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GLUP_magenta_Chirurgia vaginale oltre la tradizione_carminati
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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
0
50
100
150
200
250
300
350
Civil
i di B
rescia
Berga
mo Monz
a
Busto
Arsi
zio
Ponte
S. P
ietro Me
rate
Nigu
arda
Pio X
Mila
no
Vogh
era
Saron
no
Vares
e Di
v. A
Legn
ano
VLS
LAVH
Vaginale
Addominale
52
38
3
7
67
13
19
2111
89
62
16
518
76
147
35
18
14
11
%
35
65
3
46
3
48
55
45
77
23
26
1
7574
0
20
40
60
80
100
120
Car
ate
Bria
nza
Trad
ate
Polia
mbu
l.(BS
)
San
Mat
teo
(PV)
Vare
se D
iv. B Lecc
o
Des
io
Vald
uce
Com
o
Bron
i
San
Giu
sepp
e
Clu
sone
Buzz
i
Rho
Mel
loni
VLS
LAVH
Vaginale
Addominale
41
8
13
38
%
75
25
60
33
16
54
20
10
16
30
53
17
36
46
18
61
9
30
59
20
8
13
63
37
9
1
35
54
7
4
14
85
1
58
7
2
33
46
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41
90
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