Gasless laparoscopic management of ovarian cysts during pregnancy
Notice bibliographique
Résumé
Ovarian cysts are commonly found on ultrasound examination during early pregnancy. Until recently, laparoscopy during pregnancy was not encouraged, but some reports have appeared on its safety [1], [2]. In this study (Canadian Task Force classification III), the safety of gasless laparoscopic ovarian cystectomy during pregnancy was evaluated retrospectively. Thirteen patients underwent gasless laparoscopic surgery with subcutaneous lifting of the abdominal wall. General anesthesia was performed in all patients, of whom 11 also received epidural anesthesia and 2 received a muscle relaxant. The 13 procedures were performed using the transperitoneal technique. After the cyst was punctured and its contents aspirated endoscopically, the adnexa was pulled through the port site and cystectomy was performed. The adnexa was then repositioned in the peritoneal cavity. Patient characteristics, pathologic diagnoses, and maternal and neonatal outcomes are presented in Table 1. All operations were performed between 10 and 17 weeks of pregnancy: 4 at 10 weeks, 3 at 11 weeks, 2 at 12 weeks, 2 at 14 weeks, 1 at 16 weeks, and 1 at 17 weeks. Main tumor diameters ranged from 54 to 130 mm. Dermoid cysts were found in 11 of the 13 patients, and there were 1 corpus luteum cyst and 1 serous cystadenoma. Postoperative complications included uterine contractions in 3 women and vaginal bleeding in 4 women, but these symptoms resolved shortly after surgery. Complications following discharge included 2 threatened preterm deliveries and 2 cases of pre-eclampsia; however, all complications were successfully managed at the outpatient clinic. All patients were delivered between 37 and 40 weeks of pregnancy. One neonate was delivered at 39 weeks with a low birth weight that was still adequate for gestational age, and another had mild hyperbilirubinemia. None of the neonates had serious complications or anomalies. It has been suggested that conventional laparoscopy, with insufflation of carbon dioxide, can lead to fetal complications such as fetal hypercarbia and fetal acidosis [1], and that premature labor can occur from the increased intra-abdominal pressure. Gasless laparoscopy, however, is not associated with risks arising from carbon dioxide insufflation. Patients in this study did not experience severe postoperative complications. All patients were delivered at term from healthy neonates. Given the small number of patients, the maternal and fetal safety of the procedure can not be determined. However, this study suggests that laparoscopic surgery can be safely performed for benign ovarian cysts discovered during pregnancy.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».