Publications by authors named "Athanasios Protopapas"

56 Publications

Delayed hysteroscopic-assisted diagnosis of giant asymptomatic hematocervix after loop conization.

J Minim Invasive Gynecol 2021 May 27. Epub 2021 May 27.

Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, Greece.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jmig.2021.05.016DOI Listing
May 2021

Menstural function preservation treatment of a primary vaginal clear cell carcinoma with ovarian transposition and vaginal brachytherapy.

Gynecol Oncol Rep 2021 May 8;36:100764. Epub 2021 Apr 8.

1st Department of Obstetrics and Gynecology, University of Athens, Greece.

Early stage vaginal carcinomas are typically treated with radical surgical procedures or radiation therapy. Both modalities impair the reproductive ability of the patients. We hereby report a case of menstrual function preservation in a 24-year-old patient with an early-stage primary vaginal clear cell carcinoma. We treated the patient with intravaginal brachytherapy after appropriate laparoscopic surgical staging and separate transposition of the ovaries and tubes. The patient is now 6 years without any evidence of disease. She reports minor. complaints during sexual intercourse, while her menstruation and hormonic profile are normal.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.gore.2021.100764DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8063755PMC
May 2021

The Emerging Role on the Use of Platelet-Rich Plasma Products in the Management of Urogynaecological Disorders.

Surg Innov 2021 Apr 28:15533506211014848. Epub 2021 Apr 28.

1st Department of Obstetrics & Gynecology, Medical School, 68989National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece.

: The regenerative efficacy of platelet-derived products has been recently investigated in the treatment of pelvic floor disorders (PFDs). We aimed to synthesize the current evidence of platelet-rich plasma (PRP) products used in urogynaecological disorders including vaginal atrophy, pelvic organ prolapse (POP), urinary incontinence, vaginal fistulas and vaginal mesh exposure. : A meticulous search of the currently available literature on the use of PRP for the management of PFDs was performed using 3 electronic databases. : PRP could be a feasible alternative modality for the management of vaginal atrophy with favourable outcomes in vaginal atrophy parameters and patients' satisfaction, especially when hormone therapy is contraindicated. In patients with POP, an increase in collagen concentration after PRP application was observed while the use of PRP resulted in improvement of stress urinary incontinence symptoms. A considerable proportion of vesicovaginal fistulas were treated after application of PRP-based injections. : There is only limited evidence of the use of PRP for PFDs. Platelet-rich plasma appears to be a promising, easy to apply, cost-effective and feasible alternative therapeutic modality for the management of various urogynaecological disorders. Future randomized trials are needed to confirm the efficacy of PRP in the treatment of urogynaecological disorders.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/15533506211014848DOI Listing
April 2021

Herlyn-Werner-Wunderlich syndrome: Report of a delayed diagnosed case with video presentation of the operative technique of vaginal septum resection.

J Obstet Gynaecol Res 2021 Jun 15;47(6):2242-2245. Epub 2021 Mar 15.

Unit of Gynecological Ultrasound, 1st Department of Obstetrics & Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece.

Herlyn-Werner-Wunderlich (HWW) syndrome is a rare congenital anomaly of Mullerian duct development characterized by uterus didelphys with blind hemivagina and ipsilateral renal agenesis. We present a case of a 29-year-old nulliparous woman, who was referred to our hospital complaining of chronic pelvic pain, dyspareunia, and a palpable mass in her vagina. At the age of 12, she underwent surgery because of a didelphys uterus diagnosis. Subsequently, she was operated on twice for endometriomas. At our institution, clinical and imaging findings revealed an obstructed hemivagina setting the diagnosis of HWW syndrome. Some of the various syndrome types may go unnoticed for months or even years after the onset of menstruation. Early diagnosis, followed by proper surgical treatment, is the key to avoid potentially severe complications.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jog.14743DOI Listing
June 2021

Extending the limits of vaginal hysterectomy under local anesthesia and conscious sedation.

Int Urogynecol J 2021 Mar 11. Epub 2021 Mar 11.

Urogynecology Unit, 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Faculty of Medicine, Athens, Greece.

Introduction And Hypothesis: In this video we present the surgical management of a 58-year-old woman presenting with a large prolapsed myomatous uterus treated with vaginal hysterectomy (VH) and pelvic floor repair (PFR) (uterosacral ligament suspension and posterior colporraphy) under local anesthesia and conscious sedation.

Methods: The patient underwent VH and PFR by using an infiltration of a local anesthetic solution of lidocaine, ropivacaine and adrenaline in combination with intravenous (iv) conscious sedation. Debulking techniques, such as intramyometrial coring, uterine bisection, myomectomy and wedge resection, were used to facilitate VH. The final weight of the removed uterus was 870 g.

Results: This video demonstrates that performing a surgically challenging VH under local anesthesia is feasible.

Conclusions: Vaginal uterine morcellation can be performed to debulk the enlarged uterus so that hysterectomy can be accomplished under local anesthesia. The use of local anesthesia may safely be offered as an alternative to patients undergoing a complex vaginal hysterectomy and reconstructive surgery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00192-021-04721-1DOI Listing
March 2021

The Role of FSHR SNPs and AMH in Follicular Fluid and Serum in Ovarian Response during COS: A Pilot Study.

Int J Reprod Med 2021 9;2021:8685158. Epub 2021 Feb 9.

1st Department of Obstetrics and Gynecology, Division of Human Reproduction, IVF Unit, Alexandra Hospital, Medical School of National Kapodistrian University of Athens, Athens, Greece.

Background: Several studies have investigated on the polymorphism Ser680Asn of FSHR and its use as a predictive indicator of response to an IVF/ICSI protocol. Furthermore, measurement of AMH in serum and follicular fluid is a useful prognostic indicator for the outcome of an assisted reproduction attempt. The purpose of this study is to examine the FSH receptor Ser680Asn polymorphism in combination with AMH levels in both serum and follicular fluid, on the day of oocyte collection.

Materials And Methods: A total of 32 women who underwent IVF/ICSI were included. Women were grouped into 2 groups: those who received rFSH ( = 11) and those who received hMG ( = 21). Serum AMH was measured on day 3 of the cycle, and AMH in the follicular fluid on the day of oocyte retrieval; the same day peripheral blood was collected for the genotyping of Ser680Asn.

Results: No statistical significant difference was found between serum AMH and follicular fluid AMH regarding the FSH receptor genotype for the Ser680Asn polymorphism. Regarding the sAMH/ffAMH ratio in the 3 genotypes, the value was lower in Asn/Asn women than Ser/Ser and Ser/Asn, but no statistical difference was obtained. Women who carry the Ser allele have a higher number of follicles, retrieved oocytes, and mature oocytes than women who do not contain the Ser allele. Women with AMH < 2.22 ng/ml presented lower AMH follicular fluid levels and lower serum AMH/follicular fluid AMH ratio in a statistically significant manner. Concerning the genotype for the polymorphism Ser680Asn of FSHR in relation to AMH levels, no statistically significant differences were found.

Conclusions: The identification of polymorphisms, such as Ser680Asn of FSHR, along with the determination of endocrine markers in the follicular fluid, such as AMH, could lead at some point, to the personalized therapy setting per woman.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2021/8685158DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7889364PMC
February 2021

Mechanical bowel preparation before gynecologic laparoscopic procedures: Is it time to abandon this practice?

J Obstet Gynaecol Res 2021 Apr 8;47(4):1487-1496. Epub 2021 Feb 8.

First Department of Obstetrics and Gynecology in Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece.

Aim: To examine the influence of mechanical bowel preparation on surgical field visualization and patients' quality of life during benign gynecologic laparoscopic procedures.

Methods: A single blind, randomized, controlled trial was undertaken with laparoscopic gynecologic surgical patients to one of the following three groups: liquid diet on the preoperative day; mechanical bowel preparation with oral polyethylene glycol (PEG) solution; minimal residue diet for 3 days. Primary outcomes included assessment of the condition of small and large bowel and the overall quality of the surgical field. Additional measures included assessment of patients' preoperative symptoms, tolerance of the preparation method and compliance to the protocol, postoperative symptoms and bowel function.

Results: One hundred forty-four patients were randomized as follows: 49 to liquid diet, 47 to mechanical bowel preparation, and 48 to minimal residue diet. Most characteristics were similar across groups. The intraoperative surgical view and the condition of large and small bowel were equal or inferior at the patients who received mechanical bowel preparation compared with the other groups. The 4-point Likert scale scoring for small bowel (2.51 vs. 2.72 vs. 2.81, p = 0.04), large bowel (2.26 vs. 2.38 vs. 2.48, p = 0.32) and overall operative field quality (2.34 vs. 2.67 vs. 2.67, p = 0.03) demonstrated no advantage from the use of preoperative mechanical bowel preparation over liquid diet and minimal residue diet, respectively. Preoperative discomfort was significantly greater in the mechanical bowel preparation group.

Conclusion: Mechanical bowel preparation before gynecologic laparoscopic operations for benign pathology could be safely abandoned.

Clinical Trial Registration: ISRCTN registry, https://doi.org/10.1186/ISRCTN59502124 (No 59502124).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jog.14674DOI Listing
April 2021

Laparoscopic management of cesarean scar pregnancy: Report of two cases with video-presentation of different operative techniques and literature review.

J Gynecol Obstet Hum Reprod 2021 Jan 20;50(8):102066. Epub 2021 Jan 20.

Endoscopic Surgery Unit, 1st Department of Obstetrics & Gynecology, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece.

Cesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy. We present two different techniques of laparoscopic management of CSP, with the concomitant repair of the coexisting uterine isthmocele. The first case is a combination of diagnostic hysteroscopy and laparoscopic extraction of conception products, and the second technique is a combination of laparoscopy and guided Dilation & Curettage. We also conducted a thorough review of the literature to present all cases of laparoscopic treatment of CSP, focusing on the surgical technique, the operation outcome, and the future pregnancies. Laparoscopy is a potential effective treatment of CSP.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jogoh.2021.102066DOI Listing
January 2021

Ectopic Pregnancy in a Hypoplastic Fallopian Tube at an Extrapelvic Location.

J Minim Invasive Gynecol 2021 Jun 4;28(6):1133-1134. Epub 2020 Dec 4.

1st Department of Obstetrics & Gynecology, Endoscopic Surgery Unit, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, Greece (all authors).

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jmig.2020.11.027DOI Listing
June 2021

Wireless Laparoscopy in the 2020s: State-of-the-Art Technology in Surgery.

Obstet Gynecol 2020 11;136(5):908-911

1st Department of Obstetrics and Gynecology, University of Athens, Alexandra Hospital, and the Department of Radiology, Alexandra Hospital, Athens, Greece.

Background: Wireless signal transduction is the future in the field of laparoscopic surgery. Cable-free endoscopic equipment would be the ideal surgical instrument for every laparoscopic surgeon.

Instrument: Our department has developed a new cable-free laparoscopic setup that couples a rigid 0°, 10-mm laparoscope with a wireless camera modified with a special adapter. We used a portable and rechargeable LED cold light source. The signal was wirelessly transmitted from the camera to a tablet computer using the corresponding mobile application.

Experience: Our team has used this setup in 14 laparoscopic operations with excellent results. Two cases performed exclusively with the new setup are presented in the videos. The image quality obtained was comparable with the conventional laparoscopic setup, and the operations performed were unaffected.

Conclusion: This report presents the use of a wireless camera throughout the course of a laparoscopic surgery, and the results are promising. The new systems' favorable characteristics, such as wireless signal transmission, cost, flexibility, and size, support this as a feasible new technique for performing laparoscopic surgery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/AOG.0000000000004108DOI Listing
November 2020

Laparoscopic Cervical Cerclage: Do Not Catch the Wrong Needle, or What to Do Next if It Happens!

J Minim Invasive Gynecol 2021 May 23;28(5):943-944. Epub 2020 Sep 23.

1st Department of Obstetrics & Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece (all authors).

Study Objective: To present a technique to correct the misplacement of tape during laparoscopic cervical cerclage. Catching and introducing the wrong needle resulted in a knot formed around the right adnexa.

Design: Step-by-step demonstration of the mistake and the technique to correct it.

Setting: A patient para 0+V (V corresponds to 5) with cervical insufficiency was managed with laparoscopic interval cerclage [1-3]. The patient's 2 most recent pregnancies had been managed with emergency transvaginal cerclage, which failed to prolong her gestation beyond 24 weeks.

Interventions: Before the cerclage procedure a 2.0 × 0.8-cm deep endometriotic nodule was excised. Both curved needles were straightened extracorporeally, and the tape was dropped inside the peritoneal cavity. The first needle was introduced successfully through the right side. After insertion of-what was believed to be-the same needle through the left side following the opposite direction, it was discovered that a tight knot had been formed around the right adnexa (Fig. 1). To avoid complete removal, the needleless tape was pulled back completely from the right side (Supplemental Fig. 1), and this end was stitched to a straight needle 2-0 polyglactin suture. The much thinner needle passed easily through the already created path, along with the tape (Supplemental Fig. 2), and the procedure was completed as planned (Supplemental Fig. 3).

Conclusion: When performing laparoscopic cervical cerclage with the tape and needles inside the abdomen, it is important to keep both under constant view. In the event of misplacement, no need to completely remove the tape. The tape's cut end can still be reintroduced successfully, stitched to a straight needle suture.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jmig.2020.08.628DOI Listing
May 2021

Vaginal Delivery at Term in a Woman with a Spontaneous Heterotopic Pregnancy Treated with Laparoscopic Salpingectomy.

Case Rep Obstet Gynecol 2020 2;2020:8892273. Epub 2020 Sep 2.

1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, 80 Vasilissis Sofias Avenue, 11528 Athens, Greece.

. The coexistence of an intrauterine pregnancy and an ectopic pregnancy (heterotopic pregnancy) is an extremely rare, yet major, complication during pregnancy. The early diagnosis of a heterotopic pregnancy is of great importance for fetal viability, maternal safety, and the progression of an uncomplicated intrauterine pregnancy. . We report a case of a naturally conceived heterotopic tubal pregnancy in a 37-year-old primigravida. The patient presented with continuous, dull, lower abdominal pain and a positive urine pregnancy test which was conducted a week prior to the start of the pain. The patient was hospitalized, and based on the clinical image and after strict monitoring, she was diagnosed with a heterotopic pregnancy. She was treated with laparoscopic salpingectomy after the rupture of the ectopic pregnancy while the desired intrauterine gestation continued without any complications. The pregnancy resulted in the birth of a healthy infant through vaginal delivery. . Strict monitoring with multiple sonographic evaluations should always be conducted in women with abnormal serum beta-hCG, adnexal abnormalities, or clinical symptoms, while heterotopic pregnancy should be in differential diagnosis and treatment should not be delayed since emerge management is important for the progression of the intrauterine pregnancy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2020/8892273DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7484683PMC
September 2020

Misoprostol vs vasopressin as a single hemostatic agent in laparoscopic myomectomy: Comparable, or just better than nothing?

J Obstet Gynaecol Res 2020 Nov 10;46(11):2356-2365. Epub 2020 Sep 10.

1st Department of Obstetrics & Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece.

Aim: Laparoscopic myomectomy may be associated with considerable blood loss, especially in patients in whom no specific hemostatic measures are used. We conducted this retrospective comparative study to investigate whether misoprosol is an effective and safe alternative to vasopressin when used as single hemostatic agent in laparoscopic myomectomy.

Methods: Two hundred cases undergoing laparoscopic myomectomy (-ies), were included. Of these, 50 pre-treated with vaginal misoprostol 400mcg 1 h before surgery (group 1), were compared with two historic consecutive groups: 100 patients treated with intraoperative intra-myometrial injection of dilute vasopressin (20 IU/100 mL normal saline) (group 2), and 50 treated without use of any hemostatic agent (group3).

Results: Mean procedure length did not differ significantly between the three groups (127.9 vs 100.6 vs 130.8 min). Mean estimated blood loss (EBL) was 179.7 ± 200.0 mL in group 1, compared with 147.8 ± 171.8 mL in group 2 (P = 0.793) and 321.8 ± 246.0 mL in group 3, respectively (P < 0.001). EBL was lower in group 2 in most of the study's subgroups of patients stratified according to size and number of fibroids compared with group 1, with the exception of patients with ≥4 fibroids, and ≥7 cm in size. In these subgroups, misoprostol appeared more effective. Neither agent was associated with serious adverse events.

Conclusion: Vaginal misoprostol can be effective in reducing blood loss during laparoscopic myomectomy. Although rates of EBL are, in general, higher compared with those obtained with vasopressin, they are significantly reduced compared with those observed when no hemostatic agent is used. In extended procedures, vaginal misoprostol, due to its prolonged uterotonic action, may be associated with reduced blood loss compared with vasopressin.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jog.14465DOI Listing
November 2020

Total laparoscopic multi-compartment native tissue repair of pelvic organ prolapse and stress urinary incontinence.

Int Urogynecol J 2021 Apr 25;32(4):1039-1041. Epub 2020 Aug 25.

First Department of Obstetrics and Gynecology, Urogynecology Unit, Faculty of Medicine, National and Kapodistrian University, Athens, Greece.

Aim Of The Video: In this video we present the surgical management of a 59-year-old woman with stress urinary incontinece (SUI) and pelvic organ prolapse (POP) who had a history of rheumatoid arthritis and endometrial hyperplasia with atypia.

Methods: A concomitant laparoscopic hysterectomy with bilateral oophorectomy and a multi-compartment laparoscopic native tissue repair of the POP, combined with a Burch urethropexy, was performed to restore pelvic floor defects and treat the underlying endometrial pathology.

Conclusion: Total laparoscopic multi-compartment repair of POP and/or SUI using native tissue appears to be a viable alternative to both laparoscopic procedures using synthetic meshes and vaginal native tissue repairs. Although not a routine option for the majority of patients with POP and SUI, this procedure may be offered in selected cases, where native tissue repair of the pelvic floor is preferred.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00192-020-04506-yDOI Listing
April 2021

Juvenile Cystic Adenomyoma vs Blind Uterine Horn: Challenges in the Diagnosis and Surgical Management.

J Pediatr Adolesc Gynecol 2020 Dec 20;33(6):735-738. Epub 2020 Aug 20.

Pediatric and Adolescent Gynecology Unit, First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Athens, Greece.

Background: Juvenile cystic adenomyomas (JCAs) are rare uterine lesions. Differential diagnosis might be difficult. We present the case of an adolescent who was diagnosed with JCA and was managed with laparoscopic excision.

Case: A 14-year-old patient with complaint of menarche with excruciating dysmenorrhea, was diagnosed using magnetic resonance imaging with a uterine anomaly consisting of a normal right hemiuterus, and a left cystic lesion with surrounding hypotense myometrium. She was managed with laparoscopic excision of the left side, and uterine reconstruction. Histology was suggestive of JCA, associated with diffuse adenomyosis. Dysmenorrhea improved considerably after surgery.

Summary And Conclusion: Differential diagnosis between cystic uterine lesions relies on clinical, imaging, and perioperative clues that might assist in their formal classification. Doubt might still remain in some cases.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpag.2020.08.010DOI Listing
December 2020

Total Laparoscopic Excision of an Altman Type IV Sacrococcygeal Teratoma with the Assistance of Intraoperative Transrectal Sonography.

J Minim Invasive Gynecol 2021 Apr 24;28(4):754-756. Epub 2020 Jul 24.

Endoscopic Surgery Unit (Drs. Protopapas, Vlachos, and Kypriotis); Gynecologic Ultrasound Unit (Dr. Domali); First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Pathology Department (Dr. Sotiropoulou), Alexandra Hospital; Second Department of Surgery, National and Kapodistrian University of Athens, Areteion Hospital (Dr. Contis), Athens, Greece.

Objective: To present the case of a young patient with an Altman type IV sacrococcygeal teratoma (Fig 1) managed exclusively with laparoscopy.

Design: A step-by-step demonstration of the technique.

Setting: A 24-year-old patient complaining of dysmenorrhea, deep dyspareunia, chronic constipation, dyschezia, and bladder atony was diagnosed with a 5-cm cystic tumor compressing the low rectum and overlying the left levator ani muscle.

Interventions: Laparoscopic excision of the tumor. At laparoscopy, significant bilateral pelvic venous congestion was found. The left medial and lateral pararectal fossa and the rectovaginal space were developed to the level of the pelvic floor. Several branches of the left internal artery and vein were dissected. The left hypogastric nerve and deep hypogastric plexus were dissected in an effort to preserve ipsilateral autonomic nerve supply to the rectum. Owing to the tumor's soft consistency and dense adherence to the surrounding structures, transrectal sonography facilitated dissection, which was performed medially to the mesorectal fascia and anteriorly to the presacral fascia. The middle sacral artery and peripheral branches of the internal iliac vasculature supplying the tumor were ligated. Part of the left levator ani had to be excised. The rectum was injured during the effort to detach the tumor from its lateral wall. The injury was repaired laparoscopically. The cut edge of the levator ani was used as a flap to reinforce the repair.

Conclusion: Sacrococcygeal teratomas lying entirely in the pelvis (Altman type IV) are extremely rare [1,2]. Complete laparoscopic excision is challenging and potentially dangerous [3-5], but it is feasible with careful dissection.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jmig.2020.07.012DOI Listing
April 2021

Transverse Vaginal Septum with a Hemiuterus: A Laparoscopic-Guided Abdominoperineal Approach.

J Pediatr Adolesc Gynecol 2020 Oct 11;33(5):590-593. Epub 2020 May 11.

1st Department of Obstetrics and Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, Greece.

Background: Transverse vaginal septum is a rare Müllerian anomaly that can coexist with other defects.

Case: A 12-year-old patient was referred to our clinic for cyclic, lower abdominal pain. Magnetic resonance imaging revealed the presence of a transverse vaginal septum, a hemiuterus with a nonfunctioning rudimentary horn, and left unilateral ureter and kidney. The septum was excised laparoscopically assisted by a vaginal dilator to guide the dissection. The mucosal gap of the vagina was then bridged with sutures using the perineal approach. The postoperative course was uneventful and the patient was discharged with instructions for vaginal dilations.

Summary And Conclusion: Early identification of a transverse vaginal septum and careful planning of the operation can improve the outcome of corrective surgery and prevent possible complications.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpag.2020.05.002DOI Listing
October 2020

Radical excision of a complicated transobturator tape.

Int Urogynecol J 2020 04 17;31(4):831-833. Epub 2019 Dec 17.

First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, "Alexandra" General Hospital, 80 Vas.Sofias Aven, 11528, Athens, Greece.

Aim Of The Video: In this video, we present the case of a late-detected sinus formation 4 years after a TOT placement.

Method: A combined surgical approach (transvaginal and transcutaneous routes) performed by a urogynecologist and an orthopaedic surgeon was chosen to carry out a radical en bloc excision of the sinus tract with the right half of the tape. This combined approach has the advantage of completely removing the biofilm adhered to the surface of the tape and the surrounding tissues, thus making antibiotic therapy more effective.

Conclusion: Surgical removal of these microbial commmunities is very important for the resolution of device-related infections. Severe infectious complications of transobturator slings should be managed by a tertiary multidisciplinary team to optimize patient care.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00192-019-04127-0DOI Listing
April 2020

Women living with a midurethral sling in their 80s: long-term outcomes.

Int Urogynecol J 2020 Dec 11;31(12):2669-2674. Epub 2019 Dec 11.

First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens "Alexandra" Hospital, 80 Vas.Sofias Avenue, 11528, Athens, Greece.

Introduction And Hypothesis: Surgical outcomes of elderly women who have been treated using midurethral slings could be influenced by confounding factors, such as age-related comorbidities. Aim of this study is to assess elderly patients (>75 years) who underwent a transobturator sling procedure with a follow-up of at least 13 years.

Methods: This is a prospective follow-up observational study including elderly women of current age ≥ 75 years old who underwent TVT-O placement at least 13 years prior to the study period. Main outcome measures were the objective and subjective cure rates at the follow-up visit. Secondary outcome measures included: patient-reported success rate, de novo urgency symptoms rate, evaluation of other subjective parameters related to the lower urinary tract function, and assessment of the health-related quality of life.

Results: Seventy-two out of 85 women (84.7%) meeting the inclusion and exclusion criteria were assessed at the follow-up visit. The mean follow-up period was 13.7 years (SD = 0.8). The overall objective and subjective cure rates were 80.5% (58 out of 72) and 84.7% (61 out of 72) respectively, whereas 9.7% of the patients (7 out of 72) reported being subjectively improved. The patient-reported success rate was 91.7% (66 out of 72). De novo urgency rate was 23.7% (9 out of 38), whereas 26.5% of the patients (9 out of 34) reported aggravation of preexisting urgency.

Conclusions: In women of advanced age, the TVT-O procedure is a highly effective and long-lasting treatment. The safety profile of the TVT-O was not influenced by geriatric conditions, whereas the long-term presence of a polypropylene sling did not appear to trigger the onset of medical disorders.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00192-019-04174-7DOI Listing
December 2020

Association between tumor necrosis factor-α gene-1031T/C promoter polymorphism and endometriosis in a European population.

Horm Mol Biol Clin Investig 2019 Sep 20;40(2). Epub 2019 Sep 20.

1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Athens, Greece.

Background Tumor necrosis factor-alpha (TNF-α) is a pro-inflammatory cytokine which plays an important role in the pathogenesis of many diseases. Endometriosis is one of the most common gynecological diseases. The purpose of this study was to investigate the association of TNF-α-1031T/C polymorphism with the genetic susceptibility of endometriosis in a European population. Materials and methods In this case-control study, 51 endometriosis patients and 67 healthy control women participated. We used endometrial tissue from the patients and peripheral blood from the healthy women to extract DNA. Polymerase chain reaction (PCR) analysis and the restriction enzyme Bbs I were used to analyze the -1031 T/C polymorphism in the TNF-α gene promoter region. Statistical analysis was performed using Fisher's exact test. We also calculated the odds ratios. Results In the group of patients, 66.7% of women were detected with the TT genotype, 33.3% with the TC genotype and 0% with the CC genotype while in the control group, 46.3% had the TT genotype, 47.8% had the TC genotype and 6% had the CC genotype. There was a significant association between the TT genotype with endometriosis (p = 0.03). There was no significant deviation from the Hardy-Weinberg equilibrium. Conclusions The TC and CC genotypes appeared more often in the healthy women than the endometriosis patients and this shows that the C allele might have a protective role in endometriosis in the Greek population. Further studies are needed to specify the role of this polymorphism in pathogenesis of endometriosis and the mechanisms that protect the patients from the disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1515/hmbci-2019-0033DOI Listing
September 2019

Severe pelvic organ prolapse. Is there a long-term cure?

Int Urogynecol J 2019 10 25;30(10):1697-1703. Epub 2018 Sep 25.

First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, "Alexandra" Hospital, 80 Vas.Sofias Avenue, 11528, Athens, Greece.

Introduction And Hypothesis: Vaginally assisted laparoscopic sacrocolpopexy (VALS) is a combined vaginal and laparoscopic surgical approach that has been described for the treatment of women with a uterus who suffer from severe multicompartmental pelvic organ prolapse (POP). The aim of this study is to evaluate the long-term anatomical and functional outcomes and report the long-term mesh-related complications.

Methods: This was a single-center prospective study of women with advanced POP who underwent VALS with at least 3 years of follow-up. The primary outcome was "composite surgical success" defined as: (1) no descent of the vaginal apex (point C) more than one-third into the vaginal canal and no anterior or posterior vaginal wall beyond the hymen (Ba and Bp < 0) (anatomical success), (2) no vaginal bulge symptoms and (3) no re-treatment for prolapse recurrence.

Results: The median follow-up was 7 years (range 3-10 years) with a composite surgical success rate of 95.7% (90/94). Failures (4.3%) included one (1.1%) case of anatomical recurrence (Bp: +1), one woman (1.1%) reporting vaginal bulge symptoms and two women (2.1%) who underwent a posterior colporrhaphy 6 and 12 months after primary surgery (reoperation rate: 2.1%). Two of 94 patients (2.1%) had been treated for mesh extrusion of the vaginal cuff prior to the follow-up visit.

Conclusions: The combined VALS technique can be considered a safe and effective procedure for the treatment of severe POP allowing a long-term anatomical restoration of all compartments with excellent functional outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00192-018-3775-3DOI Listing
October 2019

Microablative fractional CO2 laser for the genitourinary syndrome of menopause: up to 12-month results.

Menopause 2019 03;26(3):248-255

1st Department of Obstetrics and Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, Greece.

Objective: The aim of this study is to assess the efficacy of microablative fractional CO2 laser therapy for genitourinary syndrome of menopause (GSM) management, when three, four, or five laser therapies were applied in a follow-up period of 12 months.

Methods: Retrospective study evaluating GSM symptoms at baseline, and 1, 3, 6, and 12 months after last laser therapy. Visual analog scale, International Consultation on Incontinence Questionnaires- Female Urinary Tract Symptoms, International Consultation on Incontinence Questionnaires-Urinary Incontinence Short Form, Urogenital Distress Inventory-6, and Female Sexual Function Index were used for assessment of GSM symptoms' intensity or bothering and parameters of sexual function.

Results: Overall, 94 women were included (35, 35, and 24 received three, four, and five therapies, respectively). All GSM symptoms improved statistically significantly. Intensity of dyspareunia and dryness decreased from 9 (5-10) (median [minimum-maximum]) and 8 (0-10) at baseline to 0 (0-6) and 0 (0-8), 1 month after last laser therapy (all P < 0.001), respectively. FSFI and frequency of sexual intercourse increased from 10.8 (2-26.9) and 1 (0-8) at baseline to 27.8 (15.2-35.4) and 4 (2-8) 1 month after last laser therapy (all P < 0.001), respectively. The positive laser effect remained unchanged throughout the 12 months of follow-up. The same pattern was followed for symptom-free rates. Four or five laser therapies may be superior in lowering the intensity of GSM symptoms in comparison to three laser therapies, in short and long-term follow-up. Differences between four and five laser therapies were not found.

Conclusions: Laser therapy may provide significant improvement and/or absence of GSM symptoms up to 12 months follow-up, irrespectively to the number of laser therapies applied. Symptoms intensity 1 month after last laser therapy may be indicative of GSM symptoms intensity at 12 months. One month after third laser therapy is the critical time to decide whether treatment extension should be offered.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/GME.0000000000001206DOI Listing
March 2019

Vasopressin during Laparoscopic Myomectomy: Does It Really Extend Its Limits?

J Minim Invasive Gynecol 2019 Mar - Apr;26(3):441-449. Epub 2018 May 18.

Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece.

Study Objective: Τo investigate whether the use of vasopressin played an important role in the safe expansion of the indications of laparoscopic myomectomy in our practice.

Design: A retrospective comparison of prospectively collected data (Canadian Task Force classification II2).

Setting: A gynecologic endoscopy unit in a tertiary university hospital.

Patients: One hundred fifty patients undergoing laparoscopic myomectomy; 50 were treated without the use of any vasoconstrictive agent (group 1), and 100 were treated with intraoperative intramyometrial injection of dilute vasopressin (20 IU/100 mL normal saline) (group 2).

Interventions: Laparoscopic myomectomy.

Measurements And Main Results: We compared the 2 groups in terms of size, number, and type of myomas; estimated blood loss (EBL); procedure length; transfusion rates; laparoconversion rates; and rates of complications. Two cases in group 1 (4%) were laparoconverted versus none (0%) in group 2. Overall, the mean EBL was 321.8 ± 246.0 mL in group 1 compared with 147.8 ± 171.8 mL in group 2, respectively (p <.001). Additionally, EBL was significantly lower in the vasopressin group in all of the study's subgroups of patients stratified according to the size and number of myomas. Procedure length did not differ significantly between the 2 groups (130.8 ± 49.5 vs 115.6 ± 49.4 minutes, p = .078). The risk factors for prolongation of the procedure included size and number of myomas independently of vasopressin. The rates of hypercapnea and subcutaneous emphysema were higher in group 1. The risk factors for hypercapnea and subcutaneous emphysema included the size and intramural position of the largest myoma. Vasopressin was not associated with serious cardiovascular adverse events.

Conclusions: Vasopressin is effective in reducing blood loss during laparoscopic myomectomy. Although experienced surgeons may achieve comparable operation times without vasopressin, even in the most challenging cases, blood loss may still be considerable. The occurrence of hypercapnea is higher in untreated cases and may contribute to laparoconversion.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jmig.2018.05.011DOI Listing
July 2019

Using a Mobile Smartphone to Perform Laparoscopy.

J Minim Invasive Gynecol 2018 Jul - Aug;25(5):912-915. Epub 2018 Feb 6.

1st Department of Obstetrics and Gynecology, University of Athens, Alexandra Hospital, Athens, Greece.

Laparoscopy has gradually expanded its use in gynecologic surgery over the last 3 decades. In this report, a new laparoscopic setup is presented using a mobile smartphone that allows for a low-cost, portable laparoscopic viewing system. The setup was created with the coupling of a rigid 0-degree, 10-mm-diameter laparoscope via a commercially available adapter with a smartphone. The light source used was also a portable and rechargeable light-emitting diode cold light source. We completed 17 diagnostic laparoscopies for different pathologies such as ectopic pregnancy, ovarian torsion, a luteal hemorrhagic cyst, and disseminated ovarian cancer. Five operations were converted from diagnostic to operative laparoscopy. The diagnosis was right tubal pregnancy, salpingectomy was performed, and the new setup was used for the entire operation, allowing the surgeon to complete the surgery successfully. This is the first report of the application of mobile technology used to facilitate a laparoscopic operation. It is our intention that this experience coupled with future hardware improvements will lead to future studies to expand the use of mobile technology in the laparoscopic setting.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jmig.2017.12.027DOI Listing
February 2018

Ovarian vein thrombosis after total laparoscopic hysterectomy with unilateral adnexectomy: A case report.

Int J Surg Case Rep 2017 4;41:1-4. Epub 2017 Oct 4.

1st OB.GYN Department, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, Lourou and Vasilissis Sofias Ave., 11528 Athens, Greece. Electronic address:

Introduction: Ovarian vein thrombosis is a rare but potentially serious complication after surgical and gynecologic procedures such as oophorectomy and hysterectomy. The association of this event with laparoscopic hysterectomy in particular, is very rare. Only two cases have been described so far.

Presentation Of Case: We present a case of ovarian vein thrombosis after laparoscopic hysterectomy in a 40-year-old with deep endometriosis and multiple intramural uterine myomas. Laparoscopic hysterectomy, left oophorectomy, right salpingectomy, and suspension (ovariopexy) of the right ovary on the ipsilateral round ligament of the uterus were performed, using bipolar electrocautery as a hemostatic tool.

Discussion: The 7th postoperative day the patient presented to our hospital complaining of abdominal pain and fever. An abdominal CT scan demonstrated a filling defect and enlargement of the right ovarian vein, a finding compatible with ovarian vein thrombosis. She was treated with low molecular weight heparin (LMWH). On the 19th postoperative day, an MRI scan was performed and did not reveal any pathological findings of the right ovarian vein. The patient was discharged on LMWH for three months. Post treatment evaluation for thrombophilia was negative for pathological findings.

Conclusion: Our case is a very rare condition. Only two 'similar' cases have been described in the literature so far. Bipolar electrocautery and ovariopexy on the ipsilateral round ligament during laparoscopic hysterectomy should be evaluated further as possible contributing mechanisms for the thrombus formation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijscr.2017.09.022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5633753PMC
October 2017

Ultrasonographic Evaluation of the Urethral Rhabdosphincter Morphology in Female Patients With Urodynamic Stress Incontinence.

Female Pelvic Med Reconstr Surg 2017 Jul/Aug;23(4):267-271

From the First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece.

Objectives: During the last 2 decades, ultrasonography has been proposed for the morphologic evaluation of the urethral rhabdosphincter. The aims of this study were to evaluate the feasibility of a simple sonographic technique for the assessment of the urethral rhabdosphincter morphology by using a 2-dimensional (2D) transvaginal transducer and to evaluate any associations between the sonographic parameters of rhabdosphincter morphology with the presence of urodynamic stress incontinence (USI).

Methods: This was a prospective study of women who underwent urodynamic studies and an introital 2D ultrasonography and divided in 2 groups based on the presence or absence of USI. Measurements included rhabdosphincter thickness at the 3-o'clock (right) and 9-o'clock (left) positions and the rhabdosphincter outer (Π) and inner circumference (π). Based on these values, the mean thickness of the rhabdosphincter (R + L / 2), the rhabdosphincter differential perimeter (Π - π), and area (A - α) were also calculated.

Results: Statistical analysis showed that women with a rhabdosphincter area of less than 0.65 cm, mean thickness of less than 0.24 cm, and differential perimeter of less than 1.08 cm had 3.98, 5.67, and 5.41 times greater odds for USI, respectively. Receiver operating characteristic curve analysis results showed that the optimal cutoff values for the prediction of USI from rhabdosphincter thickness, differential perimeter. and surface area were 0.24 cm (79.6% sensitivity, 63.4% specificity), 1.08 cm (70.8% sensitivity and 69.1% specificity), and 0.65 cm (71.9% sensitivity, 57.1% specificity), respectively.

Conclusions: Introital ultrasonography with a 2D transvaginal probe allowed the visualization of the urethral rhabdosphincter morphology in greater than 90% of the cases. Sonographic measurements showed that patients with USI had a thinner urethral rhabdosphincter than did women with a normal sphincteric mechanism.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/SPV.0000000000000355DOI Listing
April 2018

Pre- and postoperative magnetic resonance imaging (MRI) findings in patients treated with laparoscopic sacrocolpopexy. Is it a safe procedure for all patients?

Neurourol Urodyn 2018 01 8;37(1):316-321. Epub 2017 May 8.

First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece.

Introduction: Laparoscopic sacrocolpopexy (LSCP) is a reference operation for apical compartment prolapse repair. Aim of this study is to describe the early and midterm postoperative MRI findings of the lumbosacral region (LSR) in patients undergoing LSCP and to detect any imaging changes that the presence of the mesh may cause on patients with preexisting degenerative disease of the LSR.

Methods: Patients with POP-Q grade III and IV uterovaginal or vaginal vault prolapse who were considered eligible for LSCP were invited to participate. An MRI of the LSR was performed preoperatively and then 3 and 12 months postoperatively. Patients with vaginal vault prolapse underwent LSCP, while women with uterovaginal prolapse were treated with the vaginally assisted laparoscopic sacrocolpopexy (VALS).

Results: A total of 30 patients were included in the study; 18 (60%) underwent LSCP and 12 (40%) VALS. On preoperative MRIs, 83.3% (25/30) of patients had degenerative changes and 70% (21/30) reported having low back pain (LBP). Postoperative MRIs did not reveal any imaging changes compared to the preoperative MRI findings both for patients with or without preexisting degenerative abnormalities of the LSR. No significant changes in the LBP score were observed postoperatively.

Conclusions: Any bone marrow or soft-tissue changes at MRIs of the LSR early after the insertion of a synthetic mesh, does not constitute an expected postoperative finding and should raise the suspicion of an ongoing inflammatory or infectious spinal process (spondylodiscitis). Additionally, LSCP seems to be a safe surgical approach for women with preexisting degenerative disease of the LSR.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/nau.23294DOI Listing
January 2018

Laparoscopic Cystectomy In-a-Bag of an Intact Cyst: Is It Feasible and Spillage-Free After All?

Minim Invasive Surg 2016 23;2016:8640871. Epub 2016 Mar 23.

1st Department of Obstetrics and Gynecology of the University of Athens, Alexandra Hospital, 80 Queen Sophie Avenue and Lourou Street, 11528 Athens, Greece.

This prospective study was conducted to assess the feasibility of laparoscopic cystectomy of an intact adnexal cyst performed inside a water proof endoscopic bag, aiming to avoid intraperitoneal spillage in case of cyst rupture. 102 patients were recruited. Two of them were pregnant. In 8 of the patients the lesions were bilateral, adding up to a total of 110 cysts involved in our study. The endoscopic sac did not rupture in any case. Mean diameter of the cysts was 5.7 cm (range: 2.3-10.5 cm). In 75/110 (68.2%) cases, cystectomy was completed without rupture, whereas in the remaining 35/110 (31.8%) cases the cyst ruptured. Minimal small spillage occurred despite every effort only in 8/110 (7.2%) cases with large (>8 cm) cystic teratomas. There were no intraoperative or postoperative complications. We concluded that laparoscopic cystectomy in-a-bag of an intact cyst is feasible and oncologically safe for cystic tumors with a diameter < 8 cm. Manipulation of larger tumors with the adnexa into the sac may be more difficult, and in such cases previous puncture and evacuation of the cyst contents should be considered.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2016/8640871DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4821967PMC
April 2016

Endocervical Atypical Polypoid Adenomyoma.

J Minim Invasive Gynecol 2016 Jan 22;23(1):130-2. Epub 2015 Aug 22.

First Department of Obstetrics & Gynecology, University of Athens, "Alexandra" Hospital, Athens, Greece.

Atypical polypoid adenomyomas (APAMs) are rare uterine tumors that occur predominantly in premenopausal women, with less than 250 cases reported so far, worldwide. They may recur after treatment, and they may coexist with, or precede development of an endometrial adenocarcinoma. For this reason cases managed with conservative surgery or medical therapies require long-term follow-up. We report the case of a 41 years old nulliparous patient who during a diagnostic hysteroscopy was found with an endocervical atypical polypoid adenomyoma (APAM). The patient was desirous of a pregnancy, reported menometrorrhagia, and had a coexistent 5 cm, grade 2, submucous myoma, 3 endometrial polyps, and diffuse adenomyosis. She was treated with hysteroscopic resection of the APAM and polyps, plus laparoscopic myomectomy and wedge resection of adenomyosis. She is on an IVF list and after 4 months she is symptoms-free.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jmig.2015.08.879DOI Listing
January 2016

The "1-3-5 cough test": comparing the severity of urodynamic stress incontinence with severity measures of subjective perception of stress urinary incontinence.

Int Urogynecol J 2016 Mar 4;27(3):419-25. Epub 2015 Aug 4.

Urogynaecology Unit, First Department of Obstetrics and Gynecology, University of Athens, "Alexandra Hospital", Lourou 1 Str, Athens, 11528, Greece.

Introduction And Hypothesis: The purpose of the study was to examine whether a test performed during urodynamics, the "1-3-5 cough test", could determine the severity of urodynamic stress incontinence (USI).

Methods: We included women referred for urodynamics who were diagnosed with USI. The "1-3-5 cough test" was performed to grade the severity of USI at the completion of filling cystometry. A diagnosis of "severe", "moderate" or "mild" USI was given if urine leakage was observed after one, three or five consecutive coughs respectively. We examined the associations between grades of USI severity and measures of subjective perception of stress urinary incontinence (SUI): International Consultation of Incontinence Modular Questionnaire-Female Lower Urinary Tract Symptom (ICIQ-FLUTS), King's Health Questionnaire (KHQ), Urinary Distress Inventory-6 (UDI-6), Urinary Impact Questionnaire-7 (UIQ-7).

Results: A total of 1,181 patients completed the ICIQ-FLUTS and KHQ and 612 completed the UDI-6 and UIQ-7 questionnaires. There was a statistically significant association of higher grades of USI severity with higher scores of the incontinence domain of the ICIQ-FLUTS. The scores of the UDI-6, UIQ-7 and of all KHQ domains (with the exception of general health perception and personal relationships) had statistically significant larger mean values for higher USI severity grade. Groups of higher USI severity had statistically significant associations with higher scores of most of the subjective measures of SUI.

Conclusions: Severity of USI, as defined by the "1-3-5 cough test", was associated with the severity of subjective measures of SUI. This test may be a useful tool for the objective interpretation of patients with SUI who undergo urodynamics.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00192-015-2808-4DOI Listing
March 2016