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Papers by Pattaya Hengrasmee

Research paper thumbnail of Improving the diagnosis of endometriosis in Asia‐Pacific: Consensus from the Asia‐Pacific Endometriosis Expert Panel for Endometriosis

International Journal of Gynecology & Obstetrics

Endometriosis should be diagnosed as early as possible in the continuum of care; but substantial ... more Endometriosis should be diagnosed as early as possible in the continuum of care; but substantial delays of approximately 6–8 years between symptom onset and endometriosis diagnosis have been widely reported. With the purpose of improving the prompt diagnosis of endometriosis, the Asia‐Pacific Endometriosis Expert Panel (APEX) sought to address the reasons for diagnostic delays across the region, and formulate a multi‐pronged approach to overcoming these challenges. In the first instance, clinical diagnosis is preferable to surgical diagnosis, in order to facilitate earlier empirical treatment and minimize the negative sequelae of undiagnosed/untreated disease. There should be a high clinical index of suspicion in women presenting with cyclical symptoms, including those involving extrapelvic organs. Diagnostic delays in Asia‐Pacific countries are attributable to a variety of patient, physician, and healthcare factors, including poor awareness, normalization/trivialization of pain, in...

Research paper thumbnail of Effects of Delayed Suprapubic Port Removal on Post-laparoscopic Shoulder Pain: A Randomized Controlled Trial

Research Square (Research Square), Jan 11, 2021

Background: One of the major drawbacks of gynecologic laparoscopy is post-laparoscopic shoulder p... more Background: One of the major drawbacks of gynecologic laparoscopy is post-laparoscopic shoulder pain (PLSP) that is believed to result from intra-abdominal CO 2 retention leading to peritoneal and diaphragmatic stretching and causing referred pain in C4 dermatome. Several interventions have been applied to prevent and reduce its incidence and severity, with contradictory results. Only pulmonary recruitment maneuver, extended assisted ventilation and active intra-abdominal gas aspiration have been mentioned to be effective interventions for CO 2 evacuation. However, in our experience, an alternative technique of delayed suprapubic port removal (DSPR) was found to be an effective method in CO 2 expulsion. Therefore, we conducted this randomized trial to determine the effectiveness of the DSPR technique in reducing the incidence and severity of PLSP. The trial was conducted at a single, tertiary hospital between May 2015 and May 2016. Having complied with the criteria, 220 patients scheduled for elective gynecological laparoscopy were randomly allocated into 2 groups after giving informed consent. Laparoscopic procedures were performed through 10-mm umbilical port and at least 2 ancillary, including suprapubic, ports. In conventional group, ancillary ports were removed at the end of surgery leaving only opened umbilical cannula for pneumoperitoneum de ation. Abdominal compression from periphery towards umbilicus was performed to further expel CO 2 before removing the umbilical cannula. In DSPR group, both umbilical and suprapubic cannulas were retained. Two-step abdominal compression was undertaken, primarily towards umbilicus and secondarily towards pelvic cavity, before sequentially

Research paper thumbnail of Is Mesh Erosion Following Laparoscopic Sacrocolpopexy Time-Dependent?

Journal of Minimally Invasive Gynecology, 2016

Intervention: A MEDLINE Ò search using the search terms ''paratubal borderline tumor'' revealed o... more Intervention: A MEDLINE Ò search using the search terms ''paratubal borderline tumor'' revealed only 8 cases published in the literature. Measurements and Main Results: A 17-year-old female was referred due to a large right adnexal cyst on pelvic sonogram. A CT scan showed a 19cm-sized cystic lesion with enhancing papillary projection along the wall. LESS surgery confirmed a large cystic mass that originated from the right salpinx. Right salpingectomy and right ovarian wedge resection were performed. The result of the frozen section analysis and final pathologic review indicated that the cyst was a serous papillary-type borderline tumor in a paratubal cyst. In the review of literatures, the mean age of patients upon diagnosis was 27.6AE10.6 years old (range: from 17 to 45 years). The most common pathologic diagnosis was serous borderline tumor (77.8%). Most tumors occurred in reproductive-aged women. Four of nine cases presented with pelvic pain due to a twisted cyst, while the other cysts were asymptomatic. Three of nine women underwent laparoscopic surgery, and six patients had conservative surgery. All tumors were unilateral and the tumor size ranged from 3 to 19 cm in diameter. Most cases followed patients for more than 1 year, and no recurrence was reported. Conclusion: To the best of our knowledge, this is the first case report of a BPC treated with LESS. We suggest that minimally invasive, fertilitypreserving surgery should be considered as a standard treatment of borderline paratubal cysts if patients desire future fertility.

Research paper thumbnail of Exploring the Benefits of Robotic Surgery in the Management of Severe Endometriosis

Journal of Minimally Invasive Gynecology, 2016

Research paper thumbnail of Laparoscopic Bowel Resection for Deep Infiltrating Endometriosis: The CARE Experience

Journal of Minimally Invasive Gynecology, 2015

Research paper thumbnail of 10 Practical Steps in Laparoscopic Sacrohysteropexy

Journal of Minimally Invasive Gynecology, 2015

Generally, TLH is performed by first operating on the upper ligaments, followed by the lower liga... more Generally, TLH is performed by first operating on the upper ligaments, followed by the lower ligaments. However, in the case of huge fibroids, the upper ligaments, uterine tubes and ovaries cannot be observed by the camera placed in the umbilicus. Firstly, we developed the retroperitoneal space via an anterior approach and identified the uterine artery and ureter. At this point, as the uterus had poor mobility due to the fibroids, we could not observe bilateral adnexa. After isolation of the cardinal ligaments, we opened up the posterior lobe of the broad ligament, divided the cardinal ligaments, and then transected the vagina. As a result, uterus became mobile. We tilted the uterine body laterally and moved the adnexal ligaments into the operative field to make it possible to divide the adnexal ligaments without additional ports. Adjustments to our surgical technique allowed us to safely perform TLH for huge fibroids.

Research paper thumbnail of Robotic Application and Special Surgical Techniques to Removal Multiple Fibroids in a Culturally Challenging Context

Journal of Minimally Invasive Gynecology, 2016

a 30 degree laparoscope and the use of two accessory ports for identification of anatomic landmar... more a 30 degree laparoscope and the use of two accessory ports for identification of anatomic landmarks, mobilization of tissue, adhesiolysis, desiccation of vascular pedicles and contained extraction of the specimen is demonstrated. The procedure took 55 minutes, estimated blood loss was 20cc, there were no complications and the patient was discharged home the day after surgery.

Research paper thumbnail of Effectiveness of melatonin for the treatment of nocturia: a randomized controlled trial

International Urogynecology Journal

Research paper thumbnail of Evolution of the complications of laparoscopic hysterectomy after a decade: A follow up of the Monash experience

Australian and New Zealand Journal of Obstetrics and Gynaecology, 2009

A retrospective review of medical records was performed to assess the incidence and types of sign... more A retrospective review of medical records was performed to assess the incidence and types of significant complications encountered during laparoscopic hysterectomy which would affect the use of a laparoscopic approach versus other routes of hysterectomy. A total of 526 consecutive patients' medical data between January 1994 and August 2007 were reviewed. Two hundred and thirty-two laparoscopic-assisted vaginal hysterectomies and 294 total laparoscopic hysterectomies were performed at Monash Medical Centre, a Melbourne tertiary public hospital, and three Melbourne private hospitals, by or under the supervision of three surgeons. Sixteen significant complications occurred. There were two cases of ureteric fistula, two bladder injuries, two bowel obstructions, four postoperative haematomas, one case of a bladder fistula, four conversions to laparotomy and one superficial epigastric artery injury. Inpatient stay ranged from two to six days. Our complication and inpatient stay rates are consistent with the previously reported rates, although there has been a reduction of incidence of visceral injuries with experience and introduction of new equipment.

Research paper thumbnail of SMJ One-Year Anatomical and Functional Outcomes of 302 Elevate Posterior and Apical Mesh Repairs

Objective: POP occurs as a consequence of fibromuscular and endofascial weakness. Women with prol... more Objective: POP occurs as a consequence of fibromuscular and endofascial weakness. Women with prolapse often have global support defects causing difficulty in identification and repair. Fascial plication and levatorplasty in rectocele repair can cause over-narrowing of vagina and introitus leading to dyspareunia. Mesh reinforcement is used to correct multiple defects while avoiding vaginal narrowing. Although literatures have reported encouraging results of vaginal mesh repair, the use of mesh in posterior compartment is still controversial. Elevate system® has been developed as a minimally invasive method for mesh augmentation. Our objective is to evaluate outcomes of Elevate Posterior and Apical mesh in the posterior and apical prolapse repair. Methods: We conducted a prospective study of 302 women undergoing Elevate Posterior mesh reconstruction between 2009 and 2015. Demographic and peri-operative information were recorded. Pre-and post-operative evaluation included symptom, qual...

Research paper thumbnail of Depression among gynecologic cancer patients at Siriraj Hospital: prevalence and associated factors

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2004

OBJECTIVE The purposes of this study were to determine the prevalence of depression and associate... more OBJECTIVE The purposes of this study were to determine the prevalence of depression and associated risk factors among women with gynecologic cancer at Siriraj Hospital. DESIGN Descriptive cross-sectional study. SETTING Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital. SUBJECTS A total of 149 women with gynecologic cancer were enrolled. METHOD Women's demographic data and medical information were obtained by interview and abstracted from the medical record. The health-related self-report (HRSR) questionnaire was used to determine the prevalence of depression. Certain characteristics regarding demographic and medical data were evaluated in order to find any correlation with depression. RESULTS The diagnoses in this study population included 77 cases (51.7%) of ovarian cancer, 34 cases (22.8%) of cervical cancer, 20 cases (13.4%) of uterine cancer and 18 cases (12.1%) of gestational trophoblastic tumor. The mean age was 46.6 ...

Research paper thumbnail of One-Year Anatomical and Functional Outcomes of 302 Elevate Posterior and Apical Mesh Repairs

Objective: POP occurs as a consequence of fibromuscular and endofascial weakness. Women with prol... more Objective: POP occurs as a consequence of fibromuscular and endofascial weakness. Women with prolapse often have global support defects causing difficulty in identification and repair. Fascial plication and levatorplasty in rectocele repair can cause over-narrowing of vagina and introitus leading to dyspareunia. Mesh reinforcement is used to correct multiple defects while avoiding vaginal narrowing. Although literatures have reported encouraging results of vaginal mesh repair, the use of mesh in posterior compartment is still controversial. Elevate system® has been developed as a minimally invasive method for mesh augmentation. Our objective is to evaluate outcomes of Elevate Posterior and Apical mesh in the posterior and apical prolapse repair. Methods: We conducted a prospective study of 302 women undergoing Elevate Posterior mesh reconstruction between 2009 and 2015. Demographic and peri-operative information were recorded. Pre- and post-operative evaluation included symptom, qua...

Research paper thumbnail of Urinary symptoms and urodynamic findings before and after vaginal surgery for pelvic organ prolapse

Urogynaecologia, 2021

To ascertain the difference in urodynamic findings, specifically bladder sensation, and urinary s... more To ascertain the difference in urodynamic findings, specifically bladder sensation, and urinary symptoms after vaginal surgery for Pelvic Organ Prolapse (POP). Retrospective data analysis of 126 women who underwent vaginal surgery for POP without simultaneous anti-incontinence procedure from January 2013 to April 2019 at Siriraj Hospital, Thailand. Baseline characteristics, intraoperative details and pre and post-operative urinary symptoms and urodynamic findings were recorded. There was no significant difference in the pre and post-operative first desire to void, at 158±53 mL and 162±64 mL, respectively (p=0.518). Incidence of increased bladder sensation was also unchanged, from 46.0% to 46.8% (p=1.00). Post-operative urodynamic stress incontinence was significantly increased, from 15.9% to 31.0% (p=0.003), as was the incidence of weak bladder contractility index (<100), from 47.3% to 61.8% (p=0.005). Significant improvements in post-operative urge urinary incontinence, urgency ...

Research paper thumbnail of Hemostatic agents in laparoscopic surgery

Research paper thumbnail of Effects of delayed suprapubic port removal on post-laparoscopic shoulder pain: a randomized controlled trial

Gynecological Surgery

Background One of the major drawbacks of gynecologic laparoscopy is post-laparoscopic shoulder pa... more Background One of the major drawbacks of gynecologic laparoscopy is post-laparoscopic shoulder pain (PLSP) that is believed to result from intra-abdominal CO2 retention leading to peritoneal and diaphragmatic stretching and causing referred pain in C4 dermatome. Several interventions have been applied to prevent and reduce its incidence and severity, with contradictory results. Only pulmonary recruitment maneuver, extended assisted ventilation, and active intra-abdominal gas aspiration have been mentioned to be effective interventions for CO2 evacuation. However, in our experience, an alternative technique of delayed suprapubic port removal (DSPR) was found to be an effective method in CO2 expulsion. Therefore, we conducted this randomized trial to determine the effectiveness of the DSPR technique in reducing the incidence and severity of PLSP. The trial was conducted at a single, tertiary hospital between May 2015 and May 2016. Having complied with the criteria, 220 patients schedu...

Research paper thumbnail of Neglected doughnut pessary in the uterine cavity

BMJ Case Reports

Vaginal pessary is a practical and effective tool for pelvic organ prolapse management. Neverthel... more Vaginal pessary is a practical and effective tool for pelvic organ prolapse management. Nevertheless, serious complications can occur in neglected patients such as vesicovaginal and rectovaginal fistula, erosion and impaction in adjacent structures. We report a case of neglected pessary found in the uterine cavity. The patient was treated with abdominal hysterectomy with in situ doughnut pessary. Proper pessary care and regular follow-up should be emphasised among patients, caregivers and related healthcare personnel to early detect as well as to avoid complications.

Research paper thumbnail of Outcomes of colpectomy for uterovaginal and posthysterectomy vault prolapse: A comparative study between normal and overweight women

Urogynaecologia

The objective of the study is to compare success and perioperative outcomes of colpectomy for sev... more The objective of the study is to compare success and perioperative outcomes of colpectomy for severe prolapse between normal and overweight patients. This is a retrospective cohort study of 95 non-sexually active women undergoing colpectomy for severe prolapse between July 2010 and December 2015. Vaginal hysterectomy was performed for those with uterovaginal prolapse. Prolapse stage and location were identified according to Pelvic Organ Prolapse Quantification (POP-Q) measurements. Demographic data and perioperative outcomes were recorded. Patients were categorized into normal-weight and overweight groups according to World Health Organization body mass index classification for adults. During postoperative visit, prolapse symptoms and POP-Q measurements were re-evaluated. Objective cure was defined as prolapse at or above hymen, while subjective cure determined as resolution of prolapse sensation. One-third was determined as overweight. Objective cure was 81.1%, whereas subjective c...

Research paper thumbnail of Relationship of degree of uterine prolapse between pelvic examination in lithotomy position with cervical traction and pelvic examination in standing position

International Urogynecology Journal

Research paper thumbnail of Evidence to justify retention of transvaginal mesh: comparison between laparoscopic sacral colpopexy and transvaginal Elevate™ mesh

International Urogynecology Journal

To determine if laparoscopic sacral colpopexy (LSC) offers better apical support with a lower exp... more To determine if laparoscopic sacral colpopexy (LSC) offers better apical support with a lower exposure rate than transvaginal mesh surgery with Elevate™. This was a retrospective cohort study comparing patients with apical prolapse (POP-Q point C ≥ -1) who underwent Elevate™ mesh repair (n = 146) with patients who underwent laparoscopic sacral colpopexy (n = 267). The sacral colpopexy group had a mean age of 59 years and a BMI of 25.7. Patients in the Elevate™ group were older, with a mean age of 63 and a BMI of 26.3. Most of the patients of both groups presented with pelvic organ prolapse stage III (LSC 73.8% and Elevate™ 87.0%) and their mean POP-Q point C were not significantly different (LSC 1.4 vs Elevate™ 1.2 cm). Operative time was longer in the LSC group (113 vs 91 min, p &amp;amp;lt; 0.001), but estimated blood loss was lower (75 cm(3) vs 137 cm(3), p &amp;amp;lt; 0.001). No difference in mesh exposure rate could be found between the two groups at one year (Elevate™ 0.7% vs LSC 2.6%, OR 0.26, 95% CI 0.03 to 2.10, p = 0.21). One-year objective cure rate, defined as no descent beyond the hymen, was 97.0% in the LSC group and 96.6% in the Elevate™ group (p = .81). The overall recurrence (objective, subjective recurrence or reoperation) was also not different between the groups (LSC 4.5% vs Elevate 4.8%, p = 0.89). Transvaginal Elevate™ mesh delivers comparable apical support with a low exposure rate similar to that of laparoscopic sacral colpopexy.

Research paper thumbnail of Depression among gynecologic cancer patients at Siriraj Hospital: prevalence and associated factors

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2004

The purposes of this study were to determine the prevalence of depression and associated risk fac... more The purposes of this study were to determine the prevalence of depression and associated risk factors among women with gynecologic cancer at Siriraj Hospital. Descriptive cross-sectional study. Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital. A total of 149 women with gynecologic cancer were enrolled. Women's demographic data and medical information were obtained by interview and abstracted from the medical record. The health-related self-report (HRSR) questionnaire was used to determine the prevalence of depression. Certain characteristics regarding demographic and medical data were evaluated in order to find any correlation with depression. The diagnoses in this study population included 77 cases (51.7%) of ovarian cancer, 34 cases (22.8%) of cervical cancer, 20 cases (13.4%) of uterine cancer and 18 cases (12.1%) of gestational trophoblastic tumor. The mean age was 46.6 years. Depression was detected in 20 out of 149 p...

Research paper thumbnail of Improving the diagnosis of endometriosis in Asia‐Pacific: Consensus from the Asia‐Pacific Endometriosis Expert Panel for Endometriosis

International Journal of Gynecology & Obstetrics

Endometriosis should be diagnosed as early as possible in the continuum of care; but substantial ... more Endometriosis should be diagnosed as early as possible in the continuum of care; but substantial delays of approximately 6–8 years between symptom onset and endometriosis diagnosis have been widely reported. With the purpose of improving the prompt diagnosis of endometriosis, the Asia‐Pacific Endometriosis Expert Panel (APEX) sought to address the reasons for diagnostic delays across the region, and formulate a multi‐pronged approach to overcoming these challenges. In the first instance, clinical diagnosis is preferable to surgical diagnosis, in order to facilitate earlier empirical treatment and minimize the negative sequelae of undiagnosed/untreated disease. There should be a high clinical index of suspicion in women presenting with cyclical symptoms, including those involving extrapelvic organs. Diagnostic delays in Asia‐Pacific countries are attributable to a variety of patient, physician, and healthcare factors, including poor awareness, normalization/trivialization of pain, in...

Research paper thumbnail of Effects of Delayed Suprapubic Port Removal on Post-laparoscopic Shoulder Pain: A Randomized Controlled Trial

Research Square (Research Square), Jan 11, 2021

Background: One of the major drawbacks of gynecologic laparoscopy is post-laparoscopic shoulder p... more Background: One of the major drawbacks of gynecologic laparoscopy is post-laparoscopic shoulder pain (PLSP) that is believed to result from intra-abdominal CO 2 retention leading to peritoneal and diaphragmatic stretching and causing referred pain in C4 dermatome. Several interventions have been applied to prevent and reduce its incidence and severity, with contradictory results. Only pulmonary recruitment maneuver, extended assisted ventilation and active intra-abdominal gas aspiration have been mentioned to be effective interventions for CO 2 evacuation. However, in our experience, an alternative technique of delayed suprapubic port removal (DSPR) was found to be an effective method in CO 2 expulsion. Therefore, we conducted this randomized trial to determine the effectiveness of the DSPR technique in reducing the incidence and severity of PLSP. The trial was conducted at a single, tertiary hospital between May 2015 and May 2016. Having complied with the criteria, 220 patients scheduled for elective gynecological laparoscopy were randomly allocated into 2 groups after giving informed consent. Laparoscopic procedures were performed through 10-mm umbilical port and at least 2 ancillary, including suprapubic, ports. In conventional group, ancillary ports were removed at the end of surgery leaving only opened umbilical cannula for pneumoperitoneum de ation. Abdominal compression from periphery towards umbilicus was performed to further expel CO 2 before removing the umbilical cannula. In DSPR group, both umbilical and suprapubic cannulas were retained. Two-step abdominal compression was undertaken, primarily towards umbilicus and secondarily towards pelvic cavity, before sequentially

Research paper thumbnail of Is Mesh Erosion Following Laparoscopic Sacrocolpopexy Time-Dependent?

Journal of Minimally Invasive Gynecology, 2016

Intervention: A MEDLINE Ò search using the search terms ''paratubal borderline tumor'' revealed o... more Intervention: A MEDLINE Ò search using the search terms ''paratubal borderline tumor'' revealed only 8 cases published in the literature. Measurements and Main Results: A 17-year-old female was referred due to a large right adnexal cyst on pelvic sonogram. A CT scan showed a 19cm-sized cystic lesion with enhancing papillary projection along the wall. LESS surgery confirmed a large cystic mass that originated from the right salpinx. Right salpingectomy and right ovarian wedge resection were performed. The result of the frozen section analysis and final pathologic review indicated that the cyst was a serous papillary-type borderline tumor in a paratubal cyst. In the review of literatures, the mean age of patients upon diagnosis was 27.6AE10.6 years old (range: from 17 to 45 years). The most common pathologic diagnosis was serous borderline tumor (77.8%). Most tumors occurred in reproductive-aged women. Four of nine cases presented with pelvic pain due to a twisted cyst, while the other cysts were asymptomatic. Three of nine women underwent laparoscopic surgery, and six patients had conservative surgery. All tumors were unilateral and the tumor size ranged from 3 to 19 cm in diameter. Most cases followed patients for more than 1 year, and no recurrence was reported. Conclusion: To the best of our knowledge, this is the first case report of a BPC treated with LESS. We suggest that minimally invasive, fertilitypreserving surgery should be considered as a standard treatment of borderline paratubal cysts if patients desire future fertility.

Research paper thumbnail of Exploring the Benefits of Robotic Surgery in the Management of Severe Endometriosis

Journal of Minimally Invasive Gynecology, 2016

Research paper thumbnail of Laparoscopic Bowel Resection for Deep Infiltrating Endometriosis: The CARE Experience

Journal of Minimally Invasive Gynecology, 2015

Research paper thumbnail of 10 Practical Steps in Laparoscopic Sacrohysteropexy

Journal of Minimally Invasive Gynecology, 2015

Generally, TLH is performed by first operating on the upper ligaments, followed by the lower liga... more Generally, TLH is performed by first operating on the upper ligaments, followed by the lower ligaments. However, in the case of huge fibroids, the upper ligaments, uterine tubes and ovaries cannot be observed by the camera placed in the umbilicus. Firstly, we developed the retroperitoneal space via an anterior approach and identified the uterine artery and ureter. At this point, as the uterus had poor mobility due to the fibroids, we could not observe bilateral adnexa. After isolation of the cardinal ligaments, we opened up the posterior lobe of the broad ligament, divided the cardinal ligaments, and then transected the vagina. As a result, uterus became mobile. We tilted the uterine body laterally and moved the adnexal ligaments into the operative field to make it possible to divide the adnexal ligaments without additional ports. Adjustments to our surgical technique allowed us to safely perform TLH for huge fibroids.

Research paper thumbnail of Robotic Application and Special Surgical Techniques to Removal Multiple Fibroids in a Culturally Challenging Context

Journal of Minimally Invasive Gynecology, 2016

a 30 degree laparoscope and the use of two accessory ports for identification of anatomic landmar... more a 30 degree laparoscope and the use of two accessory ports for identification of anatomic landmarks, mobilization of tissue, adhesiolysis, desiccation of vascular pedicles and contained extraction of the specimen is demonstrated. The procedure took 55 minutes, estimated blood loss was 20cc, there were no complications and the patient was discharged home the day after surgery.

Research paper thumbnail of Effectiveness of melatonin for the treatment of nocturia: a randomized controlled trial

International Urogynecology Journal

Research paper thumbnail of Evolution of the complications of laparoscopic hysterectomy after a decade: A follow up of the Monash experience

Australian and New Zealand Journal of Obstetrics and Gynaecology, 2009

A retrospective review of medical records was performed to assess the incidence and types of sign... more A retrospective review of medical records was performed to assess the incidence and types of significant complications encountered during laparoscopic hysterectomy which would affect the use of a laparoscopic approach versus other routes of hysterectomy. A total of 526 consecutive patients' medical data between January 1994 and August 2007 were reviewed. Two hundred and thirty-two laparoscopic-assisted vaginal hysterectomies and 294 total laparoscopic hysterectomies were performed at Monash Medical Centre, a Melbourne tertiary public hospital, and three Melbourne private hospitals, by or under the supervision of three surgeons. Sixteen significant complications occurred. There were two cases of ureteric fistula, two bladder injuries, two bowel obstructions, four postoperative haematomas, one case of a bladder fistula, four conversions to laparotomy and one superficial epigastric artery injury. Inpatient stay ranged from two to six days. Our complication and inpatient stay rates are consistent with the previously reported rates, although there has been a reduction of incidence of visceral injuries with experience and introduction of new equipment.

Research paper thumbnail of SMJ One-Year Anatomical and Functional Outcomes of 302 Elevate Posterior and Apical Mesh Repairs

Objective: POP occurs as a consequence of fibromuscular and endofascial weakness. Women with prol... more Objective: POP occurs as a consequence of fibromuscular and endofascial weakness. Women with prolapse often have global support defects causing difficulty in identification and repair. Fascial plication and levatorplasty in rectocele repair can cause over-narrowing of vagina and introitus leading to dyspareunia. Mesh reinforcement is used to correct multiple defects while avoiding vaginal narrowing. Although literatures have reported encouraging results of vaginal mesh repair, the use of mesh in posterior compartment is still controversial. Elevate system® has been developed as a minimally invasive method for mesh augmentation. Our objective is to evaluate outcomes of Elevate Posterior and Apical mesh in the posterior and apical prolapse repair. Methods: We conducted a prospective study of 302 women undergoing Elevate Posterior mesh reconstruction between 2009 and 2015. Demographic and peri-operative information were recorded. Pre-and post-operative evaluation included symptom, qual...

Research paper thumbnail of Depression among gynecologic cancer patients at Siriraj Hospital: prevalence and associated factors

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2004

OBJECTIVE The purposes of this study were to determine the prevalence of depression and associate... more OBJECTIVE The purposes of this study were to determine the prevalence of depression and associated risk factors among women with gynecologic cancer at Siriraj Hospital. DESIGN Descriptive cross-sectional study. SETTING Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital. SUBJECTS A total of 149 women with gynecologic cancer were enrolled. METHOD Women's demographic data and medical information were obtained by interview and abstracted from the medical record. The health-related self-report (HRSR) questionnaire was used to determine the prevalence of depression. Certain characteristics regarding demographic and medical data were evaluated in order to find any correlation with depression. RESULTS The diagnoses in this study population included 77 cases (51.7%) of ovarian cancer, 34 cases (22.8%) of cervical cancer, 20 cases (13.4%) of uterine cancer and 18 cases (12.1%) of gestational trophoblastic tumor. The mean age was 46.6 ...

Research paper thumbnail of One-Year Anatomical and Functional Outcomes of 302 Elevate Posterior and Apical Mesh Repairs

Objective: POP occurs as a consequence of fibromuscular and endofascial weakness. Women with prol... more Objective: POP occurs as a consequence of fibromuscular and endofascial weakness. Women with prolapse often have global support defects causing difficulty in identification and repair. Fascial plication and levatorplasty in rectocele repair can cause over-narrowing of vagina and introitus leading to dyspareunia. Mesh reinforcement is used to correct multiple defects while avoiding vaginal narrowing. Although literatures have reported encouraging results of vaginal mesh repair, the use of mesh in posterior compartment is still controversial. Elevate system® has been developed as a minimally invasive method for mesh augmentation. Our objective is to evaluate outcomes of Elevate Posterior and Apical mesh in the posterior and apical prolapse repair. Methods: We conducted a prospective study of 302 women undergoing Elevate Posterior mesh reconstruction between 2009 and 2015. Demographic and peri-operative information were recorded. Pre- and post-operative evaluation included symptom, qua...

Research paper thumbnail of Urinary symptoms and urodynamic findings before and after vaginal surgery for pelvic organ prolapse

Urogynaecologia, 2021

To ascertain the difference in urodynamic findings, specifically bladder sensation, and urinary s... more To ascertain the difference in urodynamic findings, specifically bladder sensation, and urinary symptoms after vaginal surgery for Pelvic Organ Prolapse (POP). Retrospective data analysis of 126 women who underwent vaginal surgery for POP without simultaneous anti-incontinence procedure from January 2013 to April 2019 at Siriraj Hospital, Thailand. Baseline characteristics, intraoperative details and pre and post-operative urinary symptoms and urodynamic findings were recorded. There was no significant difference in the pre and post-operative first desire to void, at 158±53 mL and 162±64 mL, respectively (p=0.518). Incidence of increased bladder sensation was also unchanged, from 46.0% to 46.8% (p=1.00). Post-operative urodynamic stress incontinence was significantly increased, from 15.9% to 31.0% (p=0.003), as was the incidence of weak bladder contractility index (<100), from 47.3% to 61.8% (p=0.005). Significant improvements in post-operative urge urinary incontinence, urgency ...

Research paper thumbnail of Hemostatic agents in laparoscopic surgery

Research paper thumbnail of Effects of delayed suprapubic port removal on post-laparoscopic shoulder pain: a randomized controlled trial

Gynecological Surgery

Background One of the major drawbacks of gynecologic laparoscopy is post-laparoscopic shoulder pa... more Background One of the major drawbacks of gynecologic laparoscopy is post-laparoscopic shoulder pain (PLSP) that is believed to result from intra-abdominal CO2 retention leading to peritoneal and diaphragmatic stretching and causing referred pain in C4 dermatome. Several interventions have been applied to prevent and reduce its incidence and severity, with contradictory results. Only pulmonary recruitment maneuver, extended assisted ventilation, and active intra-abdominal gas aspiration have been mentioned to be effective interventions for CO2 evacuation. However, in our experience, an alternative technique of delayed suprapubic port removal (DSPR) was found to be an effective method in CO2 expulsion. Therefore, we conducted this randomized trial to determine the effectiveness of the DSPR technique in reducing the incidence and severity of PLSP. The trial was conducted at a single, tertiary hospital between May 2015 and May 2016. Having complied with the criteria, 220 patients schedu...

Research paper thumbnail of Neglected doughnut pessary in the uterine cavity

BMJ Case Reports

Vaginal pessary is a practical and effective tool for pelvic organ prolapse management. Neverthel... more Vaginal pessary is a practical and effective tool for pelvic organ prolapse management. Nevertheless, serious complications can occur in neglected patients such as vesicovaginal and rectovaginal fistula, erosion and impaction in adjacent structures. We report a case of neglected pessary found in the uterine cavity. The patient was treated with abdominal hysterectomy with in situ doughnut pessary. Proper pessary care and regular follow-up should be emphasised among patients, caregivers and related healthcare personnel to early detect as well as to avoid complications.

Research paper thumbnail of Outcomes of colpectomy for uterovaginal and posthysterectomy vault prolapse: A comparative study between normal and overweight women

Urogynaecologia

The objective of the study is to compare success and perioperative outcomes of colpectomy for sev... more The objective of the study is to compare success and perioperative outcomes of colpectomy for severe prolapse between normal and overweight patients. This is a retrospective cohort study of 95 non-sexually active women undergoing colpectomy for severe prolapse between July 2010 and December 2015. Vaginal hysterectomy was performed for those with uterovaginal prolapse. Prolapse stage and location were identified according to Pelvic Organ Prolapse Quantification (POP-Q) measurements. Demographic data and perioperative outcomes were recorded. Patients were categorized into normal-weight and overweight groups according to World Health Organization body mass index classification for adults. During postoperative visit, prolapse symptoms and POP-Q measurements were re-evaluated. Objective cure was defined as prolapse at or above hymen, while subjective cure determined as resolution of prolapse sensation. One-third was determined as overweight. Objective cure was 81.1%, whereas subjective c...

Research paper thumbnail of Relationship of degree of uterine prolapse between pelvic examination in lithotomy position with cervical traction and pelvic examination in standing position

International Urogynecology Journal

Research paper thumbnail of Evidence to justify retention of transvaginal mesh: comparison between laparoscopic sacral colpopexy and transvaginal Elevate™ mesh

International Urogynecology Journal

To determine if laparoscopic sacral colpopexy (LSC) offers better apical support with a lower exp... more To determine if laparoscopic sacral colpopexy (LSC) offers better apical support with a lower exposure rate than transvaginal mesh surgery with Elevate™. This was a retrospective cohort study comparing patients with apical prolapse (POP-Q point C ≥ -1) who underwent Elevate™ mesh repair (n = 146) with patients who underwent laparoscopic sacral colpopexy (n = 267). The sacral colpopexy group had a mean age of 59 years and a BMI of 25.7. Patients in the Elevate™ group were older, with a mean age of 63 and a BMI of 26.3. Most of the patients of both groups presented with pelvic organ prolapse stage III (LSC 73.8% and Elevate™ 87.0%) and their mean POP-Q point C were not significantly different (LSC 1.4 vs Elevate™ 1.2 cm). Operative time was longer in the LSC group (113 vs 91 min, p &amp;amp;lt; 0.001), but estimated blood loss was lower (75 cm(3) vs 137 cm(3), p &amp;amp;lt; 0.001). No difference in mesh exposure rate could be found between the two groups at one year (Elevate™ 0.7% vs LSC 2.6%, OR 0.26, 95% CI 0.03 to 2.10, p = 0.21). One-year objective cure rate, defined as no descent beyond the hymen, was 97.0% in the LSC group and 96.6% in the Elevate™ group (p = .81). The overall recurrence (objective, subjective recurrence or reoperation) was also not different between the groups (LSC 4.5% vs Elevate 4.8%, p = 0.89). Transvaginal Elevate™ mesh delivers comparable apical support with a low exposure rate similar to that of laparoscopic sacral colpopexy.

Research paper thumbnail of Depression among gynecologic cancer patients at Siriraj Hospital: prevalence and associated factors

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2004

The purposes of this study were to determine the prevalence of depression and associated risk fac... more The purposes of this study were to determine the prevalence of depression and associated risk factors among women with gynecologic cancer at Siriraj Hospital. Descriptive cross-sectional study. Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital. A total of 149 women with gynecologic cancer were enrolled. Women's demographic data and medical information were obtained by interview and abstracted from the medical record. The health-related self-report (HRSR) questionnaire was used to determine the prevalence of depression. Certain characteristics regarding demographic and medical data were evaluated in order to find any correlation with depression. The diagnoses in this study population included 77 cases (51.7%) of ovarian cancer, 34 cases (22.8%) of cervical cancer, 20 cases (13.4%) of uterine cancer and 18 cases (12.1%) of gestational trophoblastic tumor. The mean age was 46.6 years. Depression was detected in 20 out of 149 p...