Chirurgia vaginale oltre la tradizione

Focus Surgery 2010 Lanzhou China

28- 31 May 2010

Vaginal Surgery over tradition

Roberto Carminati H. Legnano- Milano Italy

- Anterior and Posterior Vaginal Myomectomy

- Ovarian Cysts: vaginal route

- Extrauterine pregnancy: vaginal remove

Median Hospital stay for Vaginal, Abdominal and Vaginal, Abdominal and

Laparoscopic HysterectomyLaparoscopic Hysterectomy

•Abdominal Hysterectomy 5-6 days

•Vaginal Hysterectomy 2-4 days

•Laparoscopic Hysterectomy 3-4 days

SLOG: Ob/Gyn Society Lomberdia-Italy

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SLOG Varese 2008SLOG Varese 2008

Anterior and Posterior

Vaginal Myomectomy

Two Different Access

Carminati RetractorCarminati Retractor

Retractor: different size

Posterior access

OPENING POSTERIOR PERITONEUMOPENING POSTERIOR PERITONEUM

GRASPING OF UTERINE WALL ON MYOMATAGRASPING OF UTERINE WALL ON MYOMATA

EXCISION OF MYOMATAEXCISION OF MYOMATA

RECOSTRUTION UTERINE WALL

VAGINAL SUTURE

ANTERIOR COLPOTOMYANTERIOR COLPOTOMY

OPENING ANTERIOR PERITONEUMOPENING ANTERIOR PERITONEUM

GRASPING OF ANTERIOR BLADDER PILLARGRASPING OF ANTERIOR BLADDER PILLAR

VISIBILITY ANTERIOR SPACE

INCISION OF UTERINE WALLINCISION OF UTERINE WALL

MYOMECTOMY

VAGINAL SUTURE

Vaginal myomectomy results

132 patients

underwent vaginal myomectomy

by anterior and/or posterior approach

From December 1998 to June 1999

U.O Ob/Gyn H. Legnano- Milano Italy

VAGINAL MYOMECTOMY: RESULTSVAGINAL MYOMECTOMY: RESULTS

SURGICAL CHARACTERISTICS

Median Operation time (min.) 90 (range 40-180)

Median Blood loss (mL) 80 (range 20-350)

Median number of fibroids

removed per patients 2 (range 1-8)

Cases of convertion rate* 4 (3 %)

Number of hysterectomy 0

* Both due: two pelvic adhesion and two endometriosis

SURGICAL CHARACTERISTICS

Median Operation time (min.) 90 (range 40-180)

Median Blood loss (mL) 80 (range 20-350)

Median number of fibroids

removed per patients 2 (range 1-8)

Cases of convertion rate* 4 (3 %)

Number of hysterectomy 0

* Both due: two pelvic adhesion and two endometriosis

VAGINAL MYOMECTOMY: RESULTSVAGINAL MYOMECTOMY: RESULTS

POSTOPERATIVE CHARACTERISTICS

Median Postoperative stay(days) 2 (range 1-3)

Postoperative transfusion rate 0

Number of Patients with postoperative complications 0

POSTOPERATIVE CHARACTERISTICS

Median Postoperative stay(days) 2 (range 1-3)

Postoperative transfusion rate 0

Number of Patients with postoperative complications 0

VAGINAL MYOMECTOMY: RESULTSVAGINAL MYOMECTOMY: RESULTS

OBSTETRICS OUTCOME Number of patients

with plan a pregnancy 30 (25%)

Numebr of pregancy 15 (50%)

Number of preterm delivery 0

Number of miscarriage 0

TC 15 (100%)

Number of term delivery 15 (100%)

Number of uterine rupture 0

OBSTETRICS OUTCOME Number of patients

with plan a pregnancy 30 (25%)

Numebr of pregancy 15 (50%)

Number of preterm delivery 0

Number of miscarriage 0

TC 15 (100%)

Number of term delivery 15 (100%)

Number of uterine rupture 0

RESULTSRESULTS

Symptoms resolved in all patients (100%)

at 6 months follow-up.

Symptoms resolved in all patients (100%)

at 6 months follow-up.

VAGINAL MYOMECTOMY RESULTSVAGINAL MYOMECTOMY RESULTS

• This series confirm that vaginal myomectomy, in well-selected cases, is feasible and safe in treating uterine myomatas.

• Thanks to the "morcellation" technique, vaginal myomectomy can be useful even in case of large, numerous, and intramural fibroids and allows optimal uterine wall reconstruction with minimal tissue trauma.

• The procedure is also low time-consuming.

• This series confirm that vaginal myomectomy, in well-selected cases, is feasible and safe in treating uterine myomatas.

• Thanks to the "morcellation" technique, vaginal myomectomy can be useful even in case of large, numerous, and intramural fibroids and allows optimal uterine wall reconstruction with minimal tissue trauma.

• The procedure is also low time-consuming.

Ovarian Cystis: vaginal route

Technical Surgery

R.Carminati, R. Giannice

R.Carminati, R. Giannice

R.Carminati, R. Giannice

R.Carminati, R. Giannice

R.Carminati, R. Giannice

R.Carminati, R. Giannice

R.Carminati, R. Giannice

R.Carminati, R. Giannice

Caso clinico 1

R.Carminati, R. Giannice

Caso clinico 1

R.Carminati, R. Giannice

Caso clinico 1

R.Carminati, R. Giannice

Extrauterine pregnancy: vaginal remove

VAGINAL SALPINGECTOMY AS SURGICAL

TREATMENT

FOR EXTRAUTERINE TUBAL PREGNANCY:

A PILOT RANDOMIZED STUDY

R. Carminati MD; R. Giannice MD, PhD; C. Patregnani MD, R. Bertozzi MD, G.Forloni MD, M. Fogliani MD.

Unità Operativa Ginecologia-Ostetricia

Ospedale Civile di Legnano

Direttore Prof. Roberto Carminati

VAGINAL SALPINGECTOMY

OBJECTIVE

• To evaluate: feasibility, safety, and

outcomes of vaginal versus laparoscopic

salpingectomy for extra-uterine tubal

pregnancy surgical treatment.

•

VAGINAL SALPINGECTOMY

METHODS• DESIGN: Prospective randomized study.

• POPULATION: Women with extra-uterine tubal pregnancy and surgical indication for salpingectomy.

• From January 2007 , all women selected for surgical

• treatment of extra-uterine tubal pregnancy were • enrolled in a prospective study: • Arm A: patients were submitted to laparoscopic

salpingectomy

• Arm B: patients were submitted to vaginal salpingectomy via posterior colpotomy.

VAGINAL SALPINGECTOMY

INCLUSION CRITERIA

Stable clinical parameters,

Hemoperitoneum < 1000-1500 mL,

Increasing beta-HCG levels,

No previous abdominal and pelvic

surgery.

VAGINAL SALPINGECTOMY

MAIN OUTCOME MEASURES

• Feasibility

• Surgical data

• Morbidity

VAGINAL SALPINGECTOMY RESULTS

CLINICAL CHARACTERISTICS

ARM A ARM B (18 PTS) (12 PTS)

salpingectomy LPS VAGINAL p

Median years age (range) 30 ( 22-40) 32 ( 25-38) n.s.

BMI> 30 10% 11%

VAGINAL SALPINGECTOMY : RESULTS

ARM A ARM B (18 PTS) (12 PTS) salpingectomy LPS VAGINAL p

Median operative time(minutes) 35 (range 30-107) 30 (range20-59) ns

Intraoperativecomplications - - ns

Median discharge (days) 1 (range 1-2 ) 1 (range 1-2) ns

VAGINAL SALPINGECTOMY MORBIDITY

ARM A ARM B (18 PTS) (12 PTS) salpingectomy LPS VAGINAL p

Intraop. Transfusion - - n.s.

Convertion rate - - n.s.

Intraop. Complications - - n.s.

Postop. Complications - - n.s.

VAGINAL SALPINGECTOMY

CONCLUSION

This series confirm that Vaginal

salpingectomy seems a feasible

and safe procedure, comparable

with the laparoscopic approach in

the treatment of extra-uterine

tubal pregnancy.

Roberto Carminati

Vaginal Surgery over Tradition

PICCIN-ITALY 2009

1 Manuscript and 2 DVD

H Civile di Legnano