Laparoscopic sacrohysteropexy and myomectomy for uterine prolapse: a case report and review of the literature

<p>Abstract</p> <p>Introduction</p> <p>A large number of hysterectomies are carried out for uterine prolapse, menorrhagia and other symptomatic but benign gynaecological conditions, which has increased interest in new approaches to treat these disorders. These new procedures are less invasive and offer reduced risk and faster recovery.</p> <p>Case presentation</p> <p>Sacrohysteropexy can be carried out instead of vaginal hysterectomy in the treatment of uterine prolapse. It involves using a synthetic mesh to suspend the uterus to the sacrum; this maintains durable anatomic restoration, normal vaginal axis and sexual function. A laparoscopic approach has major advantages over the abdominal route including shorter recovery time and less adhesion formation. We describe a laparoscopic sacrohysteropexy in a 55-year-old Caucasian British woman that was technically difficult. An intramural uterine fibroid was encroaching just above the uterosacral ligament making mesh positioning impossible. This was removed and the procedure completed successfully.</p> <p>Conclusion</p> <p>Posterior wall fibroid is not a contraindication for laparoscopic sacrohysteropexy. This procedure has increasingly become an effective treatment of uterine prolapse in women who have no indication for hysterectomy.</p

A double blind randomized trial of wound infiltration with ropivacaine after breast cancer surgery with axillary nodes dissection

<p>Abstract</p> <p>Background</p> <p>The effect of local infiltration after breast surgery is controversial. This prospective double blind randomized study sought to document the analgesic effect of local anaesthetic infiltration after breast cancer surgery.</p> <p>Methods</p> <p>Patients scheduled for mastectomy or tumorectomy and axillary nodes dissection had immediate postoperative infiltration of the surgical wound with 20 ml of ropivacaine 7.5 mg.ml^-1or isotonic saline. Pain was assessed on a visual analogue scale at H2, H4, H6, H12, H24, H72, and at 2 month, at rest and on mobilization of the arm. Patient'comfort was evaluated with numerical 0-3 scales for fatigue, quality of sleep, state of mood, social function and activity.</p> <p>Results</p> <p>Twenty-two and 24 patients were included in the ropivacaine and saline groups respectively. Postoperative pain was lower at rest and on mobilization at 2, 4 and 6 hour after surgery in the ropivacaine group. No other difference in pain intensity and patient 'comfort scoring was documented during the first 3 postoperative days. Patients did not differ at 2 month for pain and comfort scores.</p> <p>Conclusion</p> <p>Single shot infiltration with ropivacaine transiently improves postoperative pain control after breast cancer surgery.</p> <p>Trial registration number</p> <p><a href="http://www.clinicaltrials.gov/ct2/show/NCT01404377">NCT01404377</a></p

The Microanatomic Location of Metastatic Breast Cancer in Sentinel Lymph Nodes Predicts Nonsentinel Lymph Node Involvement

Background: The majority of sentinel node (SN) positive breast cancer patients do not have additional non-SN involvement and may not benefit from axillary lymph node dissection (ALND). Previous studies in melanoma have suggested that microanatomic localization of SN metastases may predict non-SN involvement. The present study was designed to assess whether these criteria might also be used to be more restrictive in selecting breast cancer patients who would benefit from an ALND. Methods: A consecutive series of 357 patients with invasive breast cancer and a tumorpositive axillary SN, followed by an ALND, was reviewed. Microanatomic SN tumor features (subcapsular, combined subcapsular and parenchymal, parenchymal, extensive localization, multifocality, and the penetrative depth from the SN capsule) were evaluated for their predictive value for non-SN involvement. Results: Non-SN metastases were found in 136/357 cases (38%). Microanatomic location and penetrative depth of SN metastases were significant predictors for non-SN involvement (<0.001); limited penetrative depth was associated with a low frequency of non-SN involvement with a minimal of 10%. Conclusions: Microanatomic location and penetrative depth of breast cancer SN metastases predict non-SN involvement. However, based on these features no subgroup of patients could be selected with less than 10% non-SN involvement