key: cord-0887480-boepvkix
authors: Hanstede, M. M.
title: Asherman's Care in a Covid-19 Pandemic
date: 2021-11-30
journal: Journal of Minimally Invasive Gynecology
DOI: 10.1016/j.jmig.2021.09.688
sha: 3e507120d054e37d400b517995760cc7db159bf7
doc_id: 887480
cord_uid: boepvkix

Study Objective We aimed to evaluate patient's satisfaction with Asherman's care in women who were referred to our center for a second opinion for Asherman's Syndrome (AS) in the Covid-19 pandemic. Design Observational cohort study. Setting University affiliated teaching hospital and tertiary referral center for Asherman's syndrome in The Netherlands from March 2020 to March 2021. Patients or Participants Women with AS, eligible for treatment were included. Interventions The first consult and pre-operative screening took place with a phone interview. The diagnosis, treatment and follow-up protocol were explained. Women were triaged on basis of their symptoms and infection exposure status and whether or not a face-to-face visit with the anesthesiologist was required. If eligible for treatment, they were given the opportunity to schedule a see and treat procedure with propofol sedation. All women who decide to proceed with surgery were treated with the standard AS protocol with special Covid-19 precaution measurements. At the recovery unit, women were asked to fill in a questionnaire. Measurements and Main Results 137 women were operated in 32 sessions between March 2020 and March 2021. Patients were matched with a cohort prior to the Covid-19 pandemic. Baseline characteristics were reported. Patients rated their satisfaction with hearing the explanation about the disease and upcoming treatment by the practitioner over the phone, the assisting on-site nurse's capability, quality of care of the treatment, convenience, and overall understanding and explanation by the practitioner post operatively. Women with AS who were treated in our center during the Covid-pandemic were equally satisfied with the information at first visit, explanation, treatment and follow-up as women in their matched cohort prior to the pandemic. Conclusion Patients with AS who were referred to our center, were offered COVID-19 adjusted protocol to inform, diagnose, treat and follow-up on their condition. Women were equally satisfied with the care provided.

Study Objective: To review the ovarian remnant syndrome characteristics and risk factors. To describe the correct surgical technique to prevent this condition. To demonstrate the appropriate preoperative evaluation and surgical resolution of the small volume ovarian remnant. Design: Educational video. Setting: Robotic assisted laparoscopic procedure. Patient in dorsal lithotomy position. Bilateral double ended tiger tail prophylactic ureteral stents used. Patients or Participants: We describe a case of a 40-year-old patient who presented with a pelvic cystic mass and pelvic pain. She had a history of multiple laparotomies including an abdominal hysterectomy and bilateral salpingo-oophorectomy. She had a known BRCA 1 mutation and a strong family history of ovarian cancer. Her estradiol and follicle-stimulating hormone (FSH) levels were in the premenopausal range. Ovarian remnant syndrome was suspected. Interventions: Robotic assisted removal of bilateral small volume ovarian remnants. Measurements and Main Results: An overview of the preoperative evaluation and management of small volume ovarian remnant syndrome is described. The surgical technique to prevent ovarian remnant syndrome is discussed. The preoperative evaluation including hormone levels, ovarian stimulation, and imaging studies are discussed. Surgical planning including discussion with radiology and pathology are reviewed. Relying on anatomical landmarks, ureterolysis, proximal ligation of the infundibulopelvic ligament, and other surgical tips for the successful removal of the small volume ovarian remnant are presented. Conclusion: Appropriate surgical technique prevents ovarian remnant syndrome. Serial MRIs may help identify cyclic changes of the ovarian remnant. Ovarian stimulation and hormone levels may assist with diagnosis and treatment planning. Preoperative discussion with Radiology to look for anatomical landmarks is important to successfully excise small volume lesions. Study Objective: The standard technique for hysterectomies has long included the insertion of a Foley catheter to theoretically reduce operative complications of urinary injury. Urinary Tract Infections (UTIs) following Gynecologic procedures have been cited in the literature from 5-28%. One study suggested that 69% of CAUTI (catheter-associated UTI) can be avoided, and for each day of catheterization, infection risk increases significantly. Additionally, avoiding bladder catheterization, thus allowing bladder distention, may assist in correctly identifying the bladder during dissection, reducing intraoperative injury. Design: This is a retrospective case series of 426 MIGS hysterectomies performed without initial bladder catheterization from 12/2015 -2/2021 by a single surgeon. Setting: MIGS hysterectomies including Total Laparoscopic Hysterectomies and Robot Assisted Laparoscopic Hysterectomies.

Patients or Participants: Inclusion criteria included MIGS hysterectomy without concurrent cystoscopy, prolapse, or urinary incontinence procedures. Interventions: 20% of participants underwent perioperative catheterization. Measurements and Main Results: Of the 426 MIGS hysterectomies, 80% were completed without bladder catheterization or cystoscopy and 20% (84) underwent perioperative catheterization. Intraoperatively 18.5% (79) underwent straight catheterizations secondary to bladder overdistention, and 1 underwent indwelling catheterization for hemodynamic monitoring. Postoperatively, 1.8% (8) developed postoperative urinary retention with 6 requiring straight catheterization and 2 indwelling catheterization. At postoperative follow up, 15% complained of bladder discomfort, of which 1.6 % (5) were treated for clinical UTI with 3 undergoing a negative culture. A total of 29 patients had a urine culture performed, with only 2 (0.5%) positive. In spite of a mean of uterine size of 274g, 6.3% endometriosis and 26.9% cancer diagnoses, no bladder or ureteral injuries were encountered. Conclusion: This study reveals that MIGS hysterectomies without routine bladder catheterization or cystoscopy are feasible and can be safely performed without bladder or ureteral injury with a subsequent decrease in the incidence of UTIs. Further prospective research is warranted to evaluate the benefits of hysterectomy without routine foley placement. Study Objective: We aimed to evaluate patient's satisfaction with Asherman's care in women who were referred to our center for a second opinion for Asherman's Syndrome (AS) in the Covid-19 pandemic. Design: Observational cohort study. Setting: University affiliated teaching hospital and tertiary referral center for Asherman's syndrome in The Netherlands from March 2020 to March 2021. Patients or Participants: Women with AS, eligible for treatment were included.

Interventions: The first consult and pre-operative screening took place with a phone interview. The diagnosis, treatment and follow-up protocol were explained. Women were triaged on basis of their symptoms and infection exposure status and whether or not a face-to-face visit with the anesthesiologist was required. If eligible for treatment, they were given the opportunity to schedule a see and treat procedure with propofol sedation. All women who decide to proceed with surgery were treated with the standard AS protocol with special Covid-19 precaution measurements. At the recovery unit, women were asked to fill in a questionnaire. Measurements and Main Results: 137 women were operated in 32 sessions between March 2020 and March 2021. Patients were matched with a cohort prior to the Covid-19 pandemic. Baseline characteristics were reported. Patients rated their satisfaction with hearing the explanation about the disease and upcoming treatment by the practitioner over the phone, the assisting on-site nurse's capability, quality of care of the treatment, convenience, and overall understanding and explanation by the practitioner post operatively. Women with AS who were treated in our center during the Covid-pandemic were equally satisfied with the information at first visit, explanation, treatment and follow-up as women in their matched cohort prior to the pandemic. Conclusion: Patients with AS who were referred to our center, were offered COVID-19 adjusted protocol to inform, diagnose, treat and follow-up on their condition. Women were equally satisfied with the care provided.

Asherman's Syndrome (AS) after Long Term Use of a Levenorgestrel Containing IUD, Cause or Coincidence?

1, * Hanstede M. 2 . 1 Asherman's Expertise Center