Surgery

A new study examines the risk:benefit of the Essure device. And, does anti-osteoporosis medication in the wake of a fragility fracture reduce the risk of a future fracture? Plus: What role do high maternal blood glucose levels play in her child's future cardiovascular health?

A study tabulates the direct and indirect costs.

The FBI is investigating how much the manufacturer knew about the safety of the design. Plus, how does the clotting profile of new oral contraceptives compare to earlier formulations and a look at the impact of the PALB2 mutation on breast cancer prognosis.

A patient sues after a hysterectomy is performed even after a finding of no cancer.

Two experts take sides on the clinical merits of performing bilateral salpingectomy alone versus removing the tubes in BRCA mutation carriers.

More information on the risks of morcellation when treating fibroids; a look at the price tag associated with post-fracture use of bisphosphonates; and research on the developmental impact of a variety of air pollution.

In the latest volley in the ongoing controversy regarding the safety of some forms of hysterectomy, the country’s largest insurer will soon begin requiring prior authorization for many of the procedures. The action, taken by UnitedHealthCare, takes effect April 6, 2015 and does not apply to outpatient vaginal surgeries.

Readers comment on MOC, ureteral injury, nonimmune hydrops fetalis

Among BRCA mutation carriers, risk-reducing bilateral salpingo-oophorectomy (RRSO) results in an 80% reduction in risk of ovarian cancer and a 50% reduction in risk of breast cancer if the surgery is performed before the onset of menopause.

Six months after a tubal ligation, a woman became pregnant. She gave birth by cesarean to a child who was diagnosed with sickle cell disease.

A reader takes issue with the authors' assertion that risk of ureteral injury is higher for vaginal hysterectomy.

On July 29, 2010, a 46-year-old obese primarily Spanish-speaking patient was admitted to a hospital by her private ob/gyn Dr. A for a total laparoscopic hysterectomy (TLH) and/or laparoscopically assisted vaginal hysterectomy (LAVH) that day.

A California woman with a history of 2 premature deliveries and a single miscarriage became pregnant in 2004. A few days after the pregnancy was confirmed, she was seen by a physician at a military base in connection with an application to accompany her husband overseas. The application was approved and the patient went to Spain, where she delivered at 31 weeks’ gestation in 2005.

On November 25, the Food and Drug Agency (FDA) issued a warning against the use of laparoscopic power morcellators in the management of many women undergoing hysterectomy or myomectomy.

AAGL attendees are normally reserved, but on Wednesday they got on their feet to give an ovation to the doctor who engineered the first pregnancy in a woman with a transplanted uterus.

An analysis of data from nearly 90,000 women who underwent adnexal surgery over a 3-year period shows that robotically assisted procedures were associated with substantially higher costs and increases in intraoperative complications.

Javier F Magrina, MD, demonstates the prevention of ureteral injury while performing an endoscopic hysterectomy.

When a jury sees a big corporation in the defendant’s chair, it can have an effect, although it is never a jury’s job to “punish” a corporation.

Certain patients are at increased risk of ureteral injury during endoscopic hysterectomy due to differences in anatomy. The right tools and techniques will protect them from injury and complications.

A single-institution retrospective study published in JSLS, The Journal of the Society of Laparoendoscopic Surgeons suggests that operative times may be shorter and blood loss lower when hysterectomy is done by high-volume surgeons.

An analysis of minimally invasive hysterectomies performed at multiple institutions over a 7-year period shows that one in every 368 women who underwent morcellation had uterine cancer. According to the investigators, the study also reveals an association between advanced age and increasing prevalence of underlying cancer and endometrial hyperplasia in these patients.

Institutions around the country have responded to an FDA advisory by discouraging or banning power morcellation of uterine fibroids. Innovative methods of contained morcellation are now called for.

According to a new study in Cancer, the incidence of cervical cancer in older women may be higher than has been previously reported.

A safety communication discouraging use of power morcellation during hysterectomy or myomectomy for fibroids has been issued by the Food and Drug Administration (FDA) because of concern about risk of inadvertent spread of unsuspected cancer to abdominal and pelvic cavities.

Was there an unreasonable delay in making the diagnosis, and did that delay have an effect on the patient’s treatment and overall life expectancy?

Ovarian cancer is notorious for its late stage at diagnosis and its poor prognosis. In the absence of good screening tests, salpingectomy is the only form of prophylaxis for this cancer.

Gynecologic surgeons should give consideration to the balance of benefit and harm that accompanies laparoscopic tissue morcellation, in addition to exploring surgical alternatives and methods to mitigate complications.

Clear, consistent steps for each specific surgical procedure should be adopted so that team members can become familiar with each procedure with repetition. Procedural steps for a robotic hysterectomy are shown in the video.

Employing a separate 5-mm conventional laparoscope via the assistant port allows for safe placement of robotic ports and instruments under direct laparoscopic visualization. The robotic ports are generally placed such that they are in a straight line to minimize arms clashing. The ports are generally placed at the level of the umbilicus. They should, however, be adjusted cephalad, to accommodate complex surgical cases such as large fibroids, obese patients, or para-aortic lymph node dissection.

A commentary on ACOG Practice Bulletin Number 133: Benefits and risks of sterilization