Journal of minimally invasive gynecology最新文献

{"title":"Laparoscopic Resection of a Parasitic Leiomyoma of Mesentery Following Myomectomy.","authors":"Miao Ma, Jiongbo Liao, Ting Jiang, XiaoXia Liu","doi":"10.1016/j.jmig.2025.04.008","DOIUrl":"https://doi.org/10.1016/j.jmig.2025.04.008","url":null,"abstract":"<p><strong>Objective: </strong>To illustrate the laparoscopic removal of a parasitic leiomyoma in the mesentery, which developed from a morcellation remnant following a laparoscopic myomectomy.</p><p><strong>Setting: </strong>University hospital. A stepwise surgical demonstration with narrated video footage.</p><p><strong>Participants: </strong>A patient with a large pelvic mass two years after undergoing laparoscopic myomectomy.</p><p><strong>Interventions: </strong>The 31-year-old patient underwent laparoscopic myomectomy approximately two years prior, with no record of contained morcellation. Based on our inference, it is likely that a retrieval bag was not utilized during the previous fibroid morcellation. The postoperative pathology was confirmed as leiomyoma. She presented with abdominal bloating. An ultrasound at our hospital revealed an 8.2cm x 8.3cm x 7.3cm hypoechoic, irregular mass on the right side of the uterus. Pelvic magnetic resonance images (MRI) showed a mass of 6.9cm x 5.2cm x 9.7cm in the right anterior uterus with clear margins, hypointense on T2-weighted imaging, isointense on T1-weighted imaging, and significant post-contrast enhancement. Cancer antigen 125 and 199 were in normal range. Laparoscopy was performed, following these key steps: First, identifying the location of the mass and the orientation of the intestinal tract. Second, opening the pseudocapsule along the longitudinal axis of the mass. Third, gradually separating the mass from mesentery. Fourth, suturing the wound of mesentery. Finally, performing contained electromechanical morcellation. The final pathology confirmed leiomyoma.</p><p><strong>Conclusion: </strong>The laparoscopic resection of a parasitic leiomyoma in the mesentery is feasible and safe. The critical point of the procedure is to confirm the orientation of intestinal tract and identify the anatomical space between the mass and mesentery [1]. It is possible that the use of a contained retrieval bag could have prevented the need for this surgery.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078507","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 two-port myomectomy-A retrospective case series of a novel minimally invasive approach.","authors":"Laura A Haworth, Lauren L Siewertsz van Reesema, Hannah S Palin, Zenobia Ofori-Dankwa, Jeffrey J Woo, Joseph L Hudgens","doi":"10.1016/j.jmig.2025.05.001","DOIUrl":"https://doi.org/10.1016/j.jmig.2025.05.001","url":null,"abstract":"<p><strong>Objective: </strong>This study presents a novel two-port technique for laparoscopic myomectomy, examining perioperative outcomes from 87 cases DESIGN: Retrospective case series.</p><p><strong>Setting: </strong>Tertiary academic hospital in Norfolk, Virginia.</p><p><strong>Participants: </strong>Patients who underwent two-port laparoscopic myomectomy over a six-year period, performed by a single fellowship-trained surgeon. Cases were identified via current procedural terminology (CPT) codes for laparoscopic myomectomy.</p><p><strong>Interventions: </strong>The two-port technique uses a multi-port system at the umbilicus, a 45-degree bariatric laparoscope, and a 5-mm trocar in the right lower quadrant. This method reduces abdominal incisions, improves traction for fibroid removal, enhances triangulation for laparoscopic suturing, and expedites specimen extraction.</p><p><strong>Results: </strong>Eighty-seven patients were included, with a mean age of 37.5 years (±5.2). The most common fibroid type was FIGO type 2-5. An average of 3.6 fibroids (±3.1) were removed per case. The mean dominant fibroid diameter was 5.2 cm (±2.3), and the mean total fibroid weight removed was 139.8 grams (±114.4). The mean EBL and operative time were 128 mL (±138.9) and 153 minutes (±45.9), respectively. Fibroid number and weight correlated with increasing operative time, while fibroid weight significantly correlated with higher EBL. No conversions to laparotomy occurred. Most patients (74.7%) were discharged on the same day.</p><p><strong>Conclusion: </strong>Two-port laparoscopic myomectomy is a safe and effective option for a variety of fibroid types, with outcome data comparable to previously reported data on conventional laparoscopic methods. This technique combines the benefits of traditional triangulation with improved cosmesis of single-site surgery, while providing a dedicated specimen extraction site. Candidates for two-port myomectomy are those eligible for a conventional laparoscopic approach; however, challenges may arise with intramural fibroids >10 cm, multiple fibroids (≥4), or need for multiple hysterotomy incisions, requiring careful patient selection and surgeon discretion.</p><p><strong>Summation: </strong>For properly selected patients, a two-port laparoscopic myomectomy technique is safe, effective, and associated with favorable outcomes, including a high same-day discharge rate and minimal complications.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015825","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":"Food and Drug Administration Database Secondary Analysis: Difference in Operative Hysteroscopy Device Adverse Event Reporting.","authors":"Arielle N Valdez-Sinon, Anja S Frost, Anita M Madison, Rand El Sharaiha, Kristin E Patzkowsky, Megan E Gornet","doi":"10.1016/j.jmig.2025.04.009","DOIUrl":"https://doi.org/10.1016/j.jmig.2025.04.009","url":null,"abstract":"<p><strong>Study objective: </strong>To investigate, describe, and compare adverse event reports (AERs) and their patterns amongst commonly used operative hysteroscopy devices.</p><p><strong>Design: </strong>A secondary analysis of the Manufacturer and User Facility Device Experience (MAUDE) published by the Food and Drug Administration.</p><p><strong>Setting: </strong>N/A PATIENTS OR PARTICIPANTS: Women who underwent hysteroscopic surgery, with adverse events reported to MAUDE.</p><p><strong>Interventions: </strong>Search terms within the MAUDE database included \"resectoscope,\" \"hysteroscopic reciprocating morcellator,\" \"MyoSure,\" and \"TruClear.\" Reports were categorized by device type, patient complications, and required interventions. Statistical analysis utilized Fisher's exact tests.</p><p><strong>Measurements and main results: </strong>Between January 2014 and April 2024, 1,872 AERs were identified for hysteroscopes: 664 for resectoscopes and 1,208 for morcellation devices (MyoSure, N=645 and TruClear, N=563).While absolute complication rates are not able to calculated from MAUDE, there were significant differences in the reporting of patient complications: resectoscope devices had higher frequency of infection (p<0.01) while morcellation devices had higher frequency reporting of hemorrhage (p<0.001), uterine perforation (p<0.001), and bowel perforation (p<0.001). Morcellation device AERs more often reported operative intervention (1.1% versus 12.4%, p<0.001). Subgroup analysis comparing AERs of morcellation devices showed the majority (73.2%) of TruClear AERs registered no patient impact or harm, while only 21.2% of MyoSure AERs reported no patient impact. MyoSure device AERs had higher frequency of hemorrhage (p<0.001), infections (p<0.001), uterine perforations (p<0.001), and bowel perforations (p<0.001). Additionally, MyoSure AERs reported more surgical intervention compared to TruClear AEs (19.5% versus 4.3%, p<0.001).</p><p><strong>Conclusions: </strong>While conclusions within the MAUDE database are limited, especially given the lack of data concerning the volume of surgeries done with each device and the voluntary reporting mechanism, there are significant differences in the types of adverse events reported among operative hysteroscopy instruments. Morcellation AERs had a significantly higher frequency of patient complications and described more surgical interventions compared to AERs for resectoscopes. When comparing MyoSure and TruClear, MyoSure AERs described a significantly greater proportion of serious patient complications compared to TruClear device AERs. Devices with similar functions may differ in how stakeholders report complications.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988718","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":"Author's Reply Regarding \"Postoperative Urinary Complications in Minimally Invasive vs. Abdominal Radical Hysterectomy: A Meta-Analysis with a Focus on Ureterovaginal Fistula\".","authors":"Jong Ha Hwang, Bitnarae Kim","doi":"10.1016/j.jmig.2025.04.019","DOIUrl":"https://doi.org/10.1016/j.jmig.2025.04.019","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144007156","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":"Caring for the LGBTQIA+ Patient: A Best-Practices Primer on Language, Sexual Function Considerations, and Health Disparities in Gynecologic Care.","authors":"Molly K Irvin, Madison Ellis, Tierney K Lorenz","doi":"10.1016/j.jmig.2025.04.013","DOIUrl":"https://doi.org/10.1016/j.jmig.2025.04.013","url":null,"abstract":"<p><p>Despite representing a growing percentage of the global population, queer patients (i.e., lesbian, gay, bisexual, transgender, intersex, and/or asexual; LGBTQIA+) continue to experience significant disparities in gynecologic healthcare. Common barriers to inclusive care include discriminatory healthcare experiences, difficulty finding identity-affirming providers, and systemic lack of competency in addressing queer-specific medical needs. Such barriers arise out of heteronormative assumptions, limited provider training, and insufficient understanding of diverse sexual and gender identities. This narrative review examines gynecologic care considerations for lesbian, gay, bisexual/pansexual, asexual, intersex, and transgender patients. We review research documenting how queer patients delay or avoid healthcare due to fear of judgment, discrimination, and inadequate provider understanding. Our review highlights unique healthcare needs across different queer identities, including inclusive and culturally-sensitive sexual health screening that includes (but is not centered solely on) queer-specific sexual practices; considerations for transgender patients undergoing gender-affirming care; and incorporating intersectionality into assessment, treatment planning, and delivery. Finally, we make direct recommendations for caring for queer patients, including developing inclusive intake processes; training healthcare teams in affirming, non-discriminatory practices; using gender-neutral language; recognizing the diversity of sexual and gender identities; and addressing minority stress and its impacts on health.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976513","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":"Regarding \"Postoperative Urinary Complications in Minimally Invasive vs Abdominal Radical Hysterectomy: A Meta-Analysis with a Focus on Ureterovaginal Fistula\".","authors":"Haiying Yang, Siwei Dong","doi":"10.1016/j.jmig.2025.04.018","DOIUrl":"https://doi.org/10.1016/j.jmig.2025.04.018","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997535","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 prevalence of chronic endometritis in women diagnosed with hydrosalpinx before in vitro fertilization treatment.","authors":"Pierre-Emmanuel Bouet, Roland Antaki, Constance Rio, Caroline Boileau-Savary, Magalie Boguenet, Bruno Vielle, Guillaume Legendre, Philippe Descamps, Pascale May-Panloup, Hady El Hachem, Louise Lapensée","doi":"10.1016/j.jmig.2025.04.016","DOIUrl":"https://doi.org/10.1016/j.jmig.2025.04.016","url":null,"abstract":"<p><strong>Objective: </strong>To compare the prevalence of chronic endometritis (CE) in women with hydrosalpinx undergoing in vitro fertilization (IVF), to a control group without hydrosalpinx.</p><p><strong>Design: </strong>A bicentric historical prospective case-control study, between June 2017 and December 2021.</p><p><strong>Setting: </strong>Angers and Montreal university hospitals.</p><p><strong>Patient(s): </strong>In the Hydrosalpinx (H) group, we included all women undergoing IVF for various indications, and who were diagnosed with a hydrosalpinx before or during the cycle. In the control (C) group, we included women without hydrosalpinx, undergoing IVF for male factor infertility, or following bilateral tubal ligation.</p><p><strong>Intervention(s): </strong>A laparoscopy was scheduled for the removal of the hydrosalpinx, and an endometrial biopsy was performed concomitantly to rule out CE. In the C group, an endometrial biopsy was performed in the clinic. CE diagnosis was confirmed using immunohistochemistry.</p><p><strong>Measurements and main results: </strong>Our primary endpoint was the rate of positive biopsies for CE. Ninety-four patients were included, 62 in the H group and 32 in the C group. Mean age was 32.1 ± 5.1 years. The prevalence of CE was significantly higher in the H group compared to the C group (41.9% (26/62) vs 15.6% (5/32) (p=0.01)). Multivariate analysis showed that the presence of hydrosalpinx was an independent risk factor of CE (aOR = 3.93 (1.31-11.81)), whether the hydrosalpinx was unilateral (aOR = 4.39 (1.32-14.61)) or bilateral (aOR = 3.52 (1.01-11.99)).</p><p><strong>Conclusions: </strong>There is a significant increase in the prevalence of CE in women with hydrosalpinx undergoing IVF, whether the hydrosalpinx was unilateral or bilateral.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144008792","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-grade Appendiceal Mucinous Neoplasm Presenting as Ovarian Cyst.","authors":"Qiaofei Lyu, Xiaoyan Chen","doi":"10.1016/j.jmig.2025.04.010","DOIUrl":"https://doi.org/10.1016/j.jmig.2025.04.010","url":null,"abstract":"<p><p>Low-grade appendiceal mucinous neoplasm (LAMN) represents a rare appendiceal tumor. Diagnostic evaluation typically involves serum tumor markers (CEA, Ca19.9, and CA 125), CT imaging, and colonoscopy. CT scan remains the imaging modality of choice, while MRI, despite its sensitivity in detecting appendiceal masses, demonstrates limited specificity and may potentially lead to misdiagnosis of this malignant condition. This case underscores the diagnostic challenges associated with LAMN in specific anatomical regions and illustrates the persistent limitations and diagnostic pitfalls of MR imaging in clinical practice.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144011876","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":"Isthmocele Endometrioma: A Collapsible Conundrum.","authors":"Dr Shinjini Pande, Dr Vivek Salunke, Dr Ria Katwala","doi":"10.1016/j.jmig.2025.04.014","DOIUrl":"https://doi.org/10.1016/j.jmig.2025.04.014","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996770","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":"Author's Reply.","authors":"Jin Wu, Yifan Qin","doi":"10.1016/j.jmig.2025.04.015","DOIUrl":"https://doi.org/10.1016/j.jmig.2025.04.015","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015823","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}