Wen-Chu Huang

Single-port thoracoscopic surgery can be a first-line approach for elective thoracoscopic surgery

BACKGROUND Thoracoscopic surgery has become very popular in recent years. Conventional thoracoscopic surgery requires three or more port wounds for manipulations of endoscopic instruments. For complicated cancer surgery, more port wounds and a larger thoracotomy wound may be required due to technical reasons. We want to investigate the effectiveness of single-port thoracoscopic approach in elective thoracoscopic surgery for thoracic disease. MATERIALS AND METHODS From July 1st, 2010 to March 31, 2011, 90 consecutive patients underwent general thoracoscopic surgery performed by the same thoracic surgeon. Two patients with severe trauma and massive bleeding were excluded from the study. All patients included had thoracoscopic surgery with a single-port approach. The surgical outcomes, complications, mortality and conversion rates were recorded and analyzed. RESULTS A total of 88 patients were included in this study. All these patients were operated on by the same surgeon. For sixty-eight patients, the single-port thoracoscopic approach was used. Nineteen patients were changed to a two-port thoracoscopic approach and one patients was changed to mini-thoracotomy. Two patients died from terminal lung cancer and severe mitral regurgitation. Complications occurred in six cases. Eighty-seven patients (98.8%) were effectively managed with either single-port or a two-port approach. Only one patient was managed by mini-thoracotomy. CONCLUSION Elective thoracoscopic surgery performed through a single-port wound is feasible. Single-incisional thoracoscopic surgery can be safely applied as a first-line approach in most cases of elective thoracoscopic procedures.

Tension-free vaginal tape-obturator procedure for treatment of severe urodynamic stress incontinence : Subjective and objective outcomes during 2 years of follow-up

Aim:  To report our experience of the tension‐free vaginal tape‐obturator (TVT‐O) procedure for the treatment of severe female urodymanic stress incontinence (USI) during 2 years of follow‐up.

Polypropylene mesh used for adjuvant reconstructive surgical treatment of advanced pelvic organ prolapse

Aim:  To elucidate the outcome of transvaginal pelvic reconstructive surgery using polypropylene mesh (Gynemesh; Ethicon, Somerville, NJ, USA) for patients with pelvic organ prolapse (POP) stage III or IV.

Urinary leakage during sexual intercourse among women with incontinence: Incidence and risk factors

Background Coital incontinence is an under-reported disorder among women with urinary incontinence. Women seldom voluntarily report this condition, and as such, related data remains limited and is at times conflicting. Aims and objectives To investigate the incidence and quality of life in women with coital incontinence and to determine associated predictors. Methods This observational study involved 505 sexually active women attending the urogynecologic clinic for symptomatic urinary incontinence at a tertiary medical center. All of the patients were consulted about the experience of coital incontinence and completed evaluations including urodynamics, and valid questionnaires including the short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, the Urogenital Distress Inventory and the Incontinence Impact Questionnaire. Results Of these women, 281 (56%) had coital incontinence, while 224 (44%) did not. Among women with coital incontinence, 181 (64%) had urodynamic-proven stress incontinence, 29 (10%) had mixed incontinence, and 15 (5%) had detrusor overactivity. Only 25 (9%) sought consultation for this disorder before direct questioning. Fifty percent (84/281) of the women rarely or sometimes had incontinence during coitus, while 33% (92/281) often had incontinence, and 17% (48/281) always had incontinence. The frequency of coital incontinence was not different regarding the types of incontinence (p = 0.153). Women with mixed incontinence had the worst sexual quality of life and incontinence-related symptom distress. Based on univariate analysis, higher body mass index (OR 2.47, p = 0.027), and lower maximal urethral closure pressure (≤ 30 cmH2O) (OR 4.56, p = 0.007) were possible predictors for coital incontinence. Multivariate analysis showed lower MUCP was independently significant predictors (OR3.93, p = 0.042) Conclusions The prevalence of coital intercourse in urinary incontinence women was high. Coital incontinence in these women was associated with abnormal urodynamic diagnosis and urethral dysfunction.

Pneumothorax, pneumomediastinum and pneumopericardium complications arising from a case of wisdom tooth extraction

A 25-year-old woman underwent surgical tooth extraction. Several hours after the procedure, the woman complained of severe retrosternal pain and mild dyspnea. Subsequent imaging revealed subcutaneous emphysema from the mandibular region extending to the mediastinum and left side pneumothorax, as well as pneumopericardium. After treatment with antibiotics and analgesics, the patient recovered without any complications.

Functional and anatomic assessments for transobturator vaginal tape inside-out operation for urodynamic stress incontinence.

Aim:  The aim of the present study was to assess by urodynamic study and chain urethrocystography the functional and anatomic changes before and after transobturator vaginal tape inside‐out (TVT‐O) operation.