Publications by authors named "Ibrahim Alkatout"

141 Publications

Uterine Fibroids and Infertility.

Diagnostics (Basel) 2021 Aug 12;11(8). Epub 2021 Aug 12.

Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 3, 24105 Kiel, Germany.

Infertility is a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. Uterine fibroids are the most common tumor in women, and their prevalence is high in patients with infertility. Fibroids may be the sole cause of infertility in 2-3% of women. Depending on their location in the uterus, fibroids have been implicated in recurrent pregnancy loss as well as infertility. Pregnancy and live birth rates appear to be low in women with submucosal fibroids; their resection has been shown to improve pregnancy rates. In contrast, subserosal fibroids do not affect fertility outcomes and their removal does not confer any benefit. Intramural fibroids appear to reduce fertility, but recommendations concerning their treatment remain unclear. Myomectomy should be discussed individually with the patient; other potential symptoms such as dysmenorrhea or bleeding disorders should be included in the indication for surgery.
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http://dx.doi.org/10.3390/diagnostics11081455DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8391505PMC
August 2021

Changes in pregnancy outcomes during the COVID-19 lockdown in Iran.

BMC Pregnancy Childbirth 2021 Aug 22;21(1):577. Epub 2021 Aug 22.

Department of Obstetrics and Gynecology, Kiel School of Gynaecological Endoscopy. Campus Kiel, University Hospitals Schleswig-Holstein, Kiel, Germany.

Background: The Covid-19 pandemic response is influencing maternal and neonatal health care services especially in developing countries. However, the indirect effects of Covid-19 on pregnancy outcomes remain unknown. The aim of the present study was to compare pregnancy outcomes before and after the beginning of the Covid-19 pandemic in Iran.

Methods: We performed a retrospective analysis of the medical records of 2,503 pregnant women with singleton pregnancies, admitted to the maternity department of a women's hospital in Tehran, Iran, during the pre-Covid-19 pandemic (February 19 to April 19, 2019) and the intra-Covid- 19 pandemic (February 19 to April 19, 2020) period.

Results: We included 2,503 women admitted to the hospital; 1,287 (51.4 %) were admitted before the Covid-19 lockdown and 1,216 (48.6 %) during the Covid-19 lockdown. There were no significant differences in stillbirth rates (p = 0.584) or pregnancy complications (including preeclampsia, pregnancy-induced hypertension and gestational diabetes) (p = 0.115) between pregnant women in the pre- and intra-pandemic periods. However, decreases in preterm births (p = 0.001), and low birth weight (p = 0.005) were observed in the pandemic period compared to the pre-pandemic period. No significant difference in the mode of delivery, and no maternal deaths were observed during the two time periods.

Conclusions: In our study we observed a decrease in preterm births and low birth weight, no change in stillbirths, and a rise in the admission rates of mothers to the ICU during the initial Covid-19 lockdown period compared to pre-Covid-19 lockdown period. Further research will be needed to devise plan for immediate post-pandemic care and future health care crises.
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http://dx.doi.org/10.1186/s12884-021-04050-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8380188PMC
August 2021

Correction to: Clear-cell carcinoma originating from cesarean section scar: two case reports.

J Med Case Rep 2021 Aug 10;15(1):430. Epub 2021 Aug 10.

Kiel School of Gynaecological Endoscopy, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 24, 24105, Kiel, Germany.

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http://dx.doi.org/10.1186/s13256-021-03035-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8353859PMC
August 2021

Laparoscopic vaginal native tissue repair in combination with pectopexy. Sub-analysis from an international, prospective, and multi-centre study: short term results.

Minim Invasive Ther Allied Technol 2021 Jul 18:1-7. Epub 2021 Jul 18.

Department of Obstetrics and Gynecology, University of Kiel, Kiel, Germany.

Introduction: The use of mesh for vaginal repairs is currently problematic and as a consequence, there is increased interest in native tissue repair. We describe the follow-up data of a sub-analysis of a prospective and multi-center study focusing on the combination of pectopexy and native tissue repair. Patients were followed up for 12-18 months after surgery (+ SD: 15). Two-hundred and sixty-four patients attended the clinics for physical examination and were integrated into the follow-up. Cystocele repair was performed laparoscopically in 84 patients and vaginally in 52 patients. Posterior repair was performed vaginally in 40 patients and laparoscopically in 53 patients. : Clinical success rate, patient recommendations and patient satisfaction rates were similar in both groups. The laparoscopic anterior repair resulted in an 89% cure or anatomical improvement rate; this compared to 94.2% for the vaginal approach. In the posterior group, laparoscopy resulted in a 94.3% cure or improvement rate compared to 97.5% in the second group. The outcomes of both strategies showed satisfactory results in our study. Consequently, surgeons may choose between the two strategies according to their preference and skill. The two approaches only differed with regard to vaginal scarring. We suggest future research investigating the long-term impact of scarring.
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http://dx.doi.org/10.1080/13645706.2021.1941118DOI Listing
July 2021

Massive uterine fibroid: a diagnostic dilemma: a case report and review of the literature.

J Med Case Rep 2021 Jul 13;15(1):344. Epub 2021 Jul 13.

Department of Gynecology and Obstetrics, University Medical Center UKSH, Campus Kiel, Arnold-Heller-Straße 3, Haus C, 24105, Kiel, Germany.

Background: Fibroids of the uterus are the most common benign pelvic tumors in women worldwide. Their diagnosis is usually not missed because of the widespread and well-established use of ultrasound in gynecological clinics. Hence, the development of an unusually large myoma is a rare event, particularly in first-world countries such as Germany. It is even more uncommon that a myoma is misdiagnosed as a dietary failure.

Case Presentation: Herein, we report the case of a Caucasian woman with a giant fibroid that reached a size of over 50 cm, growing slowly over the past 15 years, and was misdiagnosed as abdominal fat due to weight gain. We aim to discuss the factors that lead to the growth of such a huge tumoral mass, including misdiagnosis and treatment, and the psychological impact. Through this case, we intend to increase the awareness among general physicians and gynecologists. Although menstrual disorders incorporate several pathologies, adequate assessment remains the primary responsibility of health care providers. A literature review revealed approximately 60 cases of giant uterine fibroids.

Conclusion: The use of clinical and diagnostic devices, especially ultrasound, in this case, is indispensable. In conclusion, the growth of a giant fibroid can have disastrous effects on a woman's health, including surgical trauma and psychological issues.
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http://dx.doi.org/10.1186/s13256-021-02959-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8276390PMC
July 2021

Babu and Magon uterine closure technique during cesarean section: A randomized double-blind trial.

J Obstet Gynaecol Res 2021 Sep 15;47(9):3186-3195. Epub 2021 Jun 15.

Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel, Germany.

Aim: We compared the effectiveness of the Babu and Magon uterine closure technique and unlocked double-layer uterine closure on the integrity and thickness of the uterine scar.

Methods: A randomized double-blind trial was performed at Hazrat-e Rasoul -e-Akram Hospital, Tehran, Iran, from March 2018 to December 2019, in 72 pregnant women who were candidates for cesarean section for the first time. Women were randomly assigned to the Babu and Magon uterine closure technique (intervention group, n = 34) or double-layer closure of the uterine incision (control group, n = 38). The primary outcome of the study was the frequency of myometrial defects at the site of the scar (niche), and a large niche. Secondary outcomes, including the time taken for uterine closure and postpartum hemorrhage (early and late), were compared between groups.

Results: Adjacent myometrium thickness (AMT) between the two groups was not statistically significant. A niche was reported in 23.5% (8/34) and 50% (19/38) of women in the intervention and controls, respectively (p = 0.02). A large niche was reported in 2.9% (1/34) and 23.7% (9/38) of women in the intervention and controls, respectively (p < 0.01). The duration of uterine closure was not statistically significant between the two groups. Hemoglobin levels did not differ significantly between groups during the first 24 h post-surgery.

Conclusion: The results of the study showed that the technique of uterine closure is one of the main potential determinants of myometrial healing. The Babu and Magon uterine closure technique seems to lead to tissue alignment during suturing and consequently cause better myometrial healing, although this issue calls for well-founded longer studies of appropriate design.
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http://dx.doi.org/10.1111/jog.14889DOI Listing
September 2021

Perioperative considerations in the treatment of endometriosis.

J Turk Ger Gynecol Assoc 2021 Jun 10. Epub 2021 Jun 10.

Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Kiel, Germany.

Endometriosis is one of the most common benign diseases in women of reproductive age. Nearly all gynecological offices and clinics are confronted with endometriosis; the frequency and severity of the disease vary from one setting to another. Adjoining specialties such as internal medicine, general medicine, surgery, urology, orthopedics, neurology and psychosomatic medicine are directly or indirectly confronted with various forms of endometriosis and its sequelae. The disease is marked by pelvic pain, dysmenorrhea, dyspareunia and sterility. Even in current times, several years elapse between the onset of the disease and its diagnosis. The diagnosis of endometriosis is rendered difficult by the fact that the symptoms may be very diverse. A precise documentation of the patient's medical history and thorough diagnostic procedures are essential to establish the disease. These will be described in the following.
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http://dx.doi.org/10.4274/jtgga.galenos.2021.2021.0017DOI Listing
June 2021

Ectopic pregnancy in noncommunicating horn of unicornuate uterus: 3D-ultrasound and primary laparoscopic management.

Clin Case Rep 2021 May 24;9(5):e04261. Epub 2021 May 24.

Department of Gynecology and Obstetrics University Hospitals Schleswig-Holstein Kiel Germany.

Unicornuate uterus with pregnancy in the noncommunicating rudimentary horn is extremely rare. Diagnosis requires awareness, high suspicion index, 3D ultrasound, and MRI. If missed, it can be catastrophic. Treatment varies across literature. We present a case where detection was done by 3D ultrasound and primary laparoscopic surgery done for treatment.
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http://dx.doi.org/10.1002/ccr3.4261DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8142796PMC
May 2021

The blooming phenomenon: a rare but a dilemma in hysteroscopic resection of myomas.

J Turk Ger Gynecol Assoc 2021 Jun 4. Epub 2021 Jun 4.

Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel, Germany.

Modern surgical technologies allow gynecologists to treat most submucosal myomas by some form of resection hysteroscopically. What appears on imaging or direct visualization to be a submucosal myoma can be a single tumor, or may represent multiple smaller myomas appearing as one, compacted together in a typical pseudo capsule. During myoma resection, the effect of the distending media can be different depending on the morphology of the myomas. After starting resection, the power of distending media can push truly solitary myoma to somewhat flatten against the uterine wall. However, in the second type of myoma, the fluid can push the myomas into the uterine cavity, similar to the blooming of a flower. The tip of the hysteroscope may enter the dissected spaces between the myomas, impairs the panoramic view. This event can be a cause of failure of hysteroscopic myomectomy to adequately treat the myomas encountered. In this study, blooming phenomenon is introduced, the problems created by this phenomenon and solutions for its management are considered.
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http://dx.doi.org/10.4274/jtgga.galenos.2021.2021.0006DOI Listing
June 2021

Has COVID-19 Affected Cancer Screening Programs? A Systematic Review.

Front Oncol 2021 17;11:675038. Epub 2021 May 17.

School of Public Health, Iran University of Medical Sciences (IUMS), Tehran, Iran.

Background: Health care services across the world have been enormously affected by the onset of the coronavirus disease 2019 (COVID-19). Services in oncology have been curtailed because medical services have been focused on preventing the spread of the virus and maximizing the number of available hospital beds. The present study was designed to investigate the impact of COVID-19 on cancer screening.

Methods: Databases such as Medline, Web of Science Core Collection (Indexes = SCI-EXPANDED, SSCI, A & HCI Timespan) and Scopus were searched comprehensively for articles published until January 2021. The keywords used were COVID-19 and , Articles dealing with cancer screening in the COVID-19 pandemic were included in the review.

Results: The review comprised 17 publications. The impact of COVID-19 was categorized into four dimensions: a significant decline in cancer screening and pathology samples, the cancer diagnosis rate, an increase in advanced cancers, mortality rate and years of life lost (YLLs).

Conclusion: Cancer screening programs have been clearly interrupted since the onset of the COVID-19 disease. The anticipated outcomes include delayed diagnosis and marked increases in the numbers of avoidable cancer deaths. Urgent policy interventions are needed to handle the backlog of routine diagnostic services and minimize the harmful effects of the COVID-19 pandemic on cancer patients.
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http://dx.doi.org/10.3389/fonc.2021.675038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8165307PMC
May 2021

Absorption, distribution, metabolism and excretion of hyaluronic acid during pregnancy: a matter of molecular weight.

Expert Opin Drug Metab Toxicol 2021 Jul 30;17(7):823-840. Epub 2021 Jun 30.

Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital,University of Insubria, Varese, Italy.

Introduction: For many years hyaluronic acid (HA) was mainly used for its hydrating properties. However, new applications have recently arisen, considering the biological properties of HA and its molecular weight. Clinical application of low molecular weight HA (LMW-HA) initially was supported by specific absorption data. The identification of high molecular weight HA (HMW-HA) absorption pathways and the knowledge of its physiological role allowed to evaluate its clinical application. Based on the immunomodulatory properties of HMW-HA and its physiological involvement as signaling molecule, pregnancy represents an interesting context of application.

Area Covered: This expert opinion includes in-vitro, in-vivo, ex-vivo and clinical studies on gestational models. It provides an overview of the physiological and the therapeutic role of HMW-HA in pregnancy starting from its metabolism. Indeed, HMW-HA is widely involved in several physiological processes as implantation, immune response, uterine quiescence and cervical remodeling, and therefore is an essential molecule for a successful pregnancy.

Expert Opinion: Available evidence suggests that HMW-HA administration can support physiological pregnancy, favoring blastocyst adhesion and development, preventing miscarriage and pre-term birth. For this reason, supplementation in pregnancy should be evaluated.
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http://dx.doi.org/10.1080/17425255.2021.1931682DOI Listing
July 2021

Clear-cell carcinoma originating from cesarean section scar: two case reports.

J Med Case Rep 2021 Apr 3;15(1):146. Epub 2021 Apr 3.

University Hospital Schleswig-Holstein, Campus Kiel, Kiel School of Gynaecological Endoscopy, Arnold-Heller-Str. 3, Haus 24, 24105, Kiel, Germany.

Background: Clear-cell carcinoma arising from the surgical cesarean section scar is very infrequent. The present study reports two patients with clear-cell carcinoma arising from an abdominal wall scar 20 and 23 years after their last cesarean section.

Case Presentation: Both Iranian patients had prior cesarean sections nearly 20 years earlier. Patients 1 and 2 had transverse and vertical abdominal incisions, respectively. The initial clinical presentation was a huge lower abdominal mass at the site of the previous cesarean section scar. Both patients underwent abdominal wall mass biopsy. The histological analysis revealed the presence of malignancy. Both patients underwent full-thickness resection of the abdominal wall mass. All surgical margins were tumor-free; however, patient 1 had a very narrow tumor-free margin near the pubic symphysis. As the imaging report of patient 2 revealed the presence of a pelvic mass, the exploration of the intraperitoneal space, simple total abdominal hysterectomy (TAH), bilateral salpingo-oophorectomy (BSO), and the excision of enlarged pelvic lymph nodes were performed during the surgery. Six cycles of paclitaxel and carboplatin every 3 weeks as adjuvant chemotherapy was administered for both patients after the surgery. One of the patients had disease recurrence 5 months after the termination of chemotherapy, and the other is still disease-free. These two patients had similar pathology and received a similar initial adjuvant treatment; however, they were different in terms of the direction of tumor spread, tumor distance from the pubic symphysis, status of tumor margins, and surgical procedures.

Conclusions: We encountered distinct prognoses in the clear-cell carcinoma of cesarean section scars presented herein. The researchers can recommend complete surgical excision of the abdominal wall mass with wide tumor-free margins, exploration of the abdominopelvic space, TAH, and BSO during the first surgery.
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http://dx.doi.org/10.1186/s13256-021-02775-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8019170PMC
April 2021

Robotic infant surgery with 3 mm instruments: a study in piglets of less than 10 kg body weight.

J Robot Surg 2021 Mar 26. Epub 2021 Mar 26.

Department of General-, Visceral-, Thoracic-, Transplant- and Pediatric Surgery, Faculty of Medicine, Christian-Albrechts-University of Kiel, UKSH University Hospital of Schleswig-Holstein Kiel Campus, Arnold-Heller-Strasse 3, 24105, Kiel, Germany.

No data exist concerning the appication of a new robotic system with 3 mm instruments (Senhance®, Transenterix) in infants and small children. Therefore, the aim of this study was to test the system for its feasibility, performance and safety of robotic pediatric abdominal and thoracic surgery in piglets simulating infants with a body weight lower than 10 kg. 34 procedures (from explorative laparoscopy to thoracoscopic esophageal repair) were performed in 12 piglets with a median age of 23 (interquartile range: 12-28) days and a median body weight of 6.9 (6.1-7.3) kg. The Senhance® robotic system was used with 3 mm instruments, a 10 mm 3D 0° or 30° videoscope and advanced energy devices, the setup consisted of the master console and three separate arms. The amount, size, and position of the applied ports, their distance as well as the distance between the three operator arms of the robot, external and internal collisions, and complications of the procedures were recorded and analyzed. We were able to perform all planned surgical procedures with 3 mm robotic instruments in piglets with a median body weight of less than 7 kg. We encountered two non-robot associated complications (bleeding from the inferior caval and hepatic vein) which led to termination of the live procedures. Technical limitations were the reaction time and speed of robotic camera movement with eye tracking, the excessive bending of the 3 mm instruments and intermittent need of re-calibration of the fulcrum point. Robotic newborn and infant surgery appears technically feasible with the Senhance® system. Software adjustments for camera movement and sensitivity of the fulcrum point calibration algorithm to adjust for the increased compliance of the abdominal wall of infants, therefore reducing the bending of the instruments, need to be implemented by the manufacturer as a result of our study. To further evaluate the Senhance® system, prospective trials comparing it to open, laparoscopic and other robotic systems are needed.
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http://dx.doi.org/10.1007/s11701-021-01229-0DOI Listing
March 2021

A randomized, double-blind, placebo-controlled pilot study of the comparative effects of dienogest and the combined oral contraceptive pill in women with endometriosis.

Int J Gynaecol Obstet 2021 Mar 17. Epub 2021 Mar 17.

Kiel School of Gynecological Endoscopy, University Hospitals Schleswig-Holstein, Kiel, Germany.

Objective: To compare the effects of dienogest and a combined oral contraceptive pill (COCP) after laparoscopic surgery on pain and quality of life in women with severe endometriosis.

Methods: A randomized double-blind pilot study was conducted from March 2018 to March 2020 in women with severe endometriosis confirmed by laparoscopic surgery. A total of 108 patients who had undergone laparoscopic surgery received dienogest, COCP, or placebo daily for 6 months. Primary and secondary outcomes were compared between the three groups.

Results: Treatment with dienogest or COCP was associated with improved self-reported pain after 6 months of treatment, as evidenced by significantly lower scores for pelvic pain and dyspareunia compared with placebo (P < 0.05). Significant differences in overall quality of life score were observed over 6 months in the dienogest, COCP, and placebo groups (mean difference 22.00, 23.45, and 6.45 points, respectively; P < 0.001). Post-hoc analysis revealed a significant difference in overall quality of life score between the placebo group and the dienogest (P < 0.001) and COCP groups (P = 0.004).

Conclusion: Postoperative administration of dienogest or COCP reduced endometriosis-associated pain and improved quality of life in women with severe endometriosis.

Clinical Trials Registration: https://en.irct.ir/trial/43070.
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http://dx.doi.org/10.1002/ijgo.13677DOI Listing
March 2021

Embryological Development and Topographic Anatomy of Pelvic Compartments-Surgical Relevance for Pelvic Lymphonodectomy.

J Clin Med 2021 Feb 11;10(4). Epub 2021 Feb 11.

Kurt Semm Center for Minimally Invasive and Robotic Surgery, Center of Clinical Anatomy, Institute of Anatomy, Kiel University, 24098 Kiel, Germany.

Background: The oncological outcome of surgery for the treatment of pelvic malignancies can be improved by performing pelvic lymphonodectomy. However, the extent and regions of lymph node harvest are debated and require profound knowledge of anatomy in order to avoid collateral damage.

Methods: The embryological development and topographic anatomy of pelvic compartments in relation to pelvic lymphonodectomy for rectal, uterine, and prostate cancer are reviewed. Based on pre-dissected anatomical specimens, lymph node regions and drainage routes of the posterior and urogenital pelvic compartments are described in both genders. Anatomical landmarks are highlighted to identify structures at risk of injury during pelvic lymphonodectomy.

Results: The ontogenesis of urogenital and anorectal compartments and their lymphatic supply are key factors for adequate lymphonodectomy, and have led to compartment-based surgical resection strategies. However, pelvic lymphonodectomy bears the risk of injury to somatic and autonomic nerves, vessels, and organs, depending on the regions and extent of surgery.

Conclusion: Embryologically defined, compartment-based resection of pelvic malignancies and their lymphatic drainage routes are based on clearly delineated anatomical landmarks, which permit template-oriented pelvic lymphonodectomy. Comprehensive knowledge of pelvic anatomy, the exchange of surgical concepts between specialties, and minimally invasive techniques will optimize pelvic lymphonodectomy and reduce complications.
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http://dx.doi.org/10.3390/jcm10040708DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7916954PMC
February 2021

Women with gynecologic cancers need more psychological attention during the COVID-19 pandemic.

EXCLI J 2021 1;20:194-196. Epub 2021 Feb 1.

University Hospitals Schleswig-Holstein, Campus Kiel, Kiel School of Gynaecological Endoscopy. Arnold-Heller-Str. 3, Haus 24, 24105 Kiel, Germany.

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http://dx.doi.org/10.17179/excli2021-3364DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7898042PMC
February 2021

Impact of nicotine and maternal BMI on fetal birth weight.

BMC Pregnancy Childbirth 2021 Feb 12;21(1):127. Epub 2021 Feb 12.

Department of Gynecology, University Hospital Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.

Background: According to the World Health Organization, smoking is the most important risk factor for adverse pregnancy outcomes in industrialized nations. As the individual factors (body mass index - BMI (kg/m) - and cigarette consumption) have been extensively investigated in pregnancy, we aimed to establish how maternal BMI and nicotine interact with regard to perinatal outcomes and birth weight.

Methods: Data from 110.047 singleton pregnancies, achieved from the German Perinatal Survey in Schleswig-Holstein and registered between 2010 and 2017 were analyzed in August 2018 concerning maternal BMI and smoking. The BMI was taken from the maternity log. Information concerning the smoking status were self-reported and further subdivided into the following four categories: a) non-smokers; b) 1-7 cigarettes/day; c) 8-14 cigarettes/ day; and d) ≥ 15 cigarettes/ day. Furthermore, we classified women by their BMI into underweight, normal weight, overweight and obese. Comparisons between non-smokers and the respective smoking group, and their relationship with maternal BMI were performed by the t-test (birth weight). A P-value ≤0.05 was considered to indicate statistical significance.

Results: A number of 97.092 women (88.2%) were non-smokers and 12.955 (11.8%) were smokers. Furthermore 10.3% of women of normal weight smoked during pregnancy, but both high and low BMI were associated with a high prevalence of smoking. The proportion of smokers was highest (18.1%) among underweight women (BMI ≤ 18.5 kg/m). A large number of smokers (15.5%) were registered in the obesity group (BMI ≥ 30 kg/m). Mean birth weight (≥ 37 + 0 gestational age) increased with increasing maternal BMI, and was reduced by smoking for every BMI category. The differences between smokers and non-smokers were always highly significant (p < 0.001). Mean birth weight varied between 2995 g in underweight frequent smokers and 3607 g in obese non-smokers.

Conclusion: Both maternal BMI and smoking during pregnancy influences the birth weight and therefore pregnancy outcome. Smoking during pregnancy was significantly associated with low birth weight. Pregnant women should be advised to cease or at least reduce smoking in order to improve the birth weight of the newborn and to minimize child morbidities.
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http://dx.doi.org/10.1186/s12884-021-03593-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7881635PMC
February 2021

Recurrent implantation failure - an overview of current research.

Gynecol Endocrinol 2021 Jul 29;37(7):584-590. Epub 2021 Jan 29.

Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Kiel, Germany.

Background: Recurrent implantation failure (RIF) can be defined as a failure to achieve a clinical pregnancy after transfer of at least four embryos of good quality in a minimum of three fresh or frozen cycles in women under the age of 40. RIF is often a complex problem with a wide variety of etiologies and mechanisms as well as treatment options.

Summary: Anatomical conditions of the uterus, thrombophilia, genetic abnormalities, or immunological factors are only a few examples which could be responsible for RIF. The recommendations for women with RIF vary depending on the source of their problem. There is not just one treatment option, but many depending on the etiology and the severity of the problem.

Key Message: However, it would help to establish a set of standardized examinations and tests to use, in order to do a preliminary evaluation on each patient, which would then hopefully direct the approach of treatment for each individual couple.
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http://dx.doi.org/10.1080/09513590.2021.1878136DOI Listing
July 2021

Video Feedback and Video Modeling in Teaching Laparoscopic Surgery: A Visionary Concept from Kiel.

J Clin Med 2021 Jan 5;10(1). Epub 2021 Jan 5.

Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller Str. 3, Building 24, 24105 Kiel, Germany.

Learning curves for endoscopic surgery are long and flat. Various techniques and methods are now available for surgical endoscopic training, such as pelvitrainers, virtual trainers, and body donor surgery. Video modeling and video feedback are commonly used in professional training. We report, for the first time, the application of video modeling and video feedback for endoscopic training in gynecology. The purpose is to present an innovative method of training. Attendees (residents and specialists) of minimally invasive surgery courses were asked to perform specific tasks, which were video recorded in a multimodular concept. Feedback was given later by an expert at a joint meeting. The attendees were asked to fill a questionnaire in order to assess video feedback given by the expert. The advantages of video feedback and video modeling for the development of surgical skills were given a high rating (median 84%, interquartile ranges (IQR) 72.5-97.5%, = 37). The question as to whether the attendees would recommend such training was also answered very positively (median 100%, IQR 89.5-100%, = 37). We noted a clear difference between subjective perception and objective feedback (58%, IQR 40.5-76%, = 37). Video feedback and video modeling are easy to implement in surgical training setups, and help trainees at all levels of education.
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http://dx.doi.org/10.3390/jcm10010163DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7796509PMC
January 2021

Involvement of medical students in a surgery congress: impact on learning motivation, decision-making for a career in surgery, and educational curriculum.

Wien Med Wochenschr 2021 May 14;171(7-8):182-193. Epub 2021 Jan 14.

Center for Clinical Anatomy, Institute of Anatomy, Christian-Albrechts-Universität zu Kiel, Otto-Hahn-Platz 8, 24118, Kiel, Germany.

During the preclinical period of medical school, the clinical relevance of theoretical knowledge is given little attention. Medical students of the second year were invited to participate in an interdisciplinary congress for robot-assisted and digital surgery. The students had to evaluate the impact of the congress on their learning motivation, decision-making for a career in surgery, and relevance for their educational curriculum. Participation in the congress increased their learning motivation for preclinical subjects, and significantly increased their interest in a surgical career. Most students considered active involvement in medical congresses a valuable supplement to the medical curriculum. Congress participation during the preclinical period was ranked positively by medical students. Greater learning motivation and enthusiasm for the pilot teaching project as well as for surgical disciplines were registered. Thus, early involvement of medical students in scientific congresses should be an integral part of their educational curriculum.
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http://dx.doi.org/10.1007/s10354-020-00802-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8057979PMC
May 2021

Surgical outcomes of conventional laparoscopic and robotic-assisted hysterectomy.

Int J Med Robot 2021 Jun 8;17(3):e2225. Epub 2021 Feb 8.

Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Luebeck, Luebeck, Germany.

Introduction: The aim of the present study was to compare surgical outcomes of total laparoscopic hysterectomy with those of the robotic approach using the da Vinci Xi system.

Methods: Patients who underwent hysterectomy with da Vinci Xi for early endometrial cancer or benign indications from 2018 to 2019 were selected. The control group consisted of patients who underwent conventional laparoscopy.

Results: A total of 300 patients were included in the study. The mean duration of surgery differed significantly (p = 0.025) between those who underwent laparoscopy (125.01 ± 76.168) and robotic-assisted surgery (142.96 ± 82.657 min). Blood loss, median hospital stay, intraoperative and postoperative complications were similar in both groups. No statistical difference was observed in the subgroups with a body mass index of more than 30 kg/m or more than 40 kg/m concerning the duration of surgery or the surgical outcome.

Conclusion: The da Vinci Xi did not improve surgical outcomes in patients who underwent hysterectomy by trained laparoscopists and takes more time than conventional laparoscopy when performed in patients of normal weight.
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http://dx.doi.org/10.1002/rcs.2225DOI Listing
June 2021

Lymphadenectomy in endometrial cancer - achieving more with less?

Minim Invasive Ther Allied Technol 2021 Jan 13:1-9. Epub 2021 Jan 13.

Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Kiel, Germany.

The lymph node status of patients with endometrial cancer is known to be a crucial determinant for the prognosis of the disease. It also provides the indication for further adjuvant treatment. The staging of endometrial cancer by surgery has been a controversial issue for more than 30 years. The significant complication rate after lymphadenectomy and the development of minimally invasive surgery have led to the use of sentinel lymph node (SLN) mapping. In the present review, we present the development of surgical staging procedures in patients with endometrial cancer and summarize the recently expanding body of published literature on the subject. SLN mapping is a safe and accurate technique, especially when indocyanine green is used as a tracer. SLN mapping appears to reduce complication rates as well as costs without affecting the oncologic outcome. Large prospective studies are needed to establish the effects of SLN mapping on the outcome of disease, especially in high-risk patients with endometrial cancer. Furthermore, the need for additional systematic lymphadenectomy prior to adjuvant radio-chemotherapy in patients diagnosed with isolated lymph node metastasis during SLN biopsy must be investigated further. This might pave the way for a new surgical approach in patients with endometrial cancer.
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http://dx.doi.org/10.1080/13645706.2020.1868009DOI Listing
January 2021

Recent Advances in Laparoscopy.

J Clin Med 2021 Jan 2;10(1). Epub 2021 Jan 2.

Department of Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.

At the end of 2019, we received reports of abnormally high rates of severe pneumonia and mortality in a city named Wuhan in the province of Hubei in China [...].
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http://dx.doi.org/10.3390/jcm10010131DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7795068PMC
January 2021

Radiotherapy and Its Intersections with Surgery in the Management of Localized Gynecological Malignancies: A Comprehensive Overview for Clinicians.

J Clin Med 2020 Dec 29;10(1). Epub 2020 Dec 29.

Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel, Germany.

Surgery, including minimally invasive surgery, and radiotherapy are key modalities in the treatment of gynecological malignancies. The aim of this review is to offer the multidisciplinary care team a comprehensive summary of the intersections of surgery and radiotherapy in the local treatment of gynecological malignancies. Recent advances in radiotherapy are highlighted. Relevant publications were identified through a review of the published literature. Ovarian, endometrial, cervical, vaginal, and vulvar cancer were included in the search. Current guidelines are summarized. The role of radiotherapy in adjuvant as well as definitive treatment of these entities is synthesized and put into context with surgery, focusing on survival and quality of life. Although these outcomes have improved recently, further research must be focused on the number of life years lost, and the potential morbidity encountered by patients.
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http://dx.doi.org/10.3390/jcm10010093DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7796321PMC
December 2020

Initial Experience with the Safe Implementation of Transanal Total Mesorectal Excision (TaTME) as a Standardized Procedure for Low Rectal Cancer.

J Clin Med 2020 Dec 28;10(1). Epub 2020 Dec 28.

Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 13353 Berlin, Germany.

Introduction: The laparoscopic approach for TME is proven to be non-inferior in oncological outcome compared to open surgery. Anatomical limitations in the male and obese pelvis with resulting pathological shortcomings and high conversion rates were stimuli for alternative approaches. The transanal approach for TME (TaTME) was introduced to overcome these limitations. The aim of this study was to evaluate the outcomes of TaTME for mid and low rectal cancer at our center.

Methods: TaTME is a hybrid procedure of simultaneously laparoscopic and transanal mesorectal excision. A retrospective analysis of all consecutive TaTME procedures performed at our center for mid and low rectal cancer between December 2014 and January 2020 was conducted.

Results: A total of 157 patients underwent TaTME, with 72.6% receiving neoadjuvant chemoradiation. Mean tumor height was 6.1 ± 2.3 cm from the anal verge, 72.6% of patients had undergone neoadjuvant chemoradiotherapy, and 34.2% of patients presented with a threatened CRM upon pretherapeutic MRI. Abdominal conversion rate was 5.7% with no conversion for the transanal dissection. Early anastomotic leakage occurred in 7.0% of the patients. Mesorectum specimen was complete in 87.3%, R1 resection rate was 4.5% (involved distal resection margin) and in 7.6%, the CRM was positive. The three-year local recurrence rate of 58 patients with a follow-up ≥ 36 months was 3.4%. Overall survival was 92.0% after 12 months, and 82.2% after 36 months.

Conclusion: TaTME can be performed safely with acceptable long-term oncological outcome. Low rectal cancer can be well addressed by TaTME, which is an appropriate alternative with low conversion, local recurrence, adequate mesorectal quality and CRM positivity rates.
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http://dx.doi.org/10.3390/jcm10010072DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7795301PMC
December 2020

Accuracy of the Triple Test Versus Colposcopy for the Diagnosis of Premalignant and Malignant Cervical Lesions.

Asian Pac J Cancer Prev 2020 Dec 1;21(12):3501-3507. Epub 2020 Dec 1.

University Hospitals Schleswig-Holstein, Campus Kiel, Kiel School of Gynaecological Endoscopy. Arnold-Heller-Str. 3, Haus 24, 24105 Kiel, Germany.

Background: Despite the World Health Organization (WHO) recommendations concerning the use of alternative tests for the detection of cervical cancer precursor lesions in low-income countries, the accuracy of these tests is a debated issue. In the present study we compare the diagnostic accuracy of the triple test with that of colposcopy for the diagnosis of premalignant and malignant cervical lesions.

Methods: A cross-sectional study was performed in 328 women referred to the gynecology clinic at Shahid Sadoughi Hospital, affiliated to Yazd University of Medical Sciences (SSUMS), Yazd, Iran, from March 2016 to June 2018. As the first step, a Pap smear was obtained from all participants. Visual inspection with acetic acid (VIA) and Lugol's iodine (VILI) was performed in accordance with the known protocol. A colposcopy was then conducted in all participants, biopsy samples were obtained, and histological features studied. Finally, the results were compared by statistical analysis.

Results: The age range of the participants was 30 - 50 years. Of 328 women, 60 (18.3 %) were postmenopausal. Two-hundred and five patients (62.5 %) had an abnormal Pap smear, 165 (50.3 %) had abnormal results on colposcopy, and 141 (43 %) had abnormal histopathology reports. The VIA was positive in 129 patients (39.3 %) and the VILI in 177 (54 %). The results of the triple test were reported to be positive in 205 cases (51.52 %). The sensitivity of the triple test in the detection of premalignant and malignant cervical lesions was 78.7 % and 69 %, respectively. The sensitivity and specificity of colposcopy in the detection of premalignant and malignant cervical lesions was 80.1 % and 72.2 %, respectively. The diagnostic accuracy of the triple test and colposcopy in the detection of premalignant and malignant cervical lesions was 73 % versus 75 %.

Conclusion: Since the results of the study showed that the diagnostic accuracy of the triple test is equivalent that of colposcopy, the former may be used in low-income countries and areas lacking access to colposcopy.
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http://dx.doi.org/10.31557/APJCP.2020.21.12.3501DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8046317PMC
December 2020

Challenges Posed by Embryonic and Anatomical Factors in Systematic Lymphadenectomy for Endometrial Cancer.

J Clin Med 2020 Dec 19;9(12). Epub 2020 Dec 19.

Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 3, 24105 Kiel, Germany.

Lymph node involvement has been shown to be one of the most relevant prognostic factors in a variety of malignancies; this is also true of endometrial cancer. The determination of the lymph node status is crucial in order to establish the tumor stage, and to consider adjuvant treatment. A wide range of surgical staging practices are currently used for the treatment of endometrial cancer. The necessity and extent of lymph node dissection is an ongoing controversial issue in gynecological oncology. Lymph node surgery in endometrial cancer is technically challenging, and can be time consuming because of the topographic complexity of lymphatic drainage as such, and the fact that the lymph nodes are directly adjacent to both blood vessels and nerves. Therefore, profound and exact knowledge of the anatomy is essential. Sentinel lymph node mapping was recently introduced in surgical staging with the aim of reducing morbidity, whilst also obtaining useful prognostic information from a patient's lymph node status. The present review summarizes the current evidence on the role of lymph node surgery in endometrial cancer, focusing on the embryological, anatomical, and technical aspects.
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http://dx.doi.org/10.3390/jcm9124107DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7766017PMC
December 2020

Do Small Incisions Need Only Minimal Anesthesia?-Anesthetic Management in Laparoscopic and Robotic Surgery.

J Clin Med 2020 Dec 15;9(12). Epub 2020 Dec 15.

Department of Anesthesiology and Critical Care, University Hospital Wuerzburg, 97080 Wuerzburg, Germany.

Laparoscopic techniques have established themselves as a major part of modern surgery. Their implementation in every surgical discipline has played a vital part in the reduction of perioperative morbidity and mortality. Precise robotic surgery, as an evolution of this, is shaping the present and future operating theatre that an anesthetist is facing. While incisions get smaller and the impact on the organism seems to dwindle, challenges for anesthetists do not lessen and could even become more demanding than in open procedures. This review focuses on the pathophysiological effects of contemporary laparoscopic and robotic procedures and summarizes anesthetic challenges and strategies for perioperative management.
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http://dx.doi.org/10.3390/jcm9124058DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7765538PMC
December 2020

Hydroceles of the Canal of Nuck in Adults-Diagnostic, Treatment and Results of a Rare Condition in Females.

J Clin Med 2020 Dec 12;9(12). Epub 2020 Dec 12.

Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augistenburger Platz 1, 13353 Berlin, Germany.

Nuck's hydroceles, which develop in a protruding part of the parietal peritoneum into the female inguinal canal, are rare abnormalities and a cause of inguinal swelling, mostly resulting in pain. They appear when this evagination of the parietal peritoneum into the inguinal canal fails to obliterate. Our review of the literature on this topic included several case reports and two case series that presented cases of Nuck hydroceles which underwent surgical therapy. We present six consecutive cases of symptomatic hydroceles of Nuck's canal from September 2016 to January 2020 at the Department of Surgery of Charité Berlin. Several of these patients had a long history of pain and consecutive consultations to outpatient clinics without diagnosis. These patients underwent laparoscopic or conventional excision and if needed simultaneous hernioplasty in our institution. Ultrasonography and/or Magnetic Resonance Imaging were used to display the cystic lesion in the inguinal area, providing the diagnosis of Nuck's hydrocele. This finding was confirmed intraoperatively and by histopathological review. Ultrasound and magnetic resonance imaging (MRI) captures, intraoperative pictures and video of minimal invasive treatment are provided. Nuck's hydroceles should be included in the differential diagnosis of an inguinal swelling. We recommend an open approach to external Type 1 Nuck´s hydroceles and a laparoscopic approach to intra-abdominal Type 2 Nuck hydroceles. Complex hydroceles like Type 3 have to be evaluated individually, as they are challenging and the surgical outcome is dependent on the surgeon's skills. If inguinal channel has been widened by the presence of a Nuck's hydrocele, a mesh plasty, as performed in hernia surgery, should be considered.
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http://dx.doi.org/10.3390/jcm9124026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7763523PMC
December 2020

Advances and Trends in Pediatric Minimally Invasive Surgery.

J Clin Med 2020 Dec 10;9(12). Epub 2020 Dec 10.

Department of General Visceral, Thoracic, Transplant and Pediatric Surgery, UKSH University Hospital of Schleswig-Holstein Kiel Campus, Arnold-Heller-Strasse 3, 24105 Kiel, Germany.

As many meta-analyses comparing pediatric minimally invasive to open surgery can be found in the literature, the aim of this review is to summarize the current state of minimally invasive pediatric surgery and specifically focus on the trends and developments which we expect in the upcoming years. Print and electronic databases were systematically searched for specific keywords, and cross-link searches with references found in the literature were added. Full-text articles were obtained, and eligibility criteria were applied independently. Pediatric minimally invasive surgery is a wide field, ranging from minimally invasive fetal surgery over microlaparoscopy in newborns to robotic surgery in adolescents. New techniques and devices, like natural orifice transluminal endoscopic surgery (NOTES), single-incision and endoscopic surgery, as well as the artificial uterus as a backup for surgery in preterm fetuses, all contribute to the development of less invasive procedures for children. In spite of all promising technical developments which will definitely change the way pediatric surgeons will perform minimally invasive procedures in the upcoming years, one must bear in mind that only hard data of prospective randomized controlled and double-blind trials can validate whether these techniques and devices really improve the surgical outcome of our patients.
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http://dx.doi.org/10.3390/jcm9123999DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7764454PMC
December 2020
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