IAGE Flash e-News

“Abdominal Compliance” an important parameter for safe laparoscopy, which is unique to each patient.
Abdominal wall compliance is the measure of the ease of abdominal expansion, determined by the abdominal wall and diaphragm elasticity. A simple practical method for compliance monitoring is not currently available. But understanding it will help improve patient safety !

A video case presentation of leiomyomatosis peritonealis disseminata in a patient with no previous history of intra-abdominal morcellation.
Only surgical history was Hysteroscopic myomectomy four years back !.

The U.S FDA has banned use of surgical mesh for transvaginal repair of POP. All such products are being recalled from the market. Over the past several years, the FDA has seen a significant increase in the number of reported adverse events associated with use of surgical mesh for transvaginal POP repair.
Midurethral slings and mesh for sacrocolpopexy are not included in this recommendation.

“Abdominal Compliance” an important parameter for safe laparoscopy, which is unique to each patient.
Abdominal wall compliance is the measure of the ease of abdominal expansion, determined by the abdominal wall and diaphragm elasticity.
A simple practical method for compliance monitoring is not currently available. But understanding it will help improve patient safety !

Novel Hysteroscopic diagnosis of intrauterine omental incarceration following a previous D&C. A fat like lesion seen during Hysteroscopy could raise the differential diagnosis of residual trophoblast, intramyometrial fat metaplasia or even very very rarely omentum !
Watch video.

NVITRO ACTIVATION OF OOCYTES
In vitro activation (IVA) is a new, developing option for women who have diminished ovarian reserve. This involves removing the ovary, AKT Pathway activation of follicles in vitro, cortical fragmentation and finally auto transplanting back into the woman.
Link is to a video of a simple technique of IVA.

World’s first live birth following uterus transplant from a deceased donor ;
Reported from Sao Palo Brazil. This has been heralded worldwide as groundbreaking for uterus transplantation, and gives credence to clinical trials persisting with deceased donation, despite previous attempts failing.

Colorectal deep infiltrating endometriosis: endometriosis surgery vs first line IVF; optimal management is a huge debate.
This well designed study published in human reproduction, supports first line surgery showing PR of 74%, of which 53% of conceptions were natural.

CORNUAL SUTURE ; An optimized salpingectomy technique plays an important role in pretreatment before embryo transfer in patients with hydrosalpinx. Cornual suture at the time of salpingectomy May help reduce the risk of Interstitial pregnancy following IVF.

Consensus statement on “Isthemocele”from Global Congress on Hysteroscopy scientific committee. Incidence approximately 60% after one c-section 100% after 3 CSs. Myometrial thickness > 3 mm, hysteroscopic correction, < 3 mm, laparoscopic approach. Management surgical in fertile patients to avoid the risk of a subsequent cesarean scar pregnancy. After correction follow-up Hysteroscopy at 3 months and scheduled CS at 38 weeks in subsequent pregnancy.

Robert’s uterus. A rare Mullerian anomaly, poses diagnostic and therapeutic challenges to the clinician. This recent paper discusses with beautiful 3D USG pictures , the option of sonography guided Hysteroscopic management.
Ultrasound combined with hysteroscopy is considered a practical and safe choice for asymmetric septal ablation therapy for Robert’s uterus.

In a large (21057 patients) meta analysis of Hysteroscopically resected endometrial polyps the prevalence of premalignant and malignant lesions was 3.4 %. Clinical & demographic risk factors identified were women aged ≥60 years, postmenopausal women, and women with abnormal uterine bleeding, systemic arterial hypertension, diabetes mellitus, obesity, and tamoxifen use.

Finally a competitor to DA Vinci surgical robot ?
Versius, the world’s smallest surgical robot.
Created by CMR Surgical, the bot is essentially three robotic arms attached to a mobile unit about the size of a barstool. Likely to come into regular clinical practice by year end.

Laparoscopic vs vaginal cuff closure following TLH : results of a recent large RCT….
Laparoscopic closure of the cuff is associated with a significant reduction of vaginal dehiscence, vaginal bleeding, cuff hematoma, postoperative infection, need for vaginal resuture and reintervention.

A new pilot study shows myoma cells are disseminated even before electromechanical morcellation in cases of myomectomy. Containing the morcellation may not solve the problem. Irrigation and suctioning with 3 L normal saline or sterile water after morcellation may reduce myoma cell dissemination.

INDIA LEADS THE WORLD WITH THE first ever laparoscopic-assisted uterus retrieval in a live donor for uterus transplant !!
The world acknowledges what every Indian knew.
Article published in JMIG May 2018, with an editorial commending this notable achievement.