Huang Hui Chen

Comparison of robotic approach, laparoscopic approach and laparotomy in treating epithelial ovarian cancer.

The purpose of this study was to evaluate the feasibility of robotic surgery and compare its surgical outcomes with those of laparoscopic surgery and laparotomy, with regard to performing staging surgery to manage ovarian cancer.

Dual triggering with GnRH agonist plus hCG versus triggering with hCG alone for IVF/ICSI outcome in GnRH antagonist cycles: a systematic review and meta-analysis

PurposeTo summarize available evidence from randomized-controlled trials which have evaluated triggering of final oocyte maturation with concomitant GnRH agonists and hCG in patients undergoing IVF, and to analyze whether dual triggering is as efficacious as hCG triggering in terms of oocyte and pregnancy outcomes.MethodsA comprehensive literature search was performed to identify randomized-controlled trials comparing IVF outcomes between women receiving combined administration of hCG with GnRH agonists and those receiving hCG alone for triggering of final oocyte maturation.ResultsFour studies including 527 patients eligible for inclusion in meta-analysis were identified. No significant difference in the number of mature oocytes or fertilized oocytes retrieved was found between groups. Clinical pregnancy rate with dual triggering was significantly higher as compared with hCG-alone triggering (pooled OR = 0.48, 95% CI 0.31–0.77, P = 0.002), but there was no significant difference in the ongoing pregnancy rate between groups.ConclusionResults of meta-analysis indicate comparable or significantly improved outcomes with the use of GnRH agonists plus hCG as compared with hCG alone for triggering of final oocyte maturation.

Delayed postcoital vaginal cuff dehiscence with small bowel evisceration after robotic-assisted staging surgery

OBJECTIVE We report a rare case of vaginal cuff dehiscence with small bowel evisceration at 7 months post robotic-staging surgery. CASE REPORT A 41-year-old woman was sent to the emergency room with sudden onset of abdominal pain, vaginal bleeding, and vaginal protruding mass after sexual activity. She had a history of synchronous uterine and ovarian cancer treated with robotic-staging surgery 7 months before. Then she received six courses of postoperative adjuvant chemotherapy, and the last chemotherapy ended 1 month ago. At the operation room, some small bowel loops were noted in the vaginal tip with cuff dehiscence and bleeding. After repositioning of the small bowel, a 2.5-cm vaginal cuff dehiscence was repaired transvaginally. The patient recovered well, and is free of disease and has normal sexual activity 2 months after repairs. CONCLUSION Unusual delayed-type vaginal cuff dehiscence hints the possibility that a combination of robotic surgery and postoperative chemotherapy might result in delayed healing of the vaginal cuff.

Comparison of Perioperative Complications Between of Robotics and Laparoscopy Approaches in the Management of Gynecologic Malignances

Design: Case Report. Setting: Academic hospital in Mexico. Patients: A woman with a symptomatic uterine fibroid resulting in abnormal uterine bleeding. Intervention: Transcervical radiofrequency ablation of uterine fibroids. Measurements and Main Results: This is a report on a pregnancy that occurred in a multigravida after transcervical radiofrequency ablation of a type 1 myoma with the Sonata System, which includes an integral intrauterine sonography probe for imaging in concert with a graphical targeting system. The patient underwent successful treatment and noted amenorrhea at her six-month visit. Prior to that time she had reported a decrease in her menstrual bleeding and fibroid symptoms, and a contrast-enhanced MRI noted significant reductions in perfused and total fibroid volumes. The patient proceeded to term and delivered a viable infant via elective repeat Cesarean section with Apgar scores of 91 and 105. There was no evidence of an ablated fibroid or of any myometrial defect at the time of hysterotomy. Conclusion: This first report of a term pregnancy after treatment with the Sonata System adds to the growing literature base suggesting compatibility between hyperthermic ablation (focused ultrasound, radiofrequency ablation) and pregnancy.

Improvement of overactive bladder symptoms: Is correction of the paravaginal defect in anterior vaginal wall prolapse necessary?

Background: To explore the relationship between overactive bladder (OAB) symptoms and paravaginal defects (PVDs), and to identify the necessity of PVD repair by transvaginal mesh (TVM) for the treatment of OAB symptoms. Methods: A retrospective clinical study of 30 women with advanced cystocele with limited apical and posterior vaginal wall prolapse was conducted to identify any changes in OAB symptoms following a single Perigee procedure. Prolapse was assessed using the pelvic organ prolapse quantification (POP‐Q) system, and paravaginal defects were identified by sonography. Complete urodynamic examination was performed prior to and one year after operation. All patients completed the overactive bladder questionnaire pre‐ and postoperatively for a quantitative assessment of OAB symptoms. Results: All patients showed a significant improvement at points Aa and Ba in the POP‐Q system. The results of the administered questionnaire revealed statistically significant improvement postoperatively. The difference of OAB symptoms between the group with PVDs and that with central defects was not statistically significant (p = 0.67). Moreover, no statistically significant improvement of OAB symptoms in the group with repaired PVDs was observed postoperatively (p = 0.42). Conclusion: Statistical improvements of symptoms exist after Aa and Ba points recovery as evaluated by POP‐Q system regardless of PVD existence identified by sonography. Repairing PVD did not show significantly improve the severity of OAB symptoms in objective urodynamic data or subjective questionnaire data. The superiority of TVM in PVD repair to manage OAB symptoms seems not manifest.

Complication reports for robotic surgery using three arms by a single surgeon at a single institution

Background: The aim of this study is to evaluate perioperative complications related to robotic-assisted laparoscopic surgery for management of gynaecologic disorders. Materials and Methods: Eight hundred and fifty-one women who underwent robotic procedures between December 2011 and April 2015 were retrospectively included for analysis. Patient demographics, surgical outcomes and complications were evaluated. Results: The overall complication rate was 5.5%, whereas the rate of complications for oncologic cases was 8.4%. Intra-operative complications (n = 7, 0.8%) consisted of five cases of bowel lacerations, one case of ureter laceration and one case of bladder injury. Early and late post-operative complications were 4.0% (n = 34) and 0.8% (n = 6), respectively. Six patients (0.7%) experienced Grade III complications based on the Clavien-Dindo classification and required further surgical intervention. Conclusion: Robotic-assisted laparoscopic surgery is a feasible approach for management of gynaecologic disorders; the complication rates for this type of procedure are acceptable.

Incidental Fallopian Tube Adenocarcinoma Managed using Robotic Staging Surgery

Primary fallopian tube carcinoma is an uncommon gynecological malignancy. Management of primary fallopian tube carcinoma using a robotic-assisted approach is also rare. We have described here two cases of adenocarcinoma located in the fallopian tubes that were managed using robotic-assisted staging surgery, followed by subsequent serial chemotherapy. The surgical procedure consisted of a total hysterectomy, bilateral salpingo-oophorectomy, bilateral pelvi lymph node dissection, para-aortic lymph node dissection, appendectomy, omentectomy, peritoneal biopsies, and ascites cytology. After surgery, a test for CA-125 level and a computed tomography (CT) evaluation were conducted every 3 and 6 months, respectively. In Case I, the patient received 6 cycles of chemotherapy consisting of cisplatin and paclitaxel after surgery, and CA-125 level decreased from 55.9 U/mL to 9.5 U/mL over 6 months. At 16 months after surgery, a follow-up CT scan revealed no evidence of local recurrence. In Case II, the patient received 11 cycles of chemotherapy including cisplatin and paclitaxel, and CA-125 level decreased from 52.1 U/mL to 11.1 U/mL over 12 months. At 20 months after surgery, a follow-up CT scan revealed no evidence of local recurrence. In conclusion, robotic-assisted staging surgery is a feasible approach for treating incidentally located tumors in the fallopian tubes.

Detection of Sentinel Lymph Node Mapping Using Indocyanine Green in the Management of Endometrial Cancer: A Pilot Study

Study Objective: To compare perioperative complications of roboticassisted and laparoscopic-assisted staging surgery in management of gynecologic malignances. Design: Retrospective cohort study. Setting: University-affiliated teaching hospital. Patients: Four hundred thirteen women who underwent robotic-assisted (n=210) and laparoscopic-assisted (n=203) procedures between December 2011 and February 2015 were identified for analysis. Intervention: Of all 413 women who underwent surgical treatment for gynecologic malignances, 256 received staging surgery for endometrial cancer (robotics 106 and laparoscopy 150), 80 received staging surgery for ovarian cancer (robotics 59 and laparoscopy 21), and 77 received radical hysterectomy for cervical cancer (robotics 45 and laparoscopy 32). Patient demography, surgical outcomes and complications were evaluated. Measurements and Main Results: The mean ages and BMI were 52.6 12.2 and 24.3 4.5 for robotic group, and 50.4 13.5 and 24.9 5.0 for laparoscopic group, respectively, with no significant differences between two groups. The overall complication rates were 8.6% for robotic-assisted surgery and 6.9%, respectively. No significant difference was found between groups. Conclusion: Robotic-assisted surgery is a feasible approach inmanagement of gynecologic malignances with an acceptable complication rate, as compared to laparoscopic-assisted approach.