SBA Questions
Justin C. Konje in Complete Revision Guide for MRCOG Part 2, 2019
A 29-year-old woman who has had two mid-trimester miscarriages had a transabdominal cerclage with a posterior knot at 11 weeks of gestation. She presents at 19 weeks of gestation with a brownish vaginal loss and disappearance of pregnancy signs of 3 days duration. An ultrasound scan confirms an intrauterine fetal death of 18 weeks of gestation. How best will she be managed?Hysterotomy and leave stitch in-situPosterior colpotomy to remove stitch and offer suction evacuationRemove the stitch by laparotomy and induce deliveryRemove the stitch by posterior colpotomy and induce deliveryRemove the stitch laparoscopically and induce delivery
Anterior Vaginal Wall Prolapse
Linda Cardozo, Staskin David in Textbook of Female Urology and Urogynecology - Two-Volume Set, 2017
AppendAge tips delivered by vAginAl trocArs to the sAme site (Figure 82.8). The AtFP mesh Arms provide lAterAl fixAtion. An index finger plAced into the vAginA pAlpAtes the AtFP from the ischiAl spine to the posterior pubis. The mesh cAn be pAssed through the upper third of the AtFP using the sAme fixAtion methods. With the uphold device, there Are no AtFP Arms to implAnt, And A sutured Anterior colporrhAphy is often performed prior to mesh plAcement. The mesh Arms Are slowly And individuAlly Adjusted to A loose tension, And then the mesh is sutured flAt. Cystoscopy with visuAlizAtion of ureterAl flow is performed to ensure integrity of the blAdder And ureters. The colpotomy is closed And the vAginA pAcked As described eArlier.
Vaginal Vault Prolapse: Treatment of Posterior IVS
Victor Gomel, Bruno van Herendael in Female Genital Prolapse and Urinary Incontinence, 2007
The first incision is an anterior and sagittal colpotomy. If the surgeon foresees the placement of a sub-urethral, retro pubic, prosthesis for the treatment of USI, the colpotomy has to stop some 4 cm from the meatus urethrae externus. This leaves enough space to be able to perform a separate incision for this mesh. When both prostheses are placed within the same longer incision, the risk exists for the sub-urethral mesh to slip towards the bladder neck in a later stage in time.
The Comparison of Surgical Outcomes following Laparoscopic Hysterectomy and vNOTES Hysterectomy in Obese Patients
Published in Journal of Investigative Surgery, 2022
Cihan Kaya, Şükrü Yıldız, İsmail Alay, Özgür Aslan, İlke Esin Aydıner, Levent Yaşar
Patients were placed in the high lithotomy position under general endotracheal anesthesia. The vaginal retractors were used for adequate cervical visualization. The anterior and posterior lips of the cervix grasped with two tenacula. A circumferential cervical incision was performed. Blunt and sharp dissections separated the vaginal mucosa over the cervical fascia. The sacrouterine ligaments were cut and tied as in the conventional VH. Anterior and posterior colpotomy was then performed. A self-constructed glove port with a small size Alexis wound Retractor, or a GelPoint vPath (Applied Medical, Rancho Santo Margarita, CA) was used as the vaginal access platforms. After an adequate CO2 insufflation, the pneumoperitoneum was set at 12 mmHg. A 20° Trendelenburg position was maintained through the endoscopic procedure. A rigid 0° 10-mm telescope, conventional laparoscopic forceps, and 5 mm sealing device were used. The uterine vessels, adnexal pedicles, and infundibulopelvic ligaments were sealed and cut in caudal-to-cranial direction. The uterus was removed through the vaginal route. The vaginal cuff was peritonised and sutured with a Vicryl 1-0 suture (Ethicon, Piscataway, NJ)
Total laparoscopic hysterectomy for enlarged uteri: factors associated with the rate of conversion to open surgery
Published in Journal of Obstetrics and Gynaecology, 2019
S. Cianci, S. Gueli Alletti, V. Rumolo, A. Rosati, C. Rossitto, F. Cosentino, L. C. Turco, G. Vizzielli, A. Fagotti, V. Gallotta, F. Ciccarone, G. Scambia, S. Uccella
The procedure consisted of a total extrafascial hysterectomy (class ‘A’ radical hysterectomy according to the Querleu-Morrow Classification) with bilateral salpingo-oophorectomy, or bilateral salpingectomy with ovarian preservation, depending on the patients’ age and characteristics. The round ligaments were coagulated and cut to enter the retroperitoneum. The pararectal space was developed to allow the identification and closure (with vascular endoclips) of the uterine artery at its origin from the umbilical artery. The proper ovarian ligament (according to the type of procedure) were sealed with bipolar energy and divided. The bladder peritoneum was incised distal to the cervicouterine junction. The bladder was dissected from the cervix/vagina and pushed caudally. The paracervix was coagulated and cut close to the uterus. A circular colpotomy was then performed using the monopolar hook, and the specimen was put in a bag and morcellated trough the vagina. In case of extremely large uteri (when it was impossible to extract the specimen in an endobag), a suprapubic mini-laparotomy (<4 cm length) (with extracorporeal morcellation) was performed.
Conventional Laparoscopy or Vaginally Assisted Natural Orifice Transluminal Endoscopic Surgery for Adnexal Pathologies: A Paired Sample Cross-Sectional Study
Published in Journal of Investigative Surgery, 2021
Cihan Kaya, Ismail Alay, Huseyin Cengiz, Sema Baghaki, Ozgur Aslan, Murat Ekin, Levent Yaşar
Regarding the use of NOTES to treat adnexal masses, Lee et al. [16] reported the results of 10 consecutive patients who underwent transvaginal NOTES for adnexal pathologies via a self-constructed glove port. In this report, three patients underwent tubal sterilization, three had salpingectomy for ectopic pregnancy, and four had adnexectomies for cysts smaller than 8 cm. They completed 9 of the 10 procedures via the planned route. Operative time ranged from 1 to 3 hours; intraoperative blood loss was 50 mL in all three patients; and the postoperative hospital stay ranged from one to three days [16]. In another study, Ahn et al. [17] also the reported results for 10 consecutive cases. They used a uterine manipulator through the cervical os, and a single port with multiple channels (SILS Port, Covidien, Mansfield, MA, USA) was inserted into the colpotomy site. The longest cyst diameter was 6.0 (2.9–8.0) cm. Operative time was 67.5 (50.0–100.0) min, and it tended to be longer for more complicated surgeries, such as salpingostomy and cystectomy, than for oophorectomy or salpingectomy. They stated that the average operation time decreased with increasing experience [17]. For all 10 patients, VAS pain scores at 12 and 24 hours postoperatively were 4.0 and 1.0, respectively. Yang et al. [14] reported the results for seven patients with adnexal masses who were treated with vNOTES via a self-constructed glove port. They did not report any intraoperative complications or necessity to return to CL. The mean operation time was 45 min, the mean mass size was 6 cm, and Hb decrease was 1.6 g/dL. The median postoperative hospital stay was two days (range, 1–3) [18].
Related Knowledge Centers
- Amniocentesis
- Colposcopy
- Pelvic Inflammatory Disease
- Pus
- Vaginal Fornix
- Vagina
- Rectouterine Pouch
- Culdoscopy