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Laparoscopic Hysterectomy in the Setting of Large Fibroids
Published in Rooma Sinha, Arnold P. Advincula, Kurian Joseph, FIBROID UTERUS Surgical Challenges in Minimal Access Surgery, 2020
In the large uterus, it is often difficult to open the vagina from above as the cervix may be elongated and deep. Usage of a vaginal colpotomizer allows the vaginal fornices to be pushed up so that a distinct endpoint for dissection is created. Use of a 30° scope is essential for proper visualization, especially in the uterus with fibroids in the lower segment. After the uterine vessels and cardinal ligaments are secured on either side, the vaginal vault can be opened anteriorly or posteriorly near the cervicovaginal junction, over the colpotomizer cup with a monopolar hook or other energy source. Circumferential culdotomy is carried out with the delineator as a back stop. Excessive coagulation of the vaginal vault should be avoided as it can cause poor healing and increases the risk of vault dehiscence.
DRCOG MCQs for Circuit C Questions
Published in Una F. Coales, DRCOG: Practice MCQs and OSCEs: How to Pass First Time three Complete MCQ Practice Exams (180 MCQs) Three Complete OSCE Practice Papers (60 Questions) Detailed Answers and Tips, 2020
Complications of subtotal hysterectomy include:Rectocoele.Anuria.Depression.Urinary tract infection.Vaginal vault prolapse.
Equipment, surgery and practical procedures
Published in T. Justin Clark, Arri Coomarasamy, Justin Chu, Paul Smith, Get Through MRCOG Part 3, 2019
T. Justin Clark, Arri Coomarasamy, Justin Chu, Paul Smith
Closure of vaginal vault, incorporating peritoneum and utero-sacral ligaments (for vault support). Commonly, a McCall culdoplasty is done (i.e. a single suture to incorporate the vaginal wall, peritoneum and utero-sacral ligaments, aimed at obliterating the posterior cul de sac).
Efficacy and Clinical Significance of the Zuogui Pill on Premature Ovarian Failure via the GDF-9/Smad2 Pathway
Published in Nutrition and Cancer, 2023
Su Cen, Xiaojun Qian, Chunfang Wu, Xinya Xu, Xiaohui Yang
Ultrasonography was performed using a vaginal color Doppler ultrasound (Siemens Acuson 2000) for 5 day during the menstrual cycle. The patients were required to empty the bladder and perform the bladder lithotomy position. A vaginal probe was carefully inserted into the vagina and placed in the vaginal vault. The sampling frame was placed at the cervix to observe the morphology and size of the uterus and ovaries. The color Doppler ultrasound sampling frame was placed in the medullary position of the bilateral ovaries to observe the ovarian interstitial arteries at an angle of incidence (θ) ≤ 35°. Pulsatility index (PI), peak systolic velocity (PSV), and end-diastolic velocity (EDV) were determined using a pulsed wave Doppler. The resistance index (RI) was calculated as (PSV-EDV)/PSV. Ovarian volume (OV), antral follicle count (AFC), and mean ovarian diameter (MOD) were measured using the two-dimensional (2 D) ultrasound state [24].
The ins and outs of drug-releasing vaginal rings: a literature review of expulsions and removals
Published in Expert Opinion on Drug Delivery, 2020
Peter Boyd, Ruth Merkatz, Bruce Variano, R. Karl Malcolm
Even though the ring resides around the cervix, expulsion can occur during sexual arousal since the vaginal vault undergoes physical transformation known as tenting or ballooning [86,87]. Just prior to coitus, there is increased muscular tension in the body that draws the uterus upward resulting in more space in the vaginal vault. There are also increased secretions from the vaginal wall, the cervix, and the two Bartholin glands located at the entrance to the vagina that keep the vagina lubricated during arousal and reduce friction during penetration. Depending upon the extent of these physical changes, which vary widely between women, the ring may be expelled. After sex, the vaginal canal rapidly returns to its previous size. If the ring has been expelled, it can be reinserted in accordance with specific product instructions (Table 2).
Comparison of laparoendoscopic single-site (LESS) surgery and conventional multiport laparoscopic (CMPL) surgery for hysterectomy: long-term outcomes of abdominal incisional scar
Published in Journal of Obstetrics and Gynaecology, 2020
Gökhan Demirayak, İsa Aykut Özdemir, Cihan Comba, Berna Aslan Çetin, Begüm Aydogan Mathyk, Mustafa Yıldız, Veli Mihmanlı, İbrahim Karaca, Mustafa Öztürk, Onur Güralp
Uccella et al. (2012) reported that the incidence of vaginal cuff dehiscence was significantly higher in the laparoscopic hysterectomy group compared with the abdominal or vaginal hysterectomy groups. Moreover, the time for cuff dehiscence after TLH might be up to one year (Uccella et al. 2012). Laparoscopic closure of the vaginal cuff at the end of TLH was associated with a significant reduction of vaginal dehiscence (Uccella et al. 2018). The vaginal cuff was sutured intracorporeally in one group, and it was closed through the vagina in the other group in a prospective randomised controlled study designed by Bastu et al. (2016), and cuff dehiscence was detected in neither of the groups. The cuff closure is the most difficult procedure in laparoscopic hysterectomy. Because all the laparoscopic working ports are located in the same incision, LESS has several limitations, including the breakdown of the triangulation and crossing/sword-fighting instruments (Uccella et al. 2018). Therefore, suturing is more complex in LESS than in the multiport laparoscopic technique (Bastu et al. 2016). Generally, the suturing of the vaginal vault is performed through the vagina in LESS surgery (Canes et al. 2008). In our study, the vaginal cuff was closed through the vagina in all women in the LESS surgery group, and it was sutured intracorporeally in all women in the CMPL surgery group. The cuff dehiscence was not detected in both groups in long-term as was also reported by Bastu et al. (2016).