Alexander Kotlyar

Hemostatic Techniques for Myomectomy: An Evidence-Based Approach

Uterine leiomyomas are the most common benign gynecologic tumor. They are also a significant cause of morbidity, necessitating treatments ranging from hormonal suppression to surgical intervention. Myomectomy, the removal of these highly vascular tumors, offers significant quality of life and fertility-sparing benefit for patients affected by uterine leiomyomas but with a risk of substantial intraoperative blood loss. This risk of hemorrhage leads not only an increased transfusion rate but also he need for hysterectomy and other potential operative complications. Numerous medical and surgical techniques have been developed to minimize potentially significant blood loss during abdominal, laparoscopic, and robotic-assisted myomectomies. Combined with judicious preoperative assessment, these techniques substantially enhance patient safety during a myomectomy and outcomes during recovery.

Deceased donor uterine transplantation

OBJECTIVE To share our experience in performing the first-ever deceased-donor uterine transplant in the United States. DESIGN This video uses an animation and footage from a uterine transplantation procedure to review the steps and techniques involved in performing a uterine transplant. SETTING Academic, multisite medical center. PATIENT(S) A reproductive-age patient with Mayer-Rokitansky-Kuster-Hauser syndrome. INTERVENTION(S) Transplantation of a viable uterus from a deceased donor. MAIN OUTCOME MEASURE(S) Assessment of posttransplantation uterine graft viability. RESULT(S) This video article describes the essential steps in the uterine transplant process, including selecting an appropriate donor with no history of infertility or uterine malformations. Furthermore, a deceased donor should exhibit brain death but not cardiac death. We also review our inclusion criteria for suitable recipients. In this video we outline the key steps in a uterine transplantation procedure and demonstrate footage from an actual transplant procedure. These steps include establishing bilateral end-to-side vascular anastomoses between the donor uterine artery and vein and the recipients external iliac vessels. Once this has been completed and reperfusion noted of the donor uterus, connection to the recipient vaginal cuff is then performed. CONCLUSION(S) Uterine transplantation, although currently experimental, has gained the potential to become the first true treatment for uterine factor infertility. This procedure can become a promising option for the approximately 1.5 million women worldwide for whom pregnancy is not possible because of the absence of the uterus or presence of a nonfunctional uterus. Deceased donor uterine transplantation will further serve to broaden accessibility for this procedure.

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Effect of disease‐modifying anti‐rheumatic drugs on therapeutic outcomes among women with endometriosis

To determine whether disease‐modifying anti‐rheumatic drugs (DMARDs) affect the use of hormonal treatments, subsequent ablative surgery, and need for pain management, including opioids, non‐steroidal anti‐inflammatory drugs and anti‐depressants, among women with endometriosis.

Biomarkers for Endometriosis in Saliva, Urine, and Peritoneal Fluid

Endometriosis is a pain syndrome which affects 35–50% of women with chronic pelvic pain and/or infertility. It is frequently misdiagnosed leading to delays in patients obtaining appropriate treatments. The most accurate currently available mode of diagnosis is through laparoscopy with histological confirmation. In this chapter we describe noninvasive and semi-invasive modalities to obtain biologic biomarkers which may be an adequate screening tool for patients with endometriosis who are symptomatic with normal transvaginal ultrasounds, whom are at highest risk for diagnosis delay. In this chapter we will review noninvasive (urinary, salivary) and semi-invasive biomarkers (peritoneal), as screening and diagnostic methodologies for women symptomatic endometriosis and normal ultrasound findings. Few genetic markers have been identified through DNA amplification of buccal swabs as well as hormonal markers, and this is an area with lots of potential. Various urinary peptides and proteins are discussed, some with more potential than others, which require studies with larger sample sizes, and need to be studied in more diverse populations. We also review the extensively studied peritoneal biomarkers which include cytokines, immune modulators, and growth factors. Though many of the biomarkers described have a lot of potential, there is not one that stands above the rest. Validation of these studies in larger sample sizes including various study populations is required prior to their applicability into the clinical setting. It is most probable that the answer lies in the study of combination of biomarkers and the identification of ideal panel that can predict the diagnosis and the severity of endometriosis.