Materials and Methods: A total of thirty patients among all gynecology inpatients who were planned for TLH with or without BSO with controlled medical diseases, normal preoperative investigations, and uncomplicated surgery were recruited from January 2014 to December 2016. Data were collected from electronic medical records. Postoperatively, patients who fulfilled the selection criteria were discharged within 24 h and were followed up at 6 weeks and 3 months postsurgery. The results were presented as frequency with percentage and mean standard deviation.
Results: All patients who had uncomplicated surgery and blood loss <1 l with no early postoperative complications were discharged within 24 h. They had a pain score of < 3 and were able to ambulate and tolerated orally well. None of these patients who were discharged 24 h postsurgery required readmissions. During follow-up, there were no reported complications such as persistent pain, wound infection, or herniation.
Conclusion: Twenty-four hours' discharge post-TLH with or without BSO is feasible and safe if the selection process is adhered to.
Materials and Methods: Thorough search of articles and recommendations were done to look into the characteristics of the virus in terms of transmission and risks during surgery. Smoke plume characteristics, composition and risk of viral transmission were also studied. Search includes The WHO Library, Cochrane Library and electronic databases (PubMed, Google scholar and Science Direct).
Conclusion: We concluded that there is no scientific basis of shunning laparoscopic approach in surgical intervention. Ultimately, the guiding principles would be of reducing the anesthetic and surgical duration, the availability of full protective gear for HCWs during the surgery and the status of the patient. It is mandatory for viral swab tests to be done within the shortest window period possible, for all cases planned for surgery.
Design: This was a retrospective study.
Setting: This study was conducted at tertiary hospital.
Participants: The records of 67 women who underwent LM, 22 women who underwent OM, and 14 women who had laparo-conversion from January 2010 to November 2014 were reviewed.
Measurement and Main Results: Fibroids up to 10 cm were removed by LM, while most fibroids more than 10 cm were managed through OM. The number and weight of myomas are significantly associated with laparo-conversion, with a rate of 17%. Mean blood loss was significantly reduced in LM group than the OM and laparo-conversion groups. Duration of hospital stay was also significantly less in LM (2 ± 1 days) compared to both OM and laparo-conversion groups (3 ± 1 days). Most women underwent LM (88%) had no postoperative complications compared to OM (50%) and laparo-conversion (57.1%). The number of fibroids removed and duration of surgery was positively correlated with blood loss in the women who underwent myomectomy.
Conclusion: LM is an ideal surgical approach for removal of fibroids which are up to 10 cm diameter and <5 in number, while OM is useful for cases with multiple (5 or more), larger fibroids (>10 cm), and deeply located fibroids. Preoperative evaluation of the size and number of myomas is necessary to avoid laparo-conversion and to reduce intraoperative and postoperative complications.
Design: This was a retrospective study of small cases over a 5-year period.
Setting: This study was conducted in Putrajaya Hospital, a district hospital with consultant care level in obstetrics and gynecology.
Sample: Forty women presented with confirmed cases of endometrial cancer based on histopathology result and underwent extrafascial hysterectomy with or without lymphadenectomy between January 2010 and December 2014.
Materials and Methods: Patient outcomes were compared between 26 women who underwent laparoscopic total hysterectomy with or without lymphadenectomy and 14 women who underwent open laparotomy extrafascial hysterectomy with or without lymphadenectomy. Data were collected using electronic medical records.
Main Outcome Measures: Postoperative outcomes, operative time, total intraoperative blood loss, number of lymph nodes harvested, and total days of postoperative stay were obtained.
Results: There was a significant reduction in operative blood loss in the laparoscopic group with mean 262.50 ± 47.87 and laparotomy group with mean 381.82 ± 138.33, 95% confidence interval, P < 0.05. Postoperative hospital stay was also significantly reduced in the laparoscopic group, where the mean postoperative stay in laparoscopic group was 2.5 ± 2.0 days and laparotomy 5.0 ± 3.6 days. There was no significant difference in mean operative time (the mean operative time: 256 ± 76.40 for laparotomy and 288.75 ± 43.66 for the laparoscopic approach). More number of lymph nodes were harvested laparoscopically (29.75 ± 16.59) than laparotomy (23.0 ± 12.62); however, this was not significant.
Conclusions: Laparoscopic surgery had significant lesser blood loss and it is comparable to laparotomy in the surgical management of endometrial cancer. Experienced surgeon will be able to perform hysterectomy and lymphadenectomy as equally good to laparotomy with adequate tumor excision and complete staging.
MATERIALS AND METHODS: This is a retrospective cross-sectional study which was carried out at department of O&G, Putrajaya Hospital. A total of 120 cases of ovarian mass in pregnancy between Jan 2000-December 2014 were evaluated. 115 patients had undergone laparoscopy cystectomy/salpingo-oophorectomy. Women's age, parity, gestational age, surgical technique, operative findings and time, estimated blood loss, postoperative hospital stay, post operative pain score, usage of analgesia, complications of surgery, outcome of the pregnancy and histopathology reports were evaluated.
MEASUREMENT AND MAIN RESULTS: Outcome of the pregnancy and post operative pain score and usage of analgesic were evaluated. The mean gestational week at the time of surgery was 14 weeks 1 day (±2 weeks 1 day). The duration of surgery was 87.4 mins (±34.8 mins) with average blood loss of 110.3 ml (±32.0). Median size of ovarian cyst was 6 cm (IQR 2 cm). 2 cases converted to laparotomy. Only 2 cases were reported with second trimester loss which was diagnosed after 4 weeks and 10 weeks respectively. 5 women received tocolytic agent post operatively, all of them delivered at term.The mean length of hospitalization was 1.51 day (±0.597). The average gestational age of delivery was 37.78 (±3.42) mean birth weight 2.97 kg (±0.65 kg). There was one intrauterine growth restriction baby with birth weight of 1.89 kg at 35 weeks of gestation and another baby with bladder exstrophy with ambiguous genitalia which was not related to surgery. The mean of pain score was 1.5 (±1.6) over 10. 87.9% of the women had mild pain which only 64.6% require paracetamol or no analgesia.
CONCLUSION: Majority of women with ovarian masses in pregnancy can be treated with ensured safety and reduced morbidity using the endoscopic approach.
MATERIALS AND METHODS: A cross-sectional study was conducted involving cases of interstitial ectopic in Hospital Putrajaya, Putrajaya, Malaysia, over a 10-year period (2005-2014). Data on sociodemographic, clinical profile, perioperative, and postoperative were obtained from the electronic medical records.
MEASUREMENT AND MAIN RESULTS: The prevalence of cornual pregnancy was 4.0% (n = 14) out of total 347 cases of all ectopic pregnancies in Putrajaya Hospital. The mean ± standard deviation age of patient in the LC group and OC group was 29.3 ± 5.9 years and 31.4 ± 7.3 years, respectively. The duration of hospitalization and mean operating time were both significantly shorter in the LC group than in the OC group (1.43 ± 0.54 versus 2.57 ± 0.79 and 61.4 ± 15.7 min versus 97.1 ± 38.2 min, respectively, P < 0.05).There were no statistically significant differences between both groups for the estimated blood loss, requirement of blood transfusion, complications, and future fertility.
CONCLUSION: Laparoscopic cornual resection (cornuotomy) is a safe and less invasive procedure with a comparable complication rate. It has shown that it is feasibility and should be considered as initial treatment in managing those cases in trained hand surgeons.