Objective: To demonstrate the multiple advantages of the suprapubic port in robotic assisted lapa... more Objective: To demonstrate the multiple advantages of the suprapubic port in robotic assisted laparoscopic myomectomy. Design: Video demonstration of a robotic assisted laparoscopic myomectomy technique using a suprapubic incisional retractor (GelPOINT). Setting: Hospital. Patient(s): A 32-year-old primigravid women with heavy menstrual bleeding and pelvic pain with a 12-cm leiomyoma (International Federation of Gynecology and Obstetrics type 5). Intervention(s): Illustrate a surgical approach during robotic assisted laparoscopic myomectomy with the use of a 5-cm suprapubic incision, an incisional retractor (GelPOINT) for the enucleation, and extraction of a large leiomyoma. Main Outcome Measure(s): The effective enucleation and extraction of a leiomyoma specimen using an incisional retractor and Gel-POINT. The steps of the technique and the role of GelPOINT are demonstrated. Result(s): The procedure was performed without incident, and the patient experienced pain relief and lighter menses postoperatively. This technique has been performed successfully since June 2014 on 22 women. Conclusion(s): During a robotic assisted laparoscopic myomectomy the suprapubic incision is both advantageous and practical. The small incision allows the surgery to remain minimally invasive; the primary umbilical trocar is inserted under direct visualization in an already insufflated abdomen; the location of the incision allows the surgical assistant easy access to the port; the passing of the needles occurs under direct visualization with minimal camera manipulation; and last, the extraction of large tissue can be performed within a specimen pouch through this same suprapubic incision in a short period. (Fertil Steril Ò 2017;108:e1. Ó2017 by American Society for Reproductive Medicine.
The Journal of clinical endocrinology and metabolism, May 1, 2017
Leiomyomas have abundant extracellular matrix (ECM), with upregulation of versican, a large prote... more Leiomyomas have abundant extracellular matrix (ECM), with upregulation of versican, a large proteoglycan. We investigated ADAMTS (a disintegrin-like and metalloprotease with thrombospondin type 1 motifs) protease-mediated versican cleavage in myometrium and leiomyoma and the effect of versican knockdown in leiomyoma cells. We used quantitative reverse transcription polymerase chain reaction (qRT-PCR), western blotting, immunohistochemistry, and RNA in situ hybridization for analysis of myometrium, leiomyoma and immortalized myometrium and leiomyoma cells. Short interfering RNA (siRNA) was used to knockdown versican in leiomyoma cells. This study was performed in an academic laboratory. Study subjects were women with symptomatic or asymptomatic leiomyoma. We quantified messenger RNAs (mRNAs) for versican splice variants. We identified ADAMTS-cleaved versican in myometrium and leiomyoma and ADAMTS messenger RNAs and examined the effect of VCAN siRNA on smooth muscle differentiation an...
Focal adhesions anchor cells to extracellular matrix (ECM) and direct assembly of a pre-stressed ... more Focal adhesions anchor cells to extracellular matrix (ECM) and direct assembly of a pre-stressed actin cytoskeleton. They act as a cellular sensor and regulator, linking ECM to the nucleus. Here, we identify proteolytic turnover of the anti-adhesive proteoglycan versican as a requirement for maintenance of smooth muscle cell (SMC) focal adhesions. Using conditional deletion in mice, we show that ADAMTS9, a secreted metalloprotease, is required for myometrial activation during late gestation and for parturition. Through knockdown of ADAMTS9 in uterine SMC, and manipulation of pericellular versican via knockdown or proteolysis, we demonstrate that regulated pericellular matrix dynamics is essential for focal adhesion maintenance. By influencing focal adhesion formation, pericellular versican acts upstream of cytoskeletal assembly and SMC differentiation. Thus, pericellular versican proteolysis by ADAMTS9 balances pro- and anti-adhesive forces to maintain an SMC phenotype, providing a ...
Patients affected by the presence of leiomyomas may incur a substantial physical, emotional, soci... more Patients affected by the presence of leiomyomas may incur a substantial physical, emotional, social and financial toll as well as losses in their quality of life. Although many myomas are not amenable to medical therapy or hysteroscopic resection, many others are amenable to minimally invasive surgical approaches. In patients who prefer to retain their fertility, laparoscopic myomectomy should be considered the intervention of choice. In this review we expand on the surgical techniques of both conventional laparoscopic and robotic-assisted myomectomies. We discuss port placement, enucleation of myomas, tissue extraction, minimization of blood loss, adhesion prevention and technique for closure of uterine incisions. Finally, we discuss the available data supporting the use of these two approaches as the preferred, safe, and effective fertility-sparing surgical option. We also briefly discuss the emerging technologies of uterine artery embolization, ultrasound surgery and radiofrequency ablation.
Endometriosis is a pain syndrome which affects 35–50% of women with chronic pelvic pain and/or in... more Endometriosis is a pain syndrome which affects 35–50% of women with chronic pelvic pain and/or infertility. It is frequently misdiagnosed leading to delays in patients obtaining appropriate treatments. The most accurate currently available mode of diagnosis is through laparoscopy with histological confirmation. In this chapter we describe noninvasive and semi-invasive modalities to obtain biologic biomarkers which may be an adequate screening tool for patients with endometriosis who are symptomatic with normal transvaginal ultrasounds, whom are at highest risk for diagnosis delay. In this chapter we will review noninvasive (urinary, salivary) and semi-invasive biomarkers (peritoneal), as screening and diagnostic methodologies for women symptomatic endometriosis and normal ultrasound findings. Few genetic markers have been identified through DNA amplification of buccal swabs as well as hormonal markers, and this is an area with lots of potential. Various urinary peptides and proteins are discussed, some with more potential than others, which require studies with larger sample sizes, and need to be studied in more diverse populations. We also review the extensively studied peritoneal biomarkers which include cytokines, immune modulators, and growth factors. Though many of the biomarkers described have a lot of potential, there is not one that stands above the rest. Validation of these studies in larger sample sizes including various study populations is required prior to their applicability into the clinical setting. It is most probable that the answer lies in the study of combination of biomarkers and the identification of ideal panel that can predict the diagnosis and the severity of endometriosis.
Objective: To demonstrate the multiple advantages of the suprapubic port in robotic assisted lapa... more Objective: To demonstrate the multiple advantages of the suprapubic port in robotic assisted laparoscopic myomectomy. Design: Video demonstration of a robotic assisted laparoscopic myomectomy technique using a suprapubic incisional retractor (GelPOINT). Setting: Hospital. Patient(s): A 32-year-old primigravid women with heavy menstrual bleeding and pelvic pain with a 12-cm leiomyoma (International Federation of Gynecology and Obstetrics type 5). Intervention(s): Illustrate a surgical approach during robotic assisted laparoscopic myomectomy with the use of a 5-cm suprapubic incision, an incisional retractor (GelPOINT) for the enucleation, and extraction of a large leiomyoma. Main Outcome Measure(s): The effective enucleation and extraction of a leiomyoma specimen using an incisional retractor and Gel-POINT. The steps of the technique and the role of GelPOINT are demonstrated. Result(s): The procedure was performed without incident, and the patient experienced pain relief and lighter menses postoperatively. This technique has been performed successfully since June 2014 on 22 women. Conclusion(s): During a robotic assisted laparoscopic myomectomy the suprapubic incision is both advantageous and practical. The small incision allows the surgery to remain minimally invasive; the primary umbilical trocar is inserted under direct visualization in an already insufflated abdomen; the location of the incision allows the surgical assistant easy access to the port; the passing of the needles occurs under direct visualization with minimal camera manipulation; and last, the extraction of large tissue can be performed within a specimen pouch through this same suprapubic incision in a short period. (Fertil Steril Ò 2017;108:e1. Ó2017 by American Society for Reproductive Medicine.
The Journal of clinical endocrinology and metabolism, May 1, 2017
Leiomyomas have abundant extracellular matrix (ECM), with upregulation of versican, a large prote... more Leiomyomas have abundant extracellular matrix (ECM), with upregulation of versican, a large proteoglycan. We investigated ADAMTS (a disintegrin-like and metalloprotease with thrombospondin type 1 motifs) protease-mediated versican cleavage in myometrium and leiomyoma and the effect of versican knockdown in leiomyoma cells. We used quantitative reverse transcription polymerase chain reaction (qRT-PCR), western blotting, immunohistochemistry, and RNA in situ hybridization for analysis of myometrium, leiomyoma and immortalized myometrium and leiomyoma cells. Short interfering RNA (siRNA) was used to knockdown versican in leiomyoma cells. This study was performed in an academic laboratory. Study subjects were women with symptomatic or asymptomatic leiomyoma. We quantified messenger RNAs (mRNAs) for versican splice variants. We identified ADAMTS-cleaved versican in myometrium and leiomyoma and ADAMTS messenger RNAs and examined the effect of VCAN siRNA on smooth muscle differentiation an...
Focal adhesions anchor cells to extracellular matrix (ECM) and direct assembly of a pre-stressed ... more Focal adhesions anchor cells to extracellular matrix (ECM) and direct assembly of a pre-stressed actin cytoskeleton. They act as a cellular sensor and regulator, linking ECM to the nucleus. Here, we identify proteolytic turnover of the anti-adhesive proteoglycan versican as a requirement for maintenance of smooth muscle cell (SMC) focal adhesions. Using conditional deletion in mice, we show that ADAMTS9, a secreted metalloprotease, is required for myometrial activation during late gestation and for parturition. Through knockdown of ADAMTS9 in uterine SMC, and manipulation of pericellular versican via knockdown or proteolysis, we demonstrate that regulated pericellular matrix dynamics is essential for focal adhesion maintenance. By influencing focal adhesion formation, pericellular versican acts upstream of cytoskeletal assembly and SMC differentiation. Thus, pericellular versican proteolysis by ADAMTS9 balances pro- and anti-adhesive forces to maintain an SMC phenotype, providing a ...
Patients affected by the presence of leiomyomas may incur a substantial physical, emotional, soci... more Patients affected by the presence of leiomyomas may incur a substantial physical, emotional, social and financial toll as well as losses in their quality of life. Although many myomas are not amenable to medical therapy or hysteroscopic resection, many others are amenable to minimally invasive surgical approaches. In patients who prefer to retain their fertility, laparoscopic myomectomy should be considered the intervention of choice. In this review we expand on the surgical techniques of both conventional laparoscopic and robotic-assisted myomectomies. We discuss port placement, enucleation of myomas, tissue extraction, minimization of blood loss, adhesion prevention and technique for closure of uterine incisions. Finally, we discuss the available data supporting the use of these two approaches as the preferred, safe, and effective fertility-sparing surgical option. We also briefly discuss the emerging technologies of uterine artery embolization, ultrasound surgery and radiofrequency ablation.
Endometriosis is a pain syndrome which affects 35–50% of women with chronic pelvic pain and/or in... more Endometriosis is a pain syndrome which affects 35–50% of women with chronic pelvic pain and/or infertility. It is frequently misdiagnosed leading to delays in patients obtaining appropriate treatments. The most accurate currently available mode of diagnosis is through laparoscopy with histological confirmation. In this chapter we describe noninvasive and semi-invasive modalities to obtain biologic biomarkers which may be an adequate screening tool for patients with endometriosis who are symptomatic with normal transvaginal ultrasounds, whom are at highest risk for diagnosis delay. In this chapter we will review noninvasive (urinary, salivary) and semi-invasive biomarkers (peritoneal), as screening and diagnostic methodologies for women symptomatic endometriosis and normal ultrasound findings. Few genetic markers have been identified through DNA amplification of buccal swabs as well as hormonal markers, and this is an area with lots of potential. Various urinary peptides and proteins are discussed, some with more potential than others, which require studies with larger sample sizes, and need to be studied in more diverse populations. We also review the extensively studied peritoneal biomarkers which include cytokines, immune modulators, and growth factors. Though many of the biomarkers described have a lot of potential, there is not one that stands above the rest. Validation of these studies in larger sample sizes including various study populations is required prior to their applicability into the clinical setting. It is most probable that the answer lies in the study of combination of biomarkers and the identification of ideal panel that can predict the diagnosis and the severity of endometriosis.
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Papers by Aicha Gueye