Preoperative dienogest to improve the surgical field of view in resectoscopic surgery

Introduction: Resectoscopic surgery requires high technological skill to perform the procedure in a limited field of vision. With the preoperative administration of dienogest, a good surgical field of vision can be secured. The lesion and the normal endometrium are easily distinguished, and therefore the removal of normal endometrium can be minimized. Methods: Preoperative dienogest was administered to 28 patients with submucosal myomas, 18 patients with endometrial polyps, and one patient with Asherman's syndrome. The patients began taking oral dienogest (2 mg/d) on Day 5 of preoperative menstruation until the day before surgery. Use of dienogest before resectoscopic surgery was approved by the Institutional Review Board of Toho Medical Center Oomori Hospital (Tokyo, Japan; approval number 24-185). Results: The duration of oral dienogest treatment was 14–72 days in patients with submucosal myoma and 18–85 days in patients with endometrial polyps. Slight thickening of the endometrium occurred in patients who were administered dienogest for 14 days. However, a thin endometrium occurred in patients who took the drug for 28 days or longer. Submucosal myomas and endometrial polyps were easily distinguished from the normal myometrium. A sufficient intrauterine surgical field was secured to minimize endometrial damage in all patients. Conclusion: We found that preoperative dienogest effectively minimized endometrial damage in resectoscopic surgery by thinning the endometrium and clearing the surgical field of vision

A Feasible Technique in Laparoscopic Excision for Juvenile Cystic Adenomyosis: A Case Report, Literature Review, and Surgical Video

Background: Juvenile cystic adenomyosis (JCA) is a rare uterine lesion. We present the case of a young woman who was diagnosed with JCA and subsequently managed with laparoscopic cyst removal with sharp and blunt dissection. Moreover, we provide a literature review and a surgical video. Case: A 22-year-old nulliparous woman presented with severe dysmenorrhea and was assessed using contrast-enhanced abdominal computed tomography, transvaginal ultrasonography and pelvic magnetic resonance imaging, and diagnosed with a cystic lesion on the left side of the myometrium. She underwent laparoscopic cyst excision and uterine reconstruction. Histology was suggestive of JCA. The dysmenorrhea resolved postoperatively. Conclusion: Surgical resection is the first choice of treatment for cystic adenomyosis, and a laparoscopic approach using scissor forceps is effective

Safety of uterine fundal pressure maneuver during second stage of labor in a tertiary perinatal medical center: A retrospective observational study

Objective: This study aimed to evaluate the conformity of the indications and implementation status of uterine fundal pressure maneuver (UPFM) and to examine its safety according to the Japan Society of Obstetrics and Gynecology (JSOG) guidelines. Materials and methods: We selected all the patients (n = 265) who were treated with UFPM between January 2015 and March 2017. We first evaluated the conformity of the indications and implementation status of UFPM concerning the guidelines for obstetrical practice in Japan, 2017. Second, we retrospectively examined maternal and fetal adverse events (AEs) to determine the safety of UFPM. Results: In total, 265 patients underwent UFPM; of all the UFPM-assisted deliveries, 189 patients (72%) were evaluated for conformity. Of these 189 patients, 181 (95.7%) were confirmed to be compliant. Laceration of the birth canal was the most frequently occurring maternal AE, followed by cervical laceration. No cases of uterine rupture, severe AEs leading to an extended hospital stay, and maternal deaths were observed. Although fetal AEs requiring admission to neonatal intensive care unit (NICU) were recorded for 33 patients (12.5%), all newborns developed normally without sequela. Conclusion: The findings of this study may support the validity of the 2017 guidelines. Because it is difficult to find evidence of the safety of use of UFPM, it is essential to accumulate experiences and results learned in clinical practice to build a consensus in the future using the current 2017 guidelines as a standard as done in the current study. Keywords: Kristeller maneuver, Maternal outcome, Neonatal outcome, The second stage of labor, Uterine fundal pressur