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   Table of Contents - Current issue
Coverpage
April-June 2022
Volume 11 | Issue 2
Page Nos. 81-138

Online since Wednesday, May 4, 2022

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PERSPECTIVE ARTICLE  

The accreditation and training of high-intensity focused ultrasound in the Asia-Pacific Region Highly accessed article p. 81
Lee Keen Whye, Chyi- Long Lee
DOI:10.4103/gmit.gmit_24_22  
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REVIEW ARTICLE Top

The roles of MicroRNA-133 in gynecological tumors p. 83
Yang Zhou, Zhongping Cheng
DOI:10.4103/GMIT.GMIT_79_20  
MicroRNAs are noncoding small RNAs that regulate gene expression posttranscriptionally. They act as a key role not only in the body development but also in many human diseases, including malignant tumors. With evidence of the complex role of miR-133 during gynecological malignancies initiation and progression are gradually emerging, miR-133 shows suppressive function by inhibiting tumor proliferation, invasion, and metastasis or acts as an oncogene by promoting tumor initiation, growth and invasion, depending on different tumor types and differentiation. In this review, we summarize the role and related regulatory methods of miR-133 in gynecological cancers. Moreover, then, we analyze and clarify the research status of other microRNAs acting on similar genes and pathways in gynecological tumors and look forward to their future research directions. This review may provide new expectations for applying miR-133 as diagnostic and prognostic biomarkers in gynecological tumors.
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ORIGINAL ARTICLES Top

Perioperative serum creatinine change and delayed urologic complications following total laparoscopic hysterectomy for benign indications Highly accessed article p. 88
Shota Higami, Yusuke Tanaka, Mikiko Terada, Ayako Hosoi, Shinsuke Koyama, Yasuhiko Shiki
DOI:10.4103/GMIT.GMIT_142_20  
Objectives: The objective of the study was to investigate the association between perioperative serum creatinine change and delayed urologic complications following total laparoscopic hysterectomy (TLH) for benign indications. Materials and Methods: A total of 510 cases (503 cases without delayed urologic injuries and 7 cases with delayed urologic injuries) in which TLH was performed for benign indications were retrospectively reviewed. The patient characteristics and surgical outcomes were compared between patients with and without delayed urologic injuries. Laboratory markers (serum creatinine level at the preoperative and postoperative periods, white blood cell [WBC] ratio, and C-reactive protein [CRP] ratio) were analyzed to evaluate the diagnostic value of these laboratory markers. Results: There were no statistically significant differences in age, parity, body mass index, the presence of diabetes mellitus, preoperative GnRH agonist use, previous history of abdominal surgery or the performance of adnexal surgery, ASRM score, the presence of cul-de-sac obliteration, operative time, blood loss or weight of the resected specimens between the two groups. The proportions of patients who showed an elevated creatinine level on postoperative day 1 was significantly higher in the delayed urologic injury group (9.9% vs. 57%, P < 0.001). The combination of the three laboratory markers yielded an area under the ROC curve value of 0.75 (95% confidence interval, 0.491–1) in the detection of delayed urologic injuries. Conclusion: A change in the serum creatine level over baseline after surgery may indicate the possibility of urologic injuries. The combination of creatinine change and other factors, such as WBC or CRP would be helpful for detecting urologic complications after TLH.
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Volume index is a risk factor for recurrence even in patients with clinical stage IA endometrial cancer undergoing either laparotomy or laparoscopy: A retrospective study p. 94
Kenro Chikazawa, Sachiho Netsu, Ken Imai, Azusa Kimura, Tomoyuki Kuwata, Ryo Konno
DOI:10.4103/GMIT.GMIT_12_21  
Objectives: The objective of the study was to investigate the long-term outcomes, in particular, recurrence risk, especially tumor volume, for Stage IA endometrial cancer and to identify the risk factors for recurrence. Materials and Methods: This single-center retrospective study analyzed women who underwent primary surgical treatment for the International Federation of Gynecology and Obstetrics Stage IA (Grade 1 or 2) endometrioid carcinoma at our institute between January 2010 and July 2018. Patients' demographic characteristics, including age, operative time, number of lymph nodes, final stage, volume index as tumor volume, and final histological type, were reviewed. A total of 168 patients were enrolled, with 95 and 73 patients in the laparotomy and laparoscopy groups, respectively. The Cox proportional hazards model was used to adjust for prognostic factors in the analysis including upstaged patients, tumor histology, lymphovascular invasion, and volume index. Results: There was no difference in the recurrence rate between laparoscopic and open surgeries for Stage IA endometrial cancer. The operative time was longer, and the amount of blood loss was lesser in the laparoscopy group than in the laparotomy group. For all patients undergoing either laparoscopy or open surgery, upstaged ≥IB, nonendometrioid Grade 1 or 2, lymphovascular invasion, and volume index ≥36 were significant independent recurrence risk factors. Conclusion: Laparoscopic surgery for Stage IA endometrial cancer is technically and oncologically safe. Patients with a high-volume index have a higher recurrence risk. Furthermore, the volume index can be a recurrence predictor in low-risk endometrial cancer patients.
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Modified thermal balloon endometrial ablation for treatment of heavy menstrual bleeding p. 100
Baraa Lukman Humo Al-Ibrahim, Ahmed Jasim Al Husaynei
DOI:10.4103/GMIT.GMIT_147_20  
Objectives: The objective of this study was to determine the efficacy of modified thermal balloon ablation using Foley's catheter in the treatment of heavy menstrual bleeding (HMB). Materials and Methods: Twelve patients with HMB aged 35–55 years underwent modified thermal balloon ablation using Foley's catheter. Patients were selected after complete clinical evaluation and investigations. The procedure was undertaken in the operation theater under general anesthesia/intravenous sedation. Three cycles of modified thermal balloon ablation using Foley's catheter were performed to ablate the endometrium. The time given to each cycle was 7 min. All the cycles were performed in the same setting. The main outcome measures that were studied were reduction in the menstrual flow, the need for further treatment, and relief of dysmenorrhea if present. Outcome measure regarding reduction in menstrual flow was statistically analyzed using Fisher's exact test. Statistical significance was determined at a level of P < 0.05. Results: Eighty-two percent of patients experienced a reasonable reduction in menstrual blood flow at 3-month follow-up. Eighteen percent observed no change in bleeding pattern and needed further treatment after failure of the procedure. Forty-two percent of patients complained of minor side effects such as cramp lower abdominal pain and fever. Rupture of balloon during the procedure occurred in only one case (8%). Conclusion: Modified thermal balloon ablation with Foley's catheter can be a promising management of HMB in resource-poor settings. It is a cost-effective alternative to the original endometrial ablation techniques.
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Comparative analysis of peri-operative outcomes following total laparoscopic hysterectomy with conventional bipolar-electrosurgery versus high-pressure pulsed LigaSure use p. 105
Sanskriti Batra, Punita Bhardwaj, Mamta Dagar
DOI:10.4103/GMIT.GMIT_69_20  
Objectives: Quick and effective hemostasis is essential for a successful laparoscopic surgery. Hence, it is of utmost importance for laparoscopic surgeons to understand the various available and emerging energy sources to tailor their use according to their properties and surgical requirement. The aim of this study was to compare LigaSure, an advanced bipolar versus conventional bipolar in total laparoscopic hysterectomy, with respect to operating time, mean blood loss, mean reduction in hemoglobin, intraoperative, and postoperative complications, and duration of prospective hospital stay. Materials and Methods: It was a randomized controlled study. One hundred and twenty patients scheduled for elective hysterectomy for any benign indication were randomly allocated to two groups namely, conventional bipolar group and LigaSure group. Patients with a history of ≥3 laparotomies, uterine size >20 weeks were excluded. Total laparoscopic hysterectomy with bilateral salpingectomy/salpingo oophorectomy was done in all the patients and endpoints were evaluated. Results: All the recruited participants (n = 120) achieved study endpoints. There was statistically significant difference in the meantime to dissect adnexal ligaments, primary and total operating time (for adnexal ligaments: Conventional bipolar-9.44 min vs. LigaSure-7.05 min; P = 0.000) (Primary: Conventional bipolar-97.03 min vs. LigaSure 74.39 min; P = 0.000) (Total: 142.5 min vs. 136.37 min P = 0.002). Mean blood loss (145 ml vs. 141.67 ml; P = 0.846), mean reduction in hemoglobin (0.802 versus 0.752; P = 0.484) and duration of postoperative stay (2.54 days vs. 2.32 days; P = 0.128) were comparable (P > 0.05). None of the participants suffered from any major complication during the surgery or in the postoperative recovery period. Conclusion: With an ability to effectively reduce operating time, LigaSure is a safe and efficient instrument for laparoscopic hysterectomy.
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SHORT COMMUNICATION Top

Benefits of laparoscopic surgery for bleeding events in patients with implantable left ventricular assist devices during antithrombotic therapy p. 110
Aya Nakae, Michiko Kodama, Eiji Kobayashi, Kae Hashimoto, Yuji Tominaga, Tadashi Kimura
DOI:10.4103/GMIT.GMIT_35_21  
Hemorrhagic ovarian cysts (HOCs), a common gynecological disease causing intraabdominal bleeding, can be life threatening in patients undergoing antithrombotic therapy, especially those with left ventricular assist device (LVAD) implantation under strong antithrombotic therapy. We encountered three postLVAD implantation cases with intraabdominal bleeding due to suspected HOCs, which required surgery for hemostasis. Such patients are not only at a higher risk of bleeding but also have restrictions in available surgical incision sites to avoid damaging the LVAD driveline located underneath the abdominal wall. Laparoscopic surgery, which can be performed through minute incisions with flexible site selection, may benefit intraabdominal hemorrhage patients with LVADs.
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VIDEO ARTICLE Top

A video article: The laparoscopic uterine artery occlusion in combination with myomectomy for uterine myoma p. 114
Guihai Ai, Wei Huang, Weihong Yang, Jie Liu, Ning Luo, Jing Guo, Zhongping Cheng
DOI:10.4103/GMIT.GMIT_10_21  
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VIDEO CASE REPORT Top

Hysteroscopy-guided natural orifice repair of isthmocele p. 116
Cihan Kaya, Özgür Aslan, Mülayim Tetik
DOI:10.4103/GMIT.GMIT_13_21  
Isthmocele can be defined as a hypoechoic field within the lower uterine segment, indicating a discontinuation of the myometrium at the uterine scar of a previous cesarean section. Postmenstrual spotting, pelvic pain, dysmenorrhea, dyspareunia, uterine rupture, cesarean scar pregnancy, and secondary infertility could be seen as the complications of existing isthmocele. Such defects are prevalent with the increasing number of cesarean deliveries. A 39-year-old woman who had three prior cesarean sections complaining irregular uterine bleeding for 2 years was examined. A uterine scar defect was observed. A hysteroscopy-guided natural orifice approach was planned to repair the defect. The patient was discharged without any complication in her postoperative 6th h. She had no pain or irregular bleeding in her 2-week postoperative visit.
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CASE REPORTS Top

Vulvar angioleiomyoma p. 119
Stephanie Jillian Handler, Christina Truong, Tajnoos Yazdany
DOI:10.4103/GMIT.GMIT_6_21  
Vulvar angioleiomyoma is a very rare neoplasm. We describe the case of a 49-year-old woman who presented with a small, firm, tender labial mass. Intraoperatively, the lesion appeared hypervascular and was excised using sharp dissection. Histological and immunohistochemical analyses were necessary to make the diagnosis. The report of this extremely uncommon gynecologic lesion is important to make clinicians aware of the possibility of vulvar angioleiomyoma.
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Serosal injury to a distended stomach during open entry for laparoendoscopic single-site surgery p. 121
Pei- Chen Chen, Pei- Chen Li, Hsuan Chen, Dah- Ching Ding
DOI:10.4103/gmit.gmit_53_21  
Complications related to open entry for laparoscopic procedures are relatively rare, and the incidence of closed entry-related complications is 0.4 per 1000 cases. We report a case of serosal injury to a distended stomach that was caused during open entry. A 37-year-old woman presented with a 1-year history of dysmenorrhea. Transvaginal ultrasonography revealed a uterine myoma and cesarean section (C/S) wound defect. Laparoscopic single-site myomectomy and repair of the C/S wound defect were planned. Open abdominal entry was achieved at the umbilicus, and the patient's stomach was distended and injured by the electric knife (30 watts). After identifying the injury, we inserted a nasogastric tube to deflate the stomach and repaired the gastric serosal injury. The laparoscopic myomectomy and C/S defect repair were subsequently performed without complications. The patient has remained free from complications during the 1-year follow-up. Gastric serosal injury during open entry is a rare complication. Insertion of a nasopharyngeal tube and routine percussion of the abdomen before entering the abdominal cavity are the most important steps to prevent this complication.
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Fallopian tube autoamputation after acute large endometrioma torsion p. 124
Luay Ibrahim Abu Atileh, Nouf Moh'd Khalifeh
DOI:10.4103/gmit.gmit_41_21  
Adnexal torsion is the fifth most common gynecological emergency. However, endometrioma torsion is a very rare entity due to the associated pelvic adhesions. A 26-year-old woman presented to the emergency department complaining of acute lower abdominal pain for the past 6 h. Physical examination showed localized left iliac fossa tenderness. Ultrasound showed a 13 cm endometrioma with a normal color Doppler. Laparoscopy revealed a 13 cm large endometrioma arising from the left ovary. The left Fallopian tube was amputated at its attachment to the left cornua. Reconstruction of the ovary was done and the specimen was retrieved through the umbilicus inside a bag. Autoamputation of the Fallopian tube alone, although very rare, is typically associated with a preceding torsion. It is critical to be aware of adnexal torsion, as it can have implications for future fertility. Therefore, laparoscopic detorsion and cystectomy are the gold standard management.
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Robotic-assisted total hysterectomy with low pneumoperitoneal pressure (6 mmHg) and use of surgical plume evacuator system to minimize potential airborne particles according to the joint statement on minimally invasive gynecologic surgery during the COVID-19 pandemic: A case report from Japan p. 127
Yoshiaki Ota, Kuniaki Ota, Toshifumi Takahashi, Soichiro Suzuki, Rikiya Sano, Mitsuru Shiota
DOI:10.4103/GMIT.GMIT_131_20  
We presented a case of uncontrolled genital bleeding caused by subserosal fibroid and treated by robotic-assisted hysterectomy during the coronavirus disease 2019 (COVID-19) pandemic. A 49-year-old woman had severe anemia with hypermenorrhea due to submucosal fibroid. Hysterectomy was deemed necessary to control genital bleeding. However, at that time, the number of confirmed COVID-19 cases has been increasing in Japan. Serious concerns have been raised about the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) dissemination during minimally invasive surgery due to pneumoperitoneum-associated aerosolization of particles. We tried to prevent the spread of surgical plume by performing surgery under low pneumoperitoneal pressure at 6 mmHg and by using an evacuation/filtration system. As a result, we successfully performed robotic-assisted hysterectomy with minimized risk of spreading surgical plume-containing aerosol particles into the operating room. It is essential to follow the guidelines issued by the relevant societies and act accordingly to reduce the risk of SARS-CoV-2 infection in medical settings while performing surgery. We hope that our experience will help prevent secondary cases of future SARS-CoV-2 infections.
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CLINICAL IMAGES Top

Embolic microspheres observed during metroplasty p. 131
Pedro Brandao, Nathan Ceschin, José Bellver, Jaime Ferro
DOI:10.4103/gmit.gmit_58_21  
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Giant mucinous cystadenocarcinoma of the ovary with cavitary metastases to lungs in a postmenopausal woman: A rare presentation p. 134
Ravikanth Reddy
DOI:10.4103/gmit.gmit_73_21  
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Benign multicystic peritoneal mesothelioma complicating fertility preservation p. 137
Satoshi Shikanai, Tasuku Mariya, Masahiro Iwasaki, Tsuyoshi Saito
DOI:10.4103/GMIT.GMIT_43_21  
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