Yanzhou Wang

A systematic review and meta-analysis of conventional laparoscopic sacrocolpopexy versus robot-assisted laparoscopic sacrocolpopexy

Robot‐assisted laparoscopic sacrocolpopexy (RALSC) has spread rapidly without the availability of comprehensive and systematically recorded outcome data.

Prospective randomized comparison of laparoscopic peritoneal vaginoplasty with laparoscopic sigmoid vaginoplasty for treating congenital vaginal agenesis.

Introduction and hypothesisThe aim of this study was to compare the effectiveness and long-term anatomic and functional results of laparoscopic peritoneal vaginoplasty and laparoscopic sigmoid vaginoplasty.MethodsFrom January 2002 to December 2010, 40 patients with congenital vaginal agenesis were prospectively randomized to undergo either laparoscopic peritoneal vaginoplasty (26 cases) or laparoscopic sigmoid vaginoplasty (14 cases) in 2:1 ratio. Pre- and postoperative examination findings, Female Sexual Function Index (FSFI) questionnaire responses, and sexual satisfaction rates are reported.ResultsAll surgical procedures were performed successfully, with no intraoperative complications. The laparoscopic peritoneal vaginoplasty group had significantly less blood loss and a surgery shorter on average than the laparoscopic sigmoid colovaginoplasty group. Postoperative course was uneventful for all patients in both groups, though postoperative retention time and hospital stay were less for peritoneal vaginoplasty patients than for sigmoid vaginoplasty patients. Mean neovaginal length, excessive mucous production, sexual life initiation time, and sexual satisfaction rate were similar between groups. Patient complaints of abdominal discomfort, unusual odor from vaginal secretions, and vaginal contraction during intercourse were higher in the sigmoid colovaginoplasty group (p < 0.005 vs. peritoneal vaginoplasty). Postoperative FSFI scores did not differ significantly between groups.ConclusionsRelative to laparoscopic sigmoid colovaginoplasty, laparoscopic peritoneal vaginoplasty provides good anatomic and functional results and excellent patient satisfaction.

Evaluation of the biocompatibility and mechanical properties of xenogeneic (porcine) extracellular matrix (ECM) scaffold for pelvic reconstruction

Introduction and hypothesisXenogeneic (porcine) extracellular matrix (ECM) scaffolds have been suggested as ideal biomaterials for regeneration medicine; however, ECM prepared from different tissue sources has shown distinctive biological properties. Therefore, a comprehensive understanding of biological characteristics of different tissue-derived ECM is essential in the design of scaffolds for pelvic reconstruction.MethodsWe compared the biological properties of ECM derived from different tissue sources of Bama miniature pigs as a pelvic biological patch in terms of histological structure, water absorption ability, biodegradation ability, mechanical properties, antimicrobial activity, and biocompatibility in vitro.ResultsDifferent ECM scaffolds have distinct structural differences, and all have good biocompatibility, and UBM exhibited better water uptake ability (above 500%), anti-biodegradation ability, mechanical properties, antimicrobial activity, and stem cell attachment properties than other tissue-derived ECM.ConclusionsPorcine UBM might serve as an ideal pelvic biological patch.

Endoscopic inguinal lymphadenectomy with a novel abdominal approach to vulvar cancer: description of technique and surgical outcome.

STUDY OBJECTIVE To evaluate the feasibility and surgical outcome of a novel technique of endoscopic inguinal lymphadenectomy to treat vulvar cancer. DESIGN Retrospective analysis performed by a single center over 2 years (Canadian Task Force classification II-2). SETTING Major university teaching hospital. PATIENTS The medical records for 17 consecutive patients who underwent endoscopic inguinal lymphadenectomy because of invasive vulvar cancer were retrospectively reviewed. INTERVENTION Endoscopic inguinal lymphadenectomy was performed using a novel abdominal approach. MEASUREMENTS AND MAIN RESULTS All patients underwent abdominal endoscopic inguinal lymphadenectomy without intraoperative complications. Median (range) operative time for the endoscopic procedure was 94 minutes, with estimated blood loss of approximately 137 mL (80-170 mL). A mean (range) of 16 (11-23) nodes were retrieved. In an additional 5 patients, pelvic node dissection was performed, with retrieval of 6 (3-11) nodes. Of the 17 patients, 2 demonstrated vulvar wound necrosis, and 1 exhibited lymphorrhea through the drain orifice. No other inguinal wound-related complications were observed. Mean postoperative hospital stay was 11 (8-19) days. All patients were followed up for more than 13 months, with no recurrence of cancer. CONCLUSIONS Endoscopic inguinal lymph node dissection using this novel abdominal approach in patients with vulvar cancer is a safe and feasible technique that may diminish the wound-related complications associated with the standard open approach.

Inhibition of Fibroblast Differentiation of Muscle-Derived Stem Cells in Cell Implantation Treatment of Stress Urinary Incontinence

The aim of this study was to investigate the effects of transforming growth factor-β1 (TGF-β1) stimulation and the blocking of the TGF-β1/Smad3 signaling pathway by vector-mediated Smad3 shRNA on muscle-derived stem cells (MDSCs) in cell implantation treatment of stress urinary incontinence (SUI) of the rat. MDSCs were infected with the GC-shSmad3 lentivirus vector. Five days after infection, the cells were treated with TGF-β1. The expression levels of desmin (a marker of muscle differentiation) and vimentin (a marker of fibroblast differentiation) were tested by real-time PCR and Western blot. GC-shSmad3 lentivirus-infected MDSCs were injected into the bladder neck and proximal urethra of SUI rats. Urodynamic test was used to measure leak point pressure (LPP) at 2 weeks and 4 weeks after MDSC transplantation. Upregulated expression of vimentin and downregulated expression of desmin were found in MDSCs after culture with TGF-β1 in vitro. GC-shSmad3 lentivirus infection inhibited fibroblast differentiation of MDSCs but allowed muscle differentiation with desmin expression. In vivo experiments showed that GC-shSmad3 lentivirus infection could improve MDSC-mediated repairing of urethra sphincter function. In conclusion, blocking Smad3 expression inhibits the fibroblast differentiation of MDSCs induced by TGF-β1 in vitro and improves the repairing of urethral sphincter function by inhibiting the fibroblast differentiation of MDSCs in a rat model of SUI in vivo.

Laparoscopic Nerve-Sparing Radical Vaginectomy in Patients With Vaginal Carcinoma: Surgical Technique and Operative Outcomes

STUDY OBJECTIVES To describe our technique for laparoscopic nerve-sparing radical vaginectomy and to assess the feasibility and safety of the procedure via operative outcomes. DESIGN Retrospective study (Canadian Task Force classification II-2). SETTING Major university teaching hospital in Chongqing, China. PATIENTS Twelve consecutive patients with early stage vaginal carcinoma. INTERVENTIONS Laparoscopic radical parametrectomy/vaginectomy with pelvic/paraaortic lymphadenectomy. MEASUREMENTS AND MAIN RESULTS Nerve-sparing radical vaginectomy was completed laparoscopically without conversion to laparotomy in 12 patients with early stage vaginal cancer. Mean (SD) operative time was 158.5 (36.7) minutes, and estimated blood loss was 135.2 (62.8) mL. No intraoperative complications occurred, and no patients required blood transfusion. The number of pelvic nodes obtained was 21.2 (9.8), and of para-aortic nodes was 13. All nodes were negative for malignancy. Histologic analysis confirmed the absence of any residual cancer tissue in the margins of the parametrial tissue and vagina. The median (range) time before Foley catheter removal was 9.76 (3-14) days, and bladder void function recovery to grade 0-I was observed in 11 patients (91.7%). Neither long-term bladder voiding dysfunction nor any other long-term complications were reported. The median duration of follow-up was 28 months. One patient with stage II vaginal cancer received pelvic regional radiation therapy; the other patients did not require adjuvant therapy after the operation. All patients were included in the follow-up protocol, and there was no recurrence of disease in any patients. CONCLUSIONS Laparoscopic radical parametrectomy/vaginectomy with pelvic/para-aortic lymphadenectomy is a therapeutic option for early stage vaginal carcinoma. Nerve-sparing radical surgery in indicated patients may lead to optimal preservation of bladder function. The technique described in this preliminary study seems to be safe and feasible, and was relatively easy to perform in our study population.

Histological response to and immunogenicity of different material patches implanted in rabbit abdominal walls

Abstract The high failure rate of traditional procedures of repairing pelvic organ prolapse by using sutures pushes multiple transvaginal mesh delivery systems into the marketplace; however, these are currently without optimal clinical results. We observed the short-term histological changes and the effects of Th1/Th2 cytokines after the implantation in rabbit abdominal walls of five materials, i.e., porcine urinary bladder matrix (UBM), cross-linked UBM, polypropylene mesh, composite cross-linked UBM, and composite UBM, and explored the feasibility of their application to pelvic reconstructive surgery. Grafts were harvested at 1, 2, 4, 8, and 12 weeks after surgery and were processed for histology in order to evaluate the host inflammatory response and the degree of tissue incorporation. Additionally, graft site cytokine levels were determined by reverse transcriptase polymerase chain reaction. The results demonstrate that the two composite groups were associated with an erosion response, whereas the other groups induced a milder response than the composite groups. The Th1/Th2 cytokine mRNA expression levels of the cross-linked UBM group at each time point were similar to that of the sham group, whereas the other groups elicited a more variable expression. The cross-linked UBM showed slow degradation, mild inflammatory response, and low immunogenicity. This suggests that cross-linked UBM is a better material of choice for pelvic reconstructive surgery.

Tourniquet device for hemorrhage control during cesarean section of complete placenta previa pregnancies.

To reduce massive and potentially fatal hemorrhage during cesarean section (CS) delivery because of the transverse incision through the lower uterine segment and placenta in central placenta previa (CPP), especially the type in which the placenta attaches to the anterior wall of the uterus.

A novel hysteroscopic hook for extracting retained contraceptive intrauterine devices under direct vision.

Abstract Objective The study evaluated the efficacy of removing retained intrauterine devices (IUDs) under direct vision using a novel hysteroscopic hook. Methods In a retrospective observational study, 83 patients (group 1) underwent IUD extraction using a hysteroscopic IUD removal hook (HIRH) and 60 patients (group 2) underwent traditional hysteroscopic IUD extraction. We recorded the blood loss, operation time and success rate. Results The operation time was shorter (10.7 vs. 17.7 min; p < 0.001) and the success rate higher in group 1 compared with group 2 (odds ratio 1.09; p = 0.027). Conclusions The HIRH is an effective, simple, inexpensive and durable tool for the direct visual removal of IUDs partially embedded in the endometrium and for damaged IUDs. Chinese Abstract 摘要 目的 本研究评估采用新型宫腔镜钩直视下取出残留宫内避孕装置（IUD）这一方法的有效性。 方法 在一项回顾性观察研究中，83位患者（组1）采用宫腔镜下IUD取除钩（HIRH）取出IUD，60位患者（组2）采用传统宫腔镜IUD取出术。我们记录失血量、手术时间和成功率。 结果 组1和组2相比，手术时间缩短（10.7 比17.7; p＜0.001）,成功率提高（优势比 1.09； p = 0.027）。 结论 对于直视下取出部分植入子宫内膜的IUD和受损坏的IUD, HIRH是一种简单有效、花费少且耐用的工具。

Laparoscopic Transient Uterine Artery Occlusion and Myomectomy for Symptomatic Uterine Myoma as an Alternative to Hysterectomy

Objective: To compare the clinical outcomes of laparoscopic transient uterine artery ligation plus myomectomy (LTUAL) to simple laparoscopic myomectomy (LM) for symptomatic myomas. Methods: A comparative observational study was adopted; 167 patients with a diagnosis of symptomatic uterine myoma were retrospectively observed. And 84 patients underwent LTUAL and LM, 83 patients underwent LM only. Operative time, blood loss, gonadal hormone level, uterine artery resistance index, menorrhea, pregnancy rate, and recurrence rate of myoma were evaluated. Results: The intraoperative blood loss in the LTUAL group was lower than in the LM group. The menstrual blood volume (MBV) and the menstrual period of the LTUAO group were unchanged after operation relative to the prediseased volume. No significant difference was found in the resistance index of the uterine artery blood flow, the recurrence rate, and the fertility rate between the LTUAL and the LM groups. Conclusions: LTUAL and LM are a promising surgical treatment for symptomatic uterine myoma and did not produce any appreciable adverse effect on fertility.