ORCID Profile
0000-0001-9331-4639
Current Organisations
Royal Australian and New Zealand College of Obstetricians and Gynaecologists
,
St Vincent's Hospital Sydney
,
University of Adelaide
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Publications
Evaluating Surgical Complexity of Endoscopic Hysterectomy: An Inter-rater and Intrarater Agreement Study of Novel Scoring Tool
Publisher: Elsevier BV
Date: 05-2022
DOI: 10.1016/J.JMIG.2022.01.010
Abstract: Evaluate inter-rater and intrarater reliability of a novel scoring tool for surgical complexity assessment of endoscopic hysterectomy. Validation study. Academic medical center. Total of 11 academic obstetrician-gynecologists with varying years of postresidency training, clinical practice, and surgical volumes. Application of a novel scoring tool to evaluate surgical complexity of 150 sets of images taken in a standardized fashion before surgical intervention (global pelvis, anterior cul-de-sac, posterior cul-de-sac, right adnexa, left adnexa). Using only these images, raters were asked to assess uterine size, number, and location of myomas, adnexal and uterine mobility, need for ureterolysis, and presence of endometriosis or adhesions in relevant locations. Surgical complexity was staged on a scale of 1 to 4 (low to high complexity). Number of postresidency years in practice for participating surgeons ranged from 2 to 15, with an average of 8 years. A total of 8 obstetrician-gynecologists (72.7%) had completed a fellowship in minimally invasive gynecologic surgery. Six (54.6%) reported an annual volume of >50 hysterectomies. Raters reported that 95.4% of the images were satisfactory for assessment. Of the 150 sets of images, most were found to be stage 1 to 2 complexity (stage 1: 23.8%, stage 2: 41.6%, stage 3: 32.8%, stage 4: 1.8%). The level of inter-rater agreement regarding stage 1 to 2 vs 3 to 4 complexity was moderate (κ = 0.49 95% confidence interval [CI], 0.42-0.56). Moderate inter-rater agreement was also found between surgeon raters with an annual hysterectomy volume >50 (κ = 0.49 95% CI, 0.40-0.57) as well as between surgeon raters with fellowship experience (κ = 0.50 95% CI, 0.42-0.58). Intrarater agreement averaged 80.2% among all raters and also achieved moderate agreement (mean weighted κ = 0.53 range, 0.38-0.72). This novel scoring tool uses clinical assessment of preintervention anatomic images to stratify the surgical complexity of endoscopic hysterectomy. It has rich and comprehensive evaluation capabilities and achieved moderate inter-rater and intrarater agreement. The tool can be used in conjunction with or instead of traditional markers of surgical complexity such as uterine weight, estimated blood loss, and operative time.
Chronic lymphocytic leukaemia masquerading as a labial lump
Publisher: BMJ
Date: 2019
Abstract: We report a case of an 82-year-old woman who presented with a 2-week history of a left labial lump. She had a history of chronic lymphocytic leukaemia (CLL) for several years and remained stable without clinical evidence of disease progression. She was observed with regular blood tests and clinical assessment. She was hypogammaglobulinaemic from the CLL and due to frequent symptomatic infections requiring hospitalisation, was commenced on monthly intravenous immunoglobulin. A tissue biopsy of the labial lump confirmed involved CLL in the genital area and further investigations and management followed.
Cerebral palsy: Causes, pathways, and the role of genetic variants
Publisher: Elsevier BV
Date: 05-2016
Laparoscopic management of a fallopian tubal torsion complicated by a large hydrosalpinx
Publisher: Informa UK Limited
Date: 11-2011
DOI: 10.2147/IJWH.S24639
Intra-abdominal haemorrhage from uterine fibroids: a systematic review of the literature.
Publisher: Springer Science and Business Media LLC
Date: 15-04-2020
DOI: 10.1186/S12893-020-00736-5
Abstract: Uterine leiomyomas are common benign tumours found in women of reproductive age that are rarely associated with intra-abdominal haemorrhage. The aetiology behind this relationship is poorly understood and the aforementioned association poorly recognized from a patient’s clinical presentation. Available information in the literature is limited to case reports. The aim of this systematic review is to document and highlight the occurrence of intra-abdominal haemorrhage from uterine fibroids, and determine associated morbidity and mortality. A systematic review of Medline, EMBASE, Web of Science, Scopus, and The Cochrane Library – CENTRAL was performed from the databases inception through to December 2018 for case report and series of patients who experienced intra-abdominal haemorrhage from uterine fibroids. Findings were presented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We identified 115 publications reporting on 125 original case reports. The documented intra-abdominal haemorrhage were commonly due to the rupture of superficial blood vessels over the surface of a fibroid, followed by rupture and avulsion of the fibroid involved. A clinical picture of sudden and profound hypovolemic shock with severe abdominal pain was often the presenting complaint, with a correct pre-operative diagnosis only made in 7 cases on computed tomography imaging. Hysterectomy and myomectomy were the most common surgery performed. Mortality was reported in 4 cases which were directly related to complications of uterine fibroids. Intra-abdominal haemorrhage secondary to uterine fibroids remained a rare phenomenon which is poorly recognized among clinicians. While this association is not representative of the population of interest, it highlights the pathophysiological spectrum of uterine fibroids and its relevance to emergency physicians, surgeons and gynaecologists during clinical practice.
The medical management of Cushing's syndrome during pregnancy
Publisher: Elsevier BV
Date: 05-2013
DOI: 10.1016/J.EJOGRB.2012.12.015
Abstract: Cushing's syndrome during pregnancy is a rare metabolic condition that is associated with high maternal and foetal morbidity. Clinical symptoms may mimic those of normal pregnancy. A diagnosis is best made based on clinical presentation, laboratory and imaging findings as well as a high index of suspicion. Medical management with anti-steroidogenic agents such as metyrapone has been shown to be effective, but surgery is usually the recommended treatment option. Its main limitation is optimal timing of the procedure in late first trimester or early second trimester to prevent spontaneous termination of pregnancy. We describe our experience and management of a 39-year-old patient with uncontrolled hypertension at 25 weeks gestation which was later diagnosed as ACTH independent Cushing's syndrome and had a favourable pregnancy outcome. The role of medical therapy and its challenges, as well as its impact on pregnancy outcomes, were explored by a literature search conducted through Pubmed and Medline databases. A total of 12 patients with Cushing's syndrome during pregnancy were reported to have been managed with metyrapone, with ketoconazole being studied to a significant degree in three cases. Of these women, 53% delivered close to term and 20% developed pre-ecl sia. Despite two neonatal deaths and one stillborn reported, medical management appeared effective in controlling hypercortisolemia during pregnancy with strict monitoring of blood pressure and foetal surveillance. It remains the only active management in the setting of pregnancy-induced Cushing's syndrome, and has shown to be a viable option in controlling serum cortisol levels especially as an adjunct to surgery as reflected in four cases. A multidisciplinary approach towards an in idualised management process is warranted with medical management to ensure a safe maternal and foetal outcome.
Spontaneous uterine artery erosion from deep infiltrating endometriosis
Publisher: Elsevier BV
Date: 04-2021
Pre-operative ureteric catherisation for major endoscopic gynaecological surgery
Publisher: Springer Science and Business Media LLC
Date: 11-09-2023
Conservative management of morbidly adherent placenta
Publisher: Elsevier BV
Date: 08-2016
Manifestation and management of intravenous leiomyomatosis: A systematic review of the literature
Publisher: Elsevier BV
Date: 12-2022
DOI: 10.1016/J.SURONC.2022.101879
Abstract: Intravenous leiomyomatosis (IVL) is characterized by the presence of vascular extension and invasion of benign smooth muscle lesions in a worm-like manner from uterine fibroids into the systemic vasculature system. Surgery with complete tumour resection remains the main treatment approach, however both treated and untreated of this disease is associated with high morbidity and mortality. The aim of this systematic review is to highlight the systemic manifestations and surgical management of IVL.
A retrospective cohort review of intrahepatic cholestasis of pregnancy in a South Australian population
Publisher: Elsevier BV
Date: 11-2017
DOI: 10.1016/J.EJOGRB.2017.09.012
Abstract: To review the management and outcomes of Intrahepatic Cholestasis of Pregnancy (ICP) in South Australia (SA) over the past decade. Retrospective cohort review. Public clinics at two teaching hospitals in SA. All pregnancies associated with ICP (defined as pruritus with serum bile acids≥10μmol/L) managed 2001-2010. Identification of subjects (laboratory database), detailed chart-review to ascertain demographics, maternal erinatal outcomes and associated pregnancy comorbidities, analysis of mild/severe disease cohorts, comparison with normal population data, using Student's t-test or Mann-Whitney U test as appropriate for continuous variables, and Pearson's chi-square test or Fisher's exact test for categorical variables. Unadjusted odds ratios (OR) with 95% confidence intervals (95% CI) were calculated in comparison with the general pregnant population for clinically significant outcomes. 320 women (359 pregnancies) were diagnosed with ICP over the 10-years: incidence 0.6%/year. Within the cohort, the incidences of gestational diabetes (12.5% OR 3.06, 95% CI 2.23-4.18), pre-ecl sia (10.3% OR 75.84, 95% CI 52.91-178.70), and spontaneous preterm labour (23.1% OR 2.05, 95% CI 1.41-2.98) were much higher than in the general SA pregnant population. Pregnancies with severe ICP (serum bile acids≥40μmol/L) had ICP diagnosed earlier (231 vs 248 days, P<0.001), and ended earlier (256 vs 260 days, P<0.001) with lower birthweights (2827g vs 3093g, P <0.001) than those with mild ICP. Neonates of severe ICP mothers were more likely to require special-care-nursery admission, but perinatal complication rates did not differ. There were no stillbirths. This large Australian retrospective cohort study confirms generally favourable outcomes associated with ICP, mild or severe, with no stillbirths, likely secondary to proactive medical management. A high proportion of pregnancies were also affected by gestational diabetes, pre-ecl sia, and/or spontaneous pre-term labour compared with the general population.
Trends and outcomes of ruptured ovarian cysts
Publisher: Oxford University Press (OUP)
Date: 12-03-2022
DOI: 10.1136/POSTGRADMEDJ-2020-138833
Abstract: Ruptured ovarian cysts are common gynaecological presentation to health institutions with abdominal pain. While this phenomenon is generally self-limiting, surgery may be necessary in cases of haemodynamic compromise or association with torsion. The aim of this audit is to identify the trend of hospital presentations, as well as the review the management of modern gynaecology practice. A retrospective audit of all women who presented to the emergency department with an imaging diagnosis of ruptured ovarian cysts was conducted over a 5-year period at St Vincent's Hospital, Sydney. During the study period, 408 women were identified. There was a trend towards conservative management, as observed in 84.7% of women, while the remaining 15.4% underwent surgery. Haemorrhagic or ruptured corpus luteum was the most common diagnoses. As expected, women who had surgical intervention were more likely to have larger cysts (20 vs 50% p<0.05), and larger free fluid findings on imaging (1.4 vs 23.8% p<0.05) compared with those managed conservatively. There were no statistically significant differences in location of ovarian cysts (right or left) or antecedent to hospital presentation (vaginal intercourse or trauma). Ruptured ovarian cysts of both functional and non-functional types remained a common clinical presentation of acute pain for women to the emergency department. Majority of women were managed conservatively in our cohort, and indications for surgery were large ovarian cysts and large free fluid seen on imaging findings. Surgery was largely feasible with minimal complications.
Analysis of emergency peripartum hysterectomy in Northern Tasmania
Publisher: Wiley
Date: 10-2014
DOI: 10.1111/AJR.12135
Abstract: There is a need for emerging Australian data on emergency peripartum hysterectomy (EPH) especially in rural areas due to the associated high maternal morbidity and mortality. The aim of this study is to review the incidence and complications of EPH in the northern region of Tasmania. A retrospective cohort study at a single health care institution during a 10 year period. Launceston General Hospital, the main maternity referral centre for the northern region of Tasmania. Case notes of women coded with hysterectomy during childbirth were included and analysed. Primary outcomes were maternal and neonatal morbidity and mortality. Eighteen women were identified, giving an incidence of 1.01 per 1000 births. Indications for surgery were abnormal placentation, uterine atony and uterine rupture. Maternal morbidity was high, and included intensive care admissions (55%), disseminated intravascular coagulopathy (50%), hypovolemic shock (38%), febrile illness (27%) and urinary tract injuries (22%). The mean estimated total blood loss was 4091.6 mL, and 88% of women received blood transfusions. All women received prophylactic antibiotics. Women with morbidly adherent placenta were likely to experience more complications and transfusions. There were no maternal or neonatal deaths identified. The rate of peripartum hysterectomy in rural Tasmania is higher compared with other Australian tertiary-level hospitals, suggesting that Australian women birthing in rural and regional areas might be at greater risk. Maternal morbidity associated with abnormal placentation is high hence, better diagnostic modalities and multidisciplinary antenatal management are required to improve maternal outcomes.
Related Organisations
Royal Australian And New Zealand College Of Obstetricians And Gynaecologists
Location: Australia
Related Funding Activities
No related grants have been discovered for Wei Lim.