Journal of minimally invasive gynecology最新文献

{"title":"Endoscopic closure of rectosigmoid injury with OTS clip after laparoscopic surgery for extensive endometriosis.","authors":"Dr Med Sami Shihada, Michael Oelckers, Gaby Moawad, Prof Dr Med Rüdiger Klapdor","doi":"10.1016/j.jmig.2024.10.029","DOIUrl":"https://doi.org/10.1016/j.jmig.2024.10.029","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142591088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"International Societies","authors":"","doi":"10.1016/S1553-4650(24)00780-5","DOIUrl":"10.1016/S1553-4650(24)00780-5","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142586736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-Volume Surgeons and Reducing Racial Disparities in Route of Hysterectomy","authors":"","doi":"10.1016/j.jmig.2024.07.003","DOIUrl":"10.1016/j.jmig.2024.07.003","url":null,"abstract":"<div><h3>Study Objective</h3><div>To examine racial disparities in route of hysterectomy and perioperative outcomes before and after expansion of high-volume minimally invasive surgeons (&gt;10 minimally invasive hysterectomies [MIHs]/year).</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting</h3><div>Multicenter academic teaching institution.</div></div><div><h3>Patients</h3><div>All patients who underwent a scheduled hysterectomy for benign indications during 2018 (preintervention) and 2022 (postintervention).</div></div><div><h3>Interventions</h3><div>Recruitment of fellowship in minimally invasive gynecologic surgery–trained faculty and increased surgical training for academic specialists in obstetrics and gynecology occurred in 2020.</div></div><div><h3>Measurements and Main Results</h3><div>Patients in the preintervention cohort (n = 171) were older (median age, 45 years vs 43 years; p = .003) whereas patients in the postintervention cohort (n = 234) had a higher burden of comorbidities (26% American Society of Anesthesiologists class III vs 19%; p = .03). Uterine weight was not significantly different between cohorts (p = .328). Between the pre- and postintervention cohorts, high-volume minimally invasive surgeons increased from 27% (n = 4) to 44% (n = 7) of those performing hysterectomies within the division and percentage of hysterectomies performed via minimally invasive route increased (63% vs 82%; p &lt;.001). In the preintervention cohort, Black patients had a lower percentage of hysterectomies performed via minimally invasive route than White patients (Black = 56% MIH vs White = 76% MIH; p = .014). In the postintervention cohort, differences by race were no longer significant (Black = 78% MIH vs White = 87% MIH; p = .127). There was a significant increase (22%) in MIH for Black patients between cohorts (p &lt;.001). After adjusting for age, body mass index, American Society of Anesthesiologists class, previous surgery, and uterine weight, disparities by race were no longer present in the postintervention cohort. Perioperative outcomes including length of stay (p &lt;.001), infection rates (p = .002), and blood loss (p = .01) improved after intervention.</div></div><div><h3>Conclusion</h3><div>Increasing fellowship in minimally invasive gynecologic surgery–trained gynecologic surgeons and providing more opportunities in robotic/laparoscopic training for academic specialists may improve access to MIH for Black patients and reduce disparities.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141555002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A National Database Study on Racial Disparities in Route of Hysterectomy With a Surrogate Control for Uterine Size: A Proposed Quality Metric for Benign Indications","authors":"","doi":"10.1016/j.jmig.2024.07.006","DOIUrl":"10.1016/j.jmig.2024.07.006","url":null,"abstract":"<div><h3>Study Objective</h3><div>To investigate the association between race and route of hysterectomy among patients undergoing hysterectomy for abnormal uterine bleeding (AUB) in the absence of uterine myoma disease and excluding malignancy.</div></div><div><h3>Design</h3><div>A cross-sectional cohort study utilizing the Healthcare Cost and Utilization Project Nationwide Inpatient Sample and National Ambulatory Surgical databases to compare abdominal to minimally invasive routes of hysterectomy.</div></div><div><h3>Setting</h3><div>Hospitals and hospital-affiliated ambulatory surgical centers participating in the Healthcare Cost and Utilization Project in 2019.</div></div><div><h3>Patients</h3><div>A total of 75 838 patients who had undergone hysterectomy for AUB, excluding uterine myoma and malignancy.</div></div><div><h3>Interventions</h3><div>n/a</div></div><div><h3>Measurements and Main Results</h3><div>Of the 75 838 hysterectomies performed for AUB in the absence of uterine myomas and malignancy, 10.1% were performed abdominally and 89.9% minimally invasively. After adjusting for confounders, Black patients were 38% more likely to undergo abdominal hysterectomy compared to White patients (OR 1.38, CI 1.12–1.70 p = .002). Black race, thus, is independently associated with open surgery.</div></div><div><h3>Conclusion</h3><div>Despite excluding uterine myomas as a risk factor for an abdominal route of hysterectomy, Black race remained an independent predictor for abdominal versus minimally invasive hysterectomy, and Black patients were found to undergo a disproportionately higher rate of abdominal hysterectomy compared to White patients.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141603782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Lithopedion in a Postmenopausal Woman","authors":"","doi":"10.1016/j.jmig.2024.07.012","DOIUrl":"10.1016/j.jmig.2024.07.012","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141734378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"TOC","authors":"","doi":"10.1016/S1553-4650(24)00782-9","DOIUrl":"10.1016/S1553-4650(24)00782-9","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142586738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Board Of Directors-Ed Calendar","authors":"","doi":"10.1016/S1553-4650(24)00779-9","DOIUrl":"10.1016/S1553-4650(24)00779-9","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142586735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bowel Endometriosis Excision: Approaches and Outcomes Including Hand Sewing of Discoid Excision","authors":"","doi":"10.1016/j.jmig.2024.07.019","DOIUrl":"10.1016/j.jmig.2024.07.019","url":null,"abstract":"<div><h3>Study Objective</h3><div>To examine the outcomes of surgery performed for bowel endometriosis including shaving, discoid resections with hand-sewn closure, and segmental resection.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting</h3><div>Large academic hospital.</div></div><div><h3>Patients</h3><div>All patients with bowel wall endometriosis who underwent surgical excision with the Division of Minimally Invasive Gynecologic Surgery between 2009 and 2022.</div></div><div><h3>Interventions</h3><div>No interventions administered.</div></div><div><h3>Measurements and Main Results</h3><div>From 2009 to 2022, a total of 112 patients underwent laparoscopic excision of endometriosis involving the rectum. From this cohort, 82 underwent shaving, 23 underwent discoid excision, and 7 had segmental bowel resection. The discoid excisions were closed in multiple layers with hand sewing and were not closed with a staple device. Average lesion size on preoperative imaging was 20.9 mm in the shave group, 22.5 mm in the discoid group, and 38.5 mm in the segmental group. Complication requiring reoperation for anastomotic leak occurred in 3 cases (3.66%) of the shave group and 1 case (4.35%) of the discoid excision group, but did not occur in any of the segmental resections. The number of layers of closure and type of suture used did not appear to have an effect on complication rate, however, this study was not powered to detect a meaningful difference.</div></div><div><h3>Conclusion</h3><div>Our data shows a similar rate of anastomotic leak complication for each closure type as that reported in the literature (2.2%, 9.7%, and 9.9% reported for shave, discoid and segmental resection, respectively). While our study is underpowered, these findings support that hand sewing for discoid excision is a safe and reasonable alternative to circular stapler closures and can be considered with an experienced surgeon. Further study is warranted to confirm safety and explore potential cost savings associated with this technique as well as applications in areas with less resources available.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141875116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Live Surgery: Educational Gold or Just Surgical Reality TV?","authors":"","doi":"10.1016/j.jmig.2024.09.019","DOIUrl":"10.1016/j.jmig.2024.09.019","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“RAIL BIOPSY” A Novel and Useful Technique for Hysteroscopic Endometrial Target Biopsy","authors":"","doi":"10.1016/j.jmig.2024.06.013","DOIUrl":"10.1016/j.jmig.2024.06.013","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Study Objective&lt;/h3&gt;&lt;div&gt;&lt;span&gt;Endometrial biopsy&lt;span&gt; (EB) is one of the most common gynecologic procedures. Office-based EB has replaced procedures involving general/loco-regional anesthesia and cervical dilatation performed in the operating room [&lt;/span&gt;&lt;/span&gt;&lt;span&gt;&lt;span&gt;1&lt;/span&gt;&lt;/span&gt;, &lt;span&gt;&lt;span&gt;2&lt;/span&gt;&lt;/span&gt;, &lt;span&gt;&lt;span&gt;3&lt;/span&gt;&lt;/span&gt;&lt;span&gt;]. The Grasp Biopsy seems to be the most appropriate EB technique for reproductive-aged women [&lt;/span&gt;&lt;span&gt;&lt;span&gt;1&lt;/span&gt;&lt;/span&gt;,&lt;span&gt;&lt;span&gt;2&lt;/span&gt;&lt;/span&gt;,&lt;span&gt;&lt;span&gt;4&lt;/span&gt;&lt;/span&gt;]. Recently, the Visual D&amp;C performed with hysteroscopic tissue removal devices has shown to be a valid alternative [&lt;span&gt;&lt;span&gt;5&lt;/span&gt;&lt;/span&gt;&lt;span&gt;]. However, it is often difficult to obtain an adequate specimens in peri/post-menopausal women with hypo/atrophic endometrium [&lt;/span&gt;&lt;span&gt;&lt;span&gt;2&lt;/span&gt;&lt;/span&gt;]. Our aim is to show a novel hysteroscopic EB technique called “Rail Biopsy” which requires widespread and cheap instruments.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;A step-by-step explanation of surgical techinque with narrated video footage. Setting: Tertiary Level Academic Hospital “IRCCS Azienda Ospedaliero-Universitaria di Bologna” Bologna, Italy.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interventions&lt;/h3&gt;&lt;div&gt;&lt;span&gt;We performed the “Rail Biopsy” technique with a 5.0 mm Continuous Flow Operative Hysteroscope with a 30° Lens and a 5Fr operative channel. We identify the endometrial target area (ETA), and we create a first track cutting through the endometrium in a caudo-cranial direction using cold scissors. We repeat the procedure, creating a second parallel track, thus completing our “rail” and isolating a wide ETA. Then, in the caudo-cranial direction, we cut through the stromal layer beneath the ETA. With a 5Fr cold grasping forceps, we clench the cranial edge of the ETA, and we remove it from the uterine cavity. A high-quality specimen, even in the case of hypo/atrophic endometrium or focal sessile lesions, can be obtained with this technique. The crucial aspect of the “Rail Biopsy” indeed is cutting through the stromal tissue while the endometrium is minimally touched, avoiding thermal damage deriving from electrosurgery. The instruments required are widespread and cheap. Moreover, this technique can be performed on any wall of the uterus, under vision, and, in the majority of patients, in an office-setting without cervical dilatation or general/loco-regional anesthesia, making it an attractive alternative to &lt;/span&gt;hysteroscopy performed in the operating room setting. Further studies comparing “Rail Biopsy” to other EB techniques are needed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;We showed a novel approach for hysteroscopic EB that may be particularly useful in patients with hypo/atrophic endometrium, easy to learn and with low costs.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Video Abstract&lt;/h3&gt;&lt;div&gt;&lt;span&gt;&lt;span&gt;&lt;span&gt;&lt;span&gt;&lt;video&gt;&lt;source&gt;&lt;/source&gt;&lt;/video&gt;&lt;/span&gt;&lt;span&gt;&lt;span&gt;Download: &lt;span&gt;Download video (34MB)&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141468656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}