnosis. ⋯ We report a case in which a patient experienced chronic vulvar pruritus that was refractory to medical treatments and did not have a pathological diagnosis. A neurological etiology was suspected, and upon replacement of the patient's sacral neuromodulation device, complete resolution of the vulvar symptoms occurred.
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J Minim Invasive Gynecol · May 2015
ReviewA medical-legal review of power morcellation in the face of the recent FDA warning and litigation.
Minimally invasive gynecologic surgeons who perform laparoscopic intraperitoneal morcellation should be aware of the recent US Food and Drug Administration (FDA) warning and litigation arising from use of morcellation devices with claims of intraperitoneal dissemination of cancerous cells. On November 24, 2014, the FDA issued a statement warning against using laparoscopic power morcellators in the majority of women undergoing hysterectomy or myomectomy for uterine fibroids. ⋯ This article is not meant to further deter gynecologists from using laparoscopic power morcellators, but rather to provide an interpretation of the FDA statement as to the patients for whom the use of power morcellation may still be permitted under the FDA guidelines. This article also offers protective measures from a legal perspective for those who choose to continue to use power morcellation in the face of the recent FDA warning and litigation.
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J Minim Invasive Gynecol · Mar 2015
Review Case ReportsMedical treatment of ureteral obstruction associated with ovarian remnants and/or endometriosis: report of three cases and review of the literature.
Experience with low-dose intermittent danazol or prolonged gonadotropin-releasing hormone agonist (GnRH-a) with and without add-back therapy in endometriosis-associated ureteral obstruction. ⋯ Low-dose intermittent danazol or GnRH-a alone or with add-back, may be effective long-term therapies in endometriosis-associated ureteral obstruction when surgery is contraindicated, refused, or difficult to perform.