Journal of minimally invasive gynecology最新文献

{"title":"Intravascular Leiomyomatosis: Benign Histology with Aggressive Behavior.","authors":"Vivian Siqueira Martimiano, Marcela Caetano Vilela Lauar, Fernanda Calixto Abdalla, Ary Wanderley de Carvalho Junior, Filomena Marino Carvalho, João Paulo Mancusi de Carvalho, Luciana Pardini Chamié","doi":"10.1016/j.jmig.2026.10.021","DOIUrl":"https://doi.org/10.1016/j.jmig.2026.10.021","url":null,"abstract":"<p><p>Intravascular leiomyomatosis is a rare benign smooth muscle neoplasm characterized by intravascular proliferation of smooth muscle tissue, with the potential to extend beyond the uterus into the pelvic venous system and, in advanced cases, the cardiopulmonary circulation. Despite its benign histologic appearance, intravascular leiomyomatosis may exhibit aggressive clinical behavior and frequently poses a diagnostic challenge. We present the case of a 27-year-old woman with no prior pregnancies underwent laparoscopic excision of a leiomyoma. Fifteen months later, MRI identified a left broad ligament mass with intermediate T2 signal intensity and cystic areas, abutting the rectosigmoid and extending into the parametrium and paracolpium, as well as a necrotic internal iliac lymph node. Restricted diffusion and heterogeneous enhancement raised concern for malignancy. Laparoscopic excision revealed masses: one extending from the left mesosalpinx into the parametrium and another from the parametrium to the vesicouterine space, with involvement of the uterine artery. Histopathology revealed smooth muscle proliferation with fascicular architecture within dilated parauterine and parametrial vessels, with hypercellular areas without atypia, necrosis or mitotic activity but extensive cystic and hydropic change confirming intravascular leiomyomatosis (IVL). Although histologically benign, intravascular leiomyomatosis may present with suspicious imaging findings and invasive biological behavior. This case highlights the importance of correlating radiologic, surgical, and histopathological findings to ensure an accurate diagnosis and appropriate therapeutic management. KEYWORDS: Uterine leiomyoma; intravascular leiomyomatosis; magnetic resonance imaging; uterine masses; vascular neoplasms.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149342536","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":"Management of Retained Products of Conception (RPOC) with Hysteroscopic Morcellator: A Systematic Review and Meta-analysis of Efficacy, Safety, and Procedural Outcomes.","authors":"Gianluca Raffaello Damiani, Daniela Turoli, Giuseppe Muzzupapa, Tommaso Di Fonzo, Luca Maria Schounauer, Andrea Tinelli, Marco Ferrante, Giuseppe Trojano, Marco Cerbone, Antonio Malvasi, Amerigo Vitagliano","doi":"10.1016/j.jmig.2026.10.022","DOIUrl":"https://doi.org/10.1016/j.jmig.2026.10.022","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the efficacy, safety, and procedural outcomes of hysteroscopic morcellation (HM) for the treatment of retained products of conception (RPOC).</p><p><strong>Data sources: </strong>A systematic literature search of PubMed and The Cochrane Library was performed from inception to January 2026, combining Medical Subject Headings and free-text terms including \"Retained Products of Conception,\" \"RPOC,\" \"Hysteroscopy,\" \"Hysteroscopic Morcellation,\" and \"Intrauterine Tissue Removal System.\" No restrictions on publication date were applied; the search was limited to peer-reviewed articles published in English. The protocol was registered in PROSPERO (CRD420251247904).</p><p><strong>Methods of study selection: </strong>Randomized controlled trials and prospective or retrospective observational studies evaluating HM for RPOC and reporting at least one outcome of interest (complete RPOC removal, additional procedures, de novo intrauterine adhesions, perioperative complications, or procedural outcomes) were eligible. Case reports, editorials, and conference abstracts were excluded. Two reviewers independently screened records and assessed full texts; four studies met the inclusion criteria (two randomized controlled trials, one prospective study, and one retrospective study).</p><p><strong>Tabulation, integration, and results: </strong>Data were independently extracted by two investigators using a standardized form and verified by a third. Risk of bias was assessed independently by two reviewers. Pooled proportions and means with 95% CIs were calculated using random-effects models, and heterogeneity was assessed with the I² statistic. The pooled complete RPOC removal rate was 95.0% (95% CI 92.2-97.7%; I²=0%). The pooled rate of additional procedures was 6.6% (95% CI 2.5-10.6%; I²=35.4%) and of de novo intrauterine adhesions 5.2% (95% CI 0.4-10.0%; I²=48.7%). Intraoperative and postoperative complication rates were 7.5% (95% CI 3.4-11.6%; I²=31.3%) and 3.4% (95% CI 1.1-5.6%; I²=0%), respectively. The pooled mean procedural time was 11.18 minutes (95% CI 8.61-13.74; I²=98.8%).</p><p><strong>Conclusion: </strong>Hysteroscopic morcellation is associated with high rates of complete RPOC removal and low rates of complications and intrauterine adhesions. However, current evidence is insufficient to establish its superiority over conventional surgical approaches, and adequately powered comparative studies are needed.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149334242","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":"When Vessel Hurt: Vascular Compression of Sciatic Nerve and Sacral Roots - a Neuropelveologic Approach","authors":"PA Ayroza Ribeiro,&nbsp;BSC Lippe,&nbsp;ISC Lippe,&nbsp;MG Leaes,&nbsp;G Rodrigues,&nbsp;H Salomão","doi":"10.1016/j.jmig.2026.09.142","DOIUrl":"10.1016/j.jmig.2026.09.142","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Study Objective&lt;/h3&gt;&lt;div&gt;To report two cases of refractory pelvic neuropathic pain caused by vascular compression of sacral nerve roots and to describe the diagnostic workup and laparoscopic neuropelveologic decompression technique.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;To report two cases of refractory pelvic neuropathic pain caused by vascular compression of sacral nerve roots and to describe the diagnostic workup and laparoscopic neuropelveologic decompression technique.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;Two-case video report including clinical, neuroimaging, intraoperative, and postoperative data.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Two-case video report including clinical, neuroimaging, intraoperative, and postoperative data.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting&lt;/h3&gt;&lt;div&gt;Laparoscopic procedures performed at Santa Casa de São Paulo. Patients were positioned in dorsal decubitus with optimized pelvic exposure and precautions to prevent nerve and compartment injuries.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Laparoscopic procedures performed at Santa Casa de São Paulo. Patients were positioned in dorsal decubitus with optimized pelvic exposure and precautions to prevent nerve and compartment injuries.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Patients or Participants&lt;/h3&gt;&lt;div&gt;Case 1: A 55-year-old male with progressive left gluteal pain radiating to the posterior thigh, worsened by sitting and unresponsive to conservative treatment. Case 2: A 52-year-old female with severe left pelvic pain radiating to the gluteal region and lateral thigh, associated with allodynia, hypoesthesia, and impaired ambulation. Both provided informed consent.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Case 1: A 55-year-old male with progressive left gluteal pain radiating to the posterior thigh, worsened by sitting and unresponsive to conservative treatment. Case 2: A 52-year-old female with severe left pelvic pain radiating to the gluteal region and lateral thigh, associated with allodynia, hypoesthesia, and impaired ambulation. Both provided informed consent.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interventions&lt;/h3&gt;&lt;div&gt;Preoperative assessment included MR neurography with diffusion tensor tractography, revealing compression of the left S2 nerve root by a dilated lateral sacral vein, with disruption of nerve fibers. Functional neurography confirmed chronic compressive neuropathy. Laparoscopic retroperitoneal access enabled identification of key landmarks and careful dissection to isolate the compressing vessel. The vein was clipped, ligated, and transected. Neural structures, including the obturator nerve, were preserved, and decompression was confirmed intraoperatively.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Preoperative assessment included MR neurography with diffusion tensor tractography, revealing compression of the left S2 nerve root by a dilated lateral sacral vein, with disruption of nerve fibers. Functional neurography confirmed chronic compressive neuropathy. Laparoscopic retroperitoneal access enabled identification of key landmarks and careful dissection to isolate the compressing vessel. The vein was clipped, ligated, and transected","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"33 11","pages":"Pages S36-S37"},"PeriodicalIF":2.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149308213","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":"Surgical Management of Obstructive Ureteral Endometriosis","authors":"R Schneyer,&nbsp;M Shats,&nbsp;C Liao,&nbsp;O Ezike,&nbsp;M Siedhoff","doi":"10.1016/j.jmig.2026.09.120","DOIUrl":"10.1016/j.jmig.2026.09.120","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Study Objective&lt;/h3&gt;&lt;div&gt;To review the presentation and management of ureteral endometriosis, to describe a case of obstructive ureteral endometriosis, to highlight surgical techniques for approaching a ureteral nodule, and to demonstrate the steps of ureteral reimplantation with a psoas hitch.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;To review the presentation and management of ureteral endometriosis, to describe a case of obstructive ureteral endometriosis, to highlight surgical techniques for approaching a ureteral nodule, and to demonstrate the steps of ureteral reimplantation with a psoas hitch.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;Educational video highlighting surgical techniques.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Educational video highlighting surgical techniques.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting&lt;/h3&gt;&lt;div&gt;Academic medical center.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Academic medical center.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Patients or Participants&lt;/h3&gt;&lt;div&gt;We present a case of a patient with obstructive ureteral endometriosis causing hydronephrosis and decreased renal function, who underwent surgical management with a multidisciplinary team.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;We present a case of a patient with obstructive ureteral endometriosis causing hydronephrosis and decreased renal function, who underwent surgical management with a multidisciplinary team.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interventions&lt;/h3&gt;&lt;div&gt;Robotic-assisted laparoscopic excision of endometriosis, including resection of the diseased segment of ureter, and ureteral reimplantation with a psoas hitch.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Robotic-assisted laparoscopic excision of endometriosis, including resection of the diseased segment of ureter, and ureteral reimplantation with a psoas hitch.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Measurements and Primary Results&lt;/h3&gt;&lt;div&gt;We first describe the intrinsic and extrinsic subtypes of ureteral endometriosis and review conservative and radical approaches to surgical management. We then demonstrate our surgical approach to tackling deeply infiltrating endometriosis of the ureter including: 1) complete ureterolysis from the pelvic brim to the ureterovesical junction, 2) division of the uterine artery at its origin, and 3) “surrounding the enemy” to isolate the borders of the ureteral nodule. Finally, we highlight the key steps of ureteral reimplantation, including: 1) ureteral transection and spatulation, 2) bladder mobilization, 3) ureteral mobilization, 4) psoas hitch, 5) cystotomy, 6) anastomosis, and 7) ureteral stent placement.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;We first describe the intrinsic and extrinsic subtypes of ureteral endometriosis and review conservative and radical approaches to surgical management. We then demonstrate our surgical approach to tackling deeply infiltrating endometriosis of the ureter including: 1) complete ureterolysis from the pelvic brim to the ureterovesical junction, 2) division of the uterine artery at its origin, and 3) “surrounding the enemy” to isolate the borders of the ureteral nodule. Finally, we highlight the key steps of ureteral reimplantation, including: 1) ureteral t","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"33 11","pages":"Page S7"},"PeriodicalIF":2.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149308442","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":"Retained Products of Conception In Isthmocele with Uterine Window","authors":"F Mak,&nbsp;J DeLeeuw,&nbsp;J Travieso,&nbsp;MT Breen,&nbsp;CA Salazar","doi":"10.1016/j.jmig.2026.09.172","DOIUrl":"10.1016/j.jmig.2026.09.172","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Study Objective&lt;/h3&gt;&lt;div&gt;To review the diagnostic and therapeutic approach to an isthmocele with retained products of conception (RPOC) and complete dehiscence of the overlying myometrium.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;To review the diagnostic and therapeutic approach to an isthmocele with retained products of conception (RPOC) and complete dehiscence of the overlying myometrium.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;Stepwise demonstration of the management of a complex gynecologic case including diagnosis and surgical technique with narrated video footage.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Stepwise demonstration of the management of a complex gynecologic case including diagnosis and surgical technique with narrated video footage.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting&lt;/h3&gt;&lt;div&gt;N/a.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;N/a.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Patients or Participants&lt;/h3&gt;&lt;div&gt;This video describes a patient with a history of 1 prior cesarean delivery who presented with ongoing bleeding and elevated HCGs after spontaneous abortion of an eight-week intrauterine twin gestation.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;This video describes a patient with a history of 1 prior cesarean delivery who presented with ongoing bleeding and elevated HCGs after spontaneous abortion of an eight-week intrauterine twin gestation.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interventions&lt;/h3&gt;&lt;div&gt;This video reviews the role of ultrasound, MRI, and hysteroscopy in the diagnosis of RPOC within an isthmocele, as well as therapeutic considerations when choosing a surgical route. It discusses the Gutenberg classification of RPOC and describes the surgical techniques used during laparoscopic repair of the isthmocele, including safe bladder dissection, uterine manipulator placement, vasopressin use, closure of the defect, and second look hysteroscopy.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;This video reviews the role of ultrasound, MRI, and hysteroscopy in the diagnosis of RPOC within an isthmocele, as well as therapeutic considerations when choosing a surgical route. It discusses the Gutenberg classification of RPOC and describes the surgical techniques used during laparoscopic repair of the isthmocele, including safe bladder dissection, uterine manipulator placement, vasopressin use, closure of the defect, and second look hysteroscopy.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Measurements and Primary Results&lt;/h3&gt;&lt;div&gt;Second look hysteroscopy demonstrated adequate repair of the isthmocele and allowed for lysis of intrauterine adhesions, a known sequela of RPOC. The patient's abnormal uterine bleeding resolved and HCG normalized, with resumption of normal menses.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Second look hysteroscopy demonstrated adequate repair of the isthmocele and allowed for lysis of intrauterine adhesions, a known sequela of RPOC. The patient's abnormal uterine bleeding resolved and HCG normalized, with resumption of normal menses.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Isthmoceles can be a reservoir for RPOC. The residual myometrial thickness at the apex of the isthmocele and the Gutenberg RPOC classification system are useful tools in determining the best the","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"33 11","pages":"Page S41"},"PeriodicalIF":2.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149308514","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":"Laparoscopic Total Pelvic Exenteration for Recurrent Vaginal Vault Adenocarcinoma with Vesico Vaginal & Recto Vaginal Fistula","authors":"SP Puntambekar,&nbsp;A Puntambekar,&nbsp;DS Patil,&nbsp;SR Sampath","doi":"10.1016/j.jmig.2026.09.175","DOIUrl":"10.1016/j.jmig.2026.09.175","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Study Objective&lt;/h3&gt;&lt;div&gt;To present our experience of laparoscopic total pelvic exenteration in a case of recurrent vaginal vault adenocarcinoma with complex fistulae in a previously irradiated pelvis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;To present our experience of laparoscopic total pelvic exenteration in a case of recurrent vaginal vault adenocarcinoma with complex fistulae in a previously irradiated pelvis.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;Video demonstration of a stepwise salvage procedure highlighting adhesiolysis, dissection in a post-radiation pelvis, and en bloc multivisceral resection with reconstruction.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Video demonstration of a stepwise salvage procedure highlighting adhesiolysis, dissection in a post-radiation pelvis, and en bloc multivisceral resection with reconstruction.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting&lt;/h3&gt;&lt;div&gt;Tertiary care gynecologic oncology centre.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Tertiary care gynecologic oncology centre.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Patients or Participants&lt;/h3&gt;&lt;div&gt;A 68-year-old postmenopausal lady, known case of vaginal vault adenocarcinoma, previously treated with multiple cycles of chemotherapy and radiotherapy, and targeted therapy with Bevacizumab, had severe vaginal pain since 2 years &amp; passage of stools per vagina since 3 months.On Evaluation found to have recurrent disease with VVF and RVF.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;A 68-year-old postmenopausal lady, known case of vaginal vault adenocarcinoma, previously treated with multiple cycles of chemotherapy and radiotherapy, and targeted therapy with Bevacizumab, had severe vaginal pain since 2 years &amp; passage of stools per vagina since 3 months.On Evaluation found to have recurrent disease with VVF and RVF.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interventions&lt;/h3&gt;&lt;div&gt;Laparoscopically adhesions were released. Total pelvic exenteration was performed. It included ultra-low anterior resection with coloanal anastomosis, total vaginectomy, and en bloc resection of the involved bladder and rectum. Reconstruction was done along with Ileal conduit &amp; Colo anal Anastomosis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Laparoscopically adhesions were released. Total pelvic exenteration was performed. It included ultra-low anterior resection with coloanal anastomosis, total vaginectomy, and en bloc resection of the involved bladder and rectum. Reconstruction was done along with Ileal conduit &amp; Colo anal Anastomosis.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Measurements and Primary Results&lt;/h3&gt;&lt;div&gt;Total operative time was 4 hours, with 500 mL blood loss. Postoperative period was uneventful and the patient was discharged on day 5 without any complications. Histopathology showed moderately differentiated adenocarcinoma involving vagina, rectum, and urinary bladder. All margins, including vaginal, ureteric, and urethral, were free of tumour. Both adnexae were uninvolved. No adjuvant treatment was given. At follow-up, patient is symptomatically better and is disease free.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Total operative time was 4 hours, with 500 mL blood loss. Postoperative period was uneventful and ","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"33 11","pages":"Page S42"},"PeriodicalIF":2.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149308516","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":"Molecular Insights into Endometriosis: A Study of Gene Expression","authors":"J Borgerding,&nbsp;NM Dunn,&nbsp;J Lang,&nbsp;N Yask,&nbsp;Z Chen,&nbsp;T Kalir,&nbsp;T Martin,&nbsp;A Horowitz,&nbsp;C Ascher-Walsh,&nbsp;S Kim-Schulze,&nbsp;S Khalil","doi":"10.1016/j.jmig.2026.09.055","DOIUrl":"10.1016/j.jmig.2026.09.055","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Study Objective&lt;/h3&gt;&lt;div&gt;To identify gene-expression signatures and molecular pathways underlying the pathogenesis of endometriosis in hopes of better establishing its molecular biology and eventually develop targeted non-hormonal therapies.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;To identify gene-expression signatures and molecular pathways underlying the pathogenesis of endometriosis in hopes of better establishing its molecular biology and eventually develop targeted non-hormonal therapies.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;Data were obtained from the Turku EndometDB database, a publicly available and interactive transcriptomic repository. Clinical parameters and expression patterns of more than 24,000 genes were compared between patients undergoing surgical excision of endometriosis and healthy controls undergoing laparoscopic sterilization.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Data were obtained from the Turku EndometDB database, a publicly available and interactive transcriptomic repository. Clinical parameters and expression patterns of more than 24,000 genes were compared between patients undergoing surgical excision of endometriosis and healthy controls undergoing laparoscopic sterilization.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting&lt;/h3&gt;&lt;div&gt;All data were obtained retrospectively using an online endometriosis database.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;All data were obtained retrospectively using an online endometriosis database.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Patients or Participants&lt;/h3&gt;&lt;div&gt;Available through EndometDB, mRNA microarray data of 115 patients undergoing surgical excision of endometriosis and 53 healthy controls undergoing laparoscopic sterilization were included. Because eutopic endometrium from affected and unaffected patients exhibits minimal transcriptional differences, ectopic endometriotic lesions were compared to peritoneal control tissue. Deep infiltrating and endometrioma samples were analyzed separately to account for environmental programming and progression.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Available through EndometDB, mRNA microarray data of 115 patients undergoing surgical excision of endometriosis and 53 healthy controls undergoing laparoscopic sterilization were included. Because eutopic endometrium from affected and unaffected patients exhibits minimal transcriptional differences, ectopic endometriotic lesions were compared to peritoneal control tissue. Deep infiltrating and endometrioma samples were analyzed separately to account for environmental programming and progression.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interventions&lt;/h3&gt;&lt;div&gt;N/A.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;N/A.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Measurements and Primary Results&lt;/h3&gt;&lt;div&gt;Differentially expressed genes clustered in pathways related to inflammation (CXCL8, SAA1), fibrosis (COL6A6, MMP7), lipid metabolism (LEP, PLIN1), and neuronal signaling (CALB2, NR4A2). Endometriomas demonstrated increased expression of lipid-metabolism and angiogenesis genes, whereas deep lesions showed heightened fibrotic and neurogenic signaling.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Differentially expressed genes clustered in pathways related ","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"33 11","pages":"Page S29"},"PeriodicalIF":2.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149308600","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":"Low Pressure Trial: Laparoscopic Optimization with Pressure Reduction—Effects on Shoulder Tip Pain, Surgical Outcomes, and Recovery","authors":"S Hojabri,&nbsp;S Ardestani,&nbsp;O Carere,&nbsp;C Vizena,&nbsp;V Wong,&nbsp;R Brull,&nbsp;D Flamer,&nbsp;ML Sobel","doi":"10.1016/j.jmig.2026.09.052","DOIUrl":"10.1016/j.jmig.2026.09.052","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Study Objective&lt;/h3&gt;&lt;div&gt;To evaluate whether low-pressure pneumoperitoneum (10 mmHg) reduces postoperative shoulder tip pain compared with standard-pressure pneumoperitoneum (15 mmHg) in patients undergoing benign gynecologic laparoscopy.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;To evaluate whether low-pressure pneumoperitoneum (10 mmHg) reduces postoperative shoulder tip pain compared with standard-pressure pneumoperitoneum (15 mmHg) in patients undergoing benign gynecologic laparoscopy.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;Prospective double-blinded randomized controlled trial with parallel group allocation (1:1). Postoperative outcomes were assessed in the immediate postoperative period and at 24 hours.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Prospective double-blinded randomized controlled trial with parallel group allocation (1:1). Postoperative outcomes were assessed in the immediate postoperative period and at 24 hours.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting&lt;/h3&gt;&lt;div&gt;Tertiary-care academic center performing minimally invasive gynecologic surgery. All procedures were conducted laparoscopically with patients in dorsal lithotomy and Trendelenburg positioning using standard port placement and CO₂ insufflation techniques.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Tertiary-care academic center performing minimally invasive gynecologic surgery. All procedures were conducted laparoscopically with patients in dorsal lithotomy and Trendelenburg positioning using standard port placement and CO₂ insufflation techniques.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Patients or Participants&lt;/h3&gt;&lt;div&gt;Eighty-two patients undergoing laparoscopic surgery for benign gynecologic indications were randomized (low-pressure n=41, standard-pressure n=41).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Eighty-two patients undergoing laparoscopic surgery for benign gynecologic indications were randomized (low-pressure n=41, standard-pressure n=41).&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Inclusion criteria&lt;/h3&gt;&lt;div&gt;≥18 years, English-speaking&lt;/div&gt;&lt;/div&gt;&lt;div&gt;≥18 years, English-speaking&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exclusion criteria&lt;/h3&gt;&lt;div&gt;gynecologic malignancy (&gt;stage I), chronic pelvic pain, stage IV endometriosis or adhesions, BMI &gt;50&lt;/div&gt;&lt;div&gt;All participants provided informed consent and completed follow-up to postoperative day 1.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;gynecologic malignancy (&gt;stage I), chronic pelvic pain, stage IV endometriosis or adhesions, BMI &gt;50&lt;/div&gt;&lt;div&gt;All participants provided informed consent and completed follow-up to postoperative day 1.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interventions&lt;/h3&gt;&lt;div&gt;• Low-pressure pneumoperitoneum (LPP): 10 mmHg&lt;/div&gt;&lt;div&gt;• Standard-pressure pneumoperitoneum (SPP): 15 mmHg&lt;/div&gt;&lt;div&gt;Surgeons were permitted to increase pressure intraoperatively if visualization was inadequate.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;• Low-pressure pneumoperitoneum (LPP): 10 mmHg&lt;/div&gt;&lt;div&gt;• Standard-pressure pneumoperitoneum (SPP): 15 mmHg&lt;/div&gt;&lt;div&gt;Surgeons were permitted to increase pressure intraoperatively if visualization was inadequate.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Measurements and Primary Results&lt;/h3&gt;&lt;div&gt;The primary outcome was shoulder tip pain on postoperative day 1","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"33 11","pages":"Pages S27-S28"},"PeriodicalIF":2.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149308786","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 an Ovary Herniated into the Inguinal Canal Managed with Oophorectomy and Hernia Repair with Mesh","authors":"H Light-Olson,&nbsp;T Ito,&nbsp;J Kim,&nbsp;W Zhang,&nbsp;C Lebares","doi":"10.1016/j.jmig.2026.09.151","DOIUrl":"10.1016/j.jmig.2026.09.151","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Study Objective&lt;/h3&gt;&lt;div&gt;To present a rare case of a Mullerian anomaly complicated by ovarian inguinal hernia managed with hysterectomy, oophorectomy, and hernia repair with mesh using the robotic platform; to discuss Mullerian anomaly pathophysiology and presentation; to discuss surgical techniques with distorted pelvic anatomy; to demonstrate inguinal canal anatomy and inguinal hernia management.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;To present a rare case of a Mullerian anomaly complicated by ovarian inguinal hernia managed with hysterectomy, oophorectomy, and hernia repair with mesh using the robotic platform; to discuss Mullerian anomaly pathophysiology and presentation; to discuss surgical techniques with distorted pelvic anatomy; to demonstrate inguinal canal anatomy and inguinal hernia management.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;Surgical video&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Surgical video&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting&lt;/h3&gt;&lt;div&gt;University of California San Francisco&lt;/div&gt;&lt;/div&gt;&lt;div&gt;University of California San Francisco&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Patients or Participants&lt;/h3&gt;&lt;div&gt;39yo G3P1203 with abnormal uterine bleeding and history of post-partum hysteroscopy complicated by perforation with conversion to laparoscopy and subsequent diagnosis of right unicornuate uterus with normal right adnexa, non-visualized left adnexa, and left pelvic kidney. MRI revealed the left adnexa present in a left-sided inguinal hernia. The patient desired definitive management of her abnormal uterine bleeding and underwent robotic-assisted laparoscopic hysterectomy, oophorectomy, and inguinal hernia repair with mesh.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;39yo G3P1203 with abnormal uterine bleeding and history of post-partum hysteroscopy complicated by perforation with conversion to laparoscopy and subsequent diagnosis of right unicornuate uterus with normal right adnexa, non-visualized left adnexa, and left pelvic kidney. MRI revealed the left adnexa present in a left-sided inguinal hernia. The patient desired definitive management of her abnormal uterine bleeding and underwent robotic-assisted laparoscopic hysterectomy, oophorectomy, and inguinal hernia repair with mesh.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interventions&lt;/h3&gt;&lt;div&gt;We present a case of a rare Mullerian anomaly complicated by ovarian herniation into the inguinal canal. We demonstrate the process of mapping the peritoneal flap for mesh placement, dissecting the hernia sac, isolating and transecting the IP, and completing the oophorectomy. We exhibit techniques for mesh placement and peritoneal closure.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;We present a case of a rare Mullerian anomaly complicated by ovarian herniation into the inguinal canal. We demonstrate the process of mapping the peritoneal flap for mesh placement, dissecting the hernia sac, isolating and transecting the IP, and completing the oophorectomy. We exhibit techniques for mesh placement and peritoneal closure.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Measurements and Primary Results&lt;/h3&gt;&lt;div&gt;Ovarian herniation into the inguinal canal can be safely managed with robotic-assi","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"33 11","pages":"Page S23"},"PeriodicalIF":2.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149308778","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":"Surgical Management of Heterotopic Cesarean Scar Pregnancy With Preservation of Intrauterine Pregnancy in the First Trimester","authors":"Emina Gulbis MD, MS,&nbsp;Kelli McEntee MD","doi":"10.1016/j.jmig.2026.03.008","DOIUrl":"10.1016/j.jmig.2026.03.008","url":null,"abstract":"<div><h3>Objective</h3><div>To demonstrate hysteroscopic selective reduction of a heterotopic cesarean scar pregnancy while preserving a concurrent intrauterine pregnancy.</div></div><div><h3>Setting</h3><div>Tertiary Care Center.</div></div><div><h3>Participants</h3><div>A single case study report of a 41-year-old G3P2001 with two prior cesarean deliveries who underwent two-embryo in vitro fertilization (IVF) transfer and was diagnosed with a heterotopic pregnancy consisting of a fundal intrauterine pregnancy and a cesarean scar pregnancy.</div></div><div><h3>Interventions</h3><div>Under intraoperative ultrasound guidance, a 27F operative bipolar hysteroscope was introduced using normal saline as the distension medium. Intrauterine pressure was maintained at ≤60 mmHg, with a final fluid deficit of 750 mL. Selective hysteroscopic reduction of the cesarean scar pregnancy was performed using a loop bipolar electrode. Complete reduction was confirmed intraoperatively using transverse and sagittal ultrasound imaging.</div></div><div><h3>Conclusion</h3><div>Surgical management using a loop bipolar hysteroscopic system enabled successful selective reduction of the cesarean scar pregnancy while preserving the concurrent intrauterine fundal pregnancy. Hysteroscopic selective reduction may represent a feasible minimally invasive approach for the management of heterotopic cesarean scar pregnancy in cases where preservation of the intrauterine pregnancy is desired.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"33 11","pages":"Pages 1582-1584"},"PeriodicalIF":2.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147458153","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}