Aizura-Syafinaz Adlan

Objectives: Conventionally, an assistant would be required to hold the ultrasound probe during therapeutic hysteroscopy. To manage without a skilled assistant, Lin developed a self-retaining hands-free probe method that can be used to hold an abdominal ultrasound probe. One can now perform ultrasound-guided hysteroscopic procedures single-handedly. The purpose of this study is to report the successful development of a method to keep an abdominal ultrasound probe self-retained without an assistant's help. Materials and Methods: A technique derived from improvisation with available equipment. Results: The hands-free ultrasound probe was used successfully in 2680 cases needing therapeutic hysteroscopy management for various endometrial pathologies. We only encountered one case of latex allergy, which serves as a reminder to ask about latex allergy before the procedure. Upon notification, the handle can be improvised to a latex-free solution. Compression indentation marks were of negligible concern as they resolved spontaneously within 1–2 h postsurgery. We have used this method successfully and to good effect, particularly in guiding us to avoid uterine perforations during dilation of the cervix as well as during the therapeutic hysteroscopy surgery itself. This device facilitates efficient and safe therapeutic hysteroscopic surgeries. In addition, this method encourages the reuse and recycling of plastic water bottles. Conclusion: The usage of Lin's self-retaining ultrasound probe method is practical, cheap, and not dependent on an assistant's participation during procedures.

Postoperative adhesions represent a frequent complication of abdominal surgery. Adhesions can result from infection, ischemia, and foreign body reaction, but commonly develop after any surgical procedure. The morbidity caused by adhesions affects quality of life and, therefore, it is paramount to continue to raise awareness and scientific recognition of the burden of adhesions in healthcare and clinical research. This 2021 Global Expert Consensus Group worked together to produce consented statements to guide future clinical research trials and advise regulatory authorities. It is critical to harmonize the expectations of research, to both develop and bring to market improved anti-adhesion therapies, with the ultimate, shared goal of improved patient outcomes.

Background: To evaluate the feasibility of timing delivery of induction of labour cases to occur during office hours and reduce night time delivery. Methods: Patients scheduled for induction of labour were randomized to 8 am or 8 pm insertion of dinoprostone vaginal tablets. The main outcome measure was time of delivery between 8 am to 5 pm. The secondary outcome measures were mode of delivery and its indications, neonatal outcomes, maternal satisfaction and labour room staff satisfaction. Results: 164 patients were recruited with 78 patients randomized to the 8 am group and 86 patients randomized to the 8 pm group. There was no significant difference in timing of delivery between both groups, with delivery between 8 am to 5 pm for the 8 am group being 35.9% and for the 8 pm group being 44.2% (P = 0.339). For the secondary outcome measures, there was no significant difference found between mode of delivery (vaginal, instrumental or Caesarean section), neonatal Apgar score and cord blood pH, nor maternal satisfaction score based on the Likert scale. However there was a statistically significant difference (P = 0.001) for labour ward staff satisfaction based on the Likert scale, favouring the 8 pm induction timing. Conclusion: 8 am versus 8 pm timing for induction of labour has no significant difference to the timing of delivery during office hours, but the 8 pm induction of labour group has significantly greater labour ward staff satisfaction.

Background: Female sterilisation is the most common method of contraception worldwide and laparoscopic tubal sterilisation is increasingly considered as a day-surgery procedure. Therefore, pain following this procedure should be seriously addressed. Instillation of 200 to 300 mg of ropivacaine intraperitoneally has been proven effective in controlling pain after laparoscopic tubal ligation (LTL). However, extreme caution must be taken as potential serum toxicity has been reported with the instillation of 150 mg of intraperitoneal ropivacaine. In search of the lowest, most effective dose, this study aimed to evaluate the effectiveness of 112.5 mg of ropivacaine intraperitoneally in reducing post-operative pain after LTL. Methods: This double-blind, placebo-controlled randomised trial was conducted in an ambulatory care centre in Malaysia. Sixty-two patients scheduled for LTL were recruited. Two patients were excluded from the trial because of intraoperative complications. Sixty patients were randomised to either the placebo group (intraperitoneal normal saline, n = 30) or the ropivacaine group (intraperitoneal ropivacaine, n = 30). Pain scores (using a visual analogue score), and the need for additional analgesia were assessed at 15, 60, 120, and 240 minutes post-LTL. Results: We observed no significant differences in pain scores or the need for additional analgesia between the groups. Conclusion: 112.5 mg of ropivacaine administered intraperitoneally is not more effective than normal saline in decreasing post-operative pain after LTL.

Background: The clinical triad presentation of a benign ovarian tumor (fibroma, thecoma, granulosa-cell tumor), ascites, and hydrothorax that resolve after removal of the aforementioned tumor characterize Meigs' syndrome. A similar presentation of ascites and hydrothorax coexisting with other benign cysts or teratomas of the ovary or leiomyomas of the uterus, are referred to as pseudo–Meigs' syndrome. Uterine leiomyomas rarely cause pseudo-Meigs' syndrome with elevated serum cancer antigen (CA)–125 levels. Case: A 38-year-old woman was initially diagnosed with a large left ovarian tumor. Intraoperatively, this tumor was revealed to be a subserosal leiomyoma with ascites, mimicking pseudo–Meigs' syndrome. Results: The leiomyoma was resected laparoscopically. Operating time was 60 minutes and resection was carried out with a 150-mL blood loss. The postoperative period was uneventful, and the patient was discharged as well on postoperative day 3. Conclusions: Uterine leiomyomas presenting as pseudo-Meigs should be considered as a differential diagnosis for large pelvic masses with ascites and elevated CA-125 levels. In such situations, laparoscopic myomectomy is feasible. (J GYNECOL SURG 36:222)

Objectives: While the issue of aerosolization of virus from the blood occurs during usage of energy sources scare practitioners, there have been no reported instances of healthcare workers (HCWs) being infected. COVID-19 virus is primarily transmitted via respiratory droplets and contact routes. Therefore, the ultimate decision for surgery, should be based on which is the safest, quickest route and concurrently ensuring that HCWs are protected during these surgeries. During the time of crisis, HCWs need to concentrate and channel resources to the care of those affected by the coronavirus hence judicious allocation of resources is mandatory. We present the guidelines and recommendations on gynecological laparoscopic surgery during this COVID-19 outbreak in Malaysia. Materials and Methods: Thorough search of articles and recommendations were done to look into the characteristics of the virus in terms of transmission and risks during surgery. Smoke plume characteristics, composition and risk of viral transmission were also studied. Search includes The WHO Library, Cochrane Library and electronic databases (PubMed, Google scholar and Science Direct). Conclusion: We concluded that there is no scientific basis of shunning laparoscopic approach in surgical intervention. Ultimately, the guiding principles would be of reducing the anesthetic and surgical duration, the availability of full protective gear for HCWs during the surgery and the status of the patient. It is mandatory for viral swab tests to be done within the shortest window period possible, for all cases planned for surgery.

Introduction: The gasless laparoscopic technique is easily operable, safe. and avoids complications of pneumoperitoneum. The suspension method from two celiac wall rods evolved to a single wall rod method, reducing one hanging rod on one side of the abdominal wall. This benefited the surgeon which reduced the inhibition of one less visible, space-consuming suspension rod, however remains a hindrance to the assistant’s optimal movement and visual field. Objective: To explore the feasibility and application value of a modified abdominal wall suspension system in standard gasless laparoscopic myomectomy. Materials and Methods: Women agreeing to participate were randomised into two arms. The standard conventional gasless method versus the modified abdominal wall lifting method. Results: A total of 100 women were randomised into two groups; the improvised technique (group 1) and the conventional technique (group 2). Surgical operating time (72.3 ± 35.6 minutes [improved] and 82.7 ± 31.9 minutes [conventional]) p < 0.01), total blood loss (204.9 ± 167.3 ml [improved] and 266.7 ± 190.5 ml [conventional], p < 0.01)) and average time of a single-myoma-removal (improved vs. conventional) were significantly reduced in the improvised technique group, as opposed to the conventional technique group. No significant difference was found between the two groups with regards to postoperative intestinal function recovery period or the postoperative hospital stay duration. Conclusion: The modified abdominal wall suspension method increases the surgeon’s operating space, making it more convenient and practical with significant rewarding postoperative surgical outcomes.

Background: Category-1 caesarean section denotes cases of immediate risk and a life threat to either mother or fetus and delivery is imminent. General anaesthesia (GA) is often the method of choice but it carries significant life threatening risks to the mother. Regional anaesthesia (RA) i.e. single shot spinal anaesthesia, should be considered; as in competent hands it can be performed as quickly and is much safer than GA. Objective: To compare the maternal and fetal outcomes between GA and RA and to prove that at least 50% of category-1 cases do not require general anaesthesia. Materials and Methods: Data collection of all category-1 caesarean sections were divided and analysed via the anaesthetic regime used (GA or RA). Results: The caesarean section was 47.4%. GA rate of category-1 was 24.3%. No significant difference of fetal outcome between GA and RA. The difference of maternal pre and post-operative haemoglobin is significantly larger in the GA group. Conclusion: RA is a safer method of anaesthesia in more than half the cases of category-1. GA is still a primary method of choice in some cases. Proper and effective communication between obstetricians, anaesthetists, and midwives is vital to ensure the safest treatment is given to patients.