Mosaicism Survival of the fittest versus no embryo left behind

Authors:
Santiago Munné, Ph.D., James Grifo, M.D., Ph.D., Dagan Wells, Ph.D.

Volume 105, Issue 5, Pages 1146-1149

Abstract:

Reflections on “Outcomes of in vitro fertilization with preimplantation genetic diagnosis: an analysis of the United States Assisted Reproductive Technology Surveillance Data, 2011–2012” by Chang et al.

The challenge of embryonic mosaicism in preimplantation genetic screening

Authors:
Richard T. Scott Jr., M.D., Daniela Galliano, M.D.

Volume 105, Issue 5, Pages 1150-1152

Abstract:

The availability of reliable 24 chromosome aneuploidy screening platforms has provided clinicians and scientists with a powerful new diagnostic tool in the embryology laboratory. Class I data demonstrate increased implantation and delivery rates and reduced multiple gestation rates by empowering more effective single ET after preimplantation genetic screening (PGS) is performed on trophectoderm biopsies (1, 2). Sustained implantation rates of 60% or higher are routinely being attained in multiple programs after synchronous transfer of euploid blastocysts—even in women in their early forties.

Robotic single site myomectomy A step by step tutorial

Original Video Article

Capsule:
This instructional video demonstrates our recently described single-site robot-assisted laparoscopic myomectomy using the da Vinci Si platform with a multilumen port and wristed, semirigid instrumentation.

Authors:
Antonio R. Gargiulo, M.D., Erin I. Lewis, M.D., Daniel J. Kaser, M.D., Serene S. Srouji, M.D.

Volume 104, Issue 5, Page e13

Abstract:

Objective:
To provide a step-by-step description of our published technique of single-site robot-assisted laparoscopic myomectomy with the goal of promoting its safe adoption.

Design:
Surgical video tutorial.

Setting:
Institutional review board-approved study at university medical center.

Patient(s):
Ten women undergoing single-site robot-assisted laparoscopic myomectomy between November 2014 and March 2015.

Intervention(s):
A 2.5-cm vertical incision is made within the umbilicus, through which a multilumen single-site port (da Vinci Single-Site; Intuitive Surgical) is seated. An 8.5-mm 0-degree laparoscope is introduced, and the teleoperator (da Vinci Si Surgical Platform; Intuitive Surgical) is docked, allowing subsequent placement of two curved 5-mm instrument cannulae. Two wristed, semirigid needle drivers are loaded onto robotic arms 1 and 2. An 8-mm assistant cannula is also placed through the multilumen single-site port; a flexible 2-mm CO2 laser fiber and all conventional 5-mm laparoscopic instruments are introduced through this cannula as needed. Intramyometrial dilute vasopressin is injected, and fibroid enucleation is performed. The hysterotomy is repaired in layers with unidirectional barbed suture (Stratafix; Ethicon). The teleoperator is undocked. The single-site port is exchanged for a self-retaining wound retractor with gel-sealed cap. An endoscopic pouch is placed in the abdomen, and the specimen is placed within the pouch. The edges of the pouch are exteriorized. Extracorporeal tissue extraction is performed with a scalpel. A running mass closure of the fascia and peritoneum is performed, followed by a subcuticular closure of the skin.

Main Outcome Measure(s):
Median number and size of fibroids removed, specimen weight, operative time, estimated blood loss, and perioperative complications.

Result(s):
The technique described in our video was successfully employed in our first 10 patients. The median number of fibroids removed was 2.5 (range: 1–8); the median size of the largest myoma was 6 cm (range: 4–8 cm); the median specimen weight was 70 g (range: 26–154 g); the median operating time was 202 minutes (range: 141–254 minutes); the median blood loss was 87.5 mL (range: 10–300 mL). No conversions to multiport robotic or open myomectomy occurred. No major complications occurred, and no patients required blood transfusion.

Conclusion(s):
Robot-assisted laparoscopic single-site myomectomy employing a multilumen port and wristed, semirigid needle drivers is a safe and reproducible technique. Our technique allows surgeons to offer myomectomy and contained, extracorporeal tissue extraction via a single 2.5-cm umbilical incision in select patients with low tumor burden.

Articles of Special Interest

Robotic single site myomectomy A step by step tutorial

Thursday, October 29, 2015

Original Video Article

Capsule:
This instructional video demonstrates our recently described single-site robot-assisted laparoscopic myomectomy using the da Vinci Si platform with a multilumen port and wristed, semirigid instrumentation.…

Time lapse monitoring of zona pellucida free embryos obtained through in vitro fertilization A retrospective case series

Wednesday, April 29, 2015

Original Video Article

Capsule:
This case series demonstrate that an oocyte with a damaged zona pellucida that has been removed could be successfully fertilized with intracytoplasmic sperm injection, cultured until blastocyst stage in a time-lapse incubator, and vitrified electively for subsequent use.…

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