Journal of minimally invasive gynecology最新文献

{"title":"The AAGL's Role In Advancing Outpatient Surgery Worldwide had a Phoenix Connection. - The surgical instrument that helped shaped worldwide the delivery of surgical care.","authors":"Franklin D Loffer","doi":"10.1016/j.jmig.2025.03.013","DOIUrl":"https://doi.org/10.1016/j.jmig.2025.03.013","url":null,"abstract":"<p><p>The AAGL took the new concept of outpatient surgery which was occurring in the United States and introduced it to the world's surgical community.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753125","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":"Enhanced Myometrial Vascularity. A Potentially Serious Complication After Pregnancy Loss. When to Wait... When to Intervene?","authors":"Patryk Piekos, Suset Rodriguez, Pasquale Patrizio, Jose Carugno","doi":"10.1016/j.jmig.2025.03.011","DOIUrl":"10.1016/j.jmig.2025.03.011","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730451","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 Near Complete Labia Majora Fusion Without Hymenal Disruption.","authors":"Houyu Yang, Yuanjunzi Shi, Gang Ji","doi":"10.1016/j.jmig.2025.03.009","DOIUrl":"10.1016/j.jmig.2025.03.009","url":null,"abstract":"<p><strong>Study objective: </strong>A 25-year-old asymptomatic nulliparous female presented with near-total midline fusion of the labia majora detected during routine physical examination. The patient reported a history of perineal trauma from a fall 19 years before, resulting in minor genital bleeding that resolved spontaneously without medical intervention.</p><p><strong>Design: </strong>Initial outpatient management with topical estriol ointment for 2 weeks failed to achieve adhesiolysis. The gynecological evaluation confirmed complete fibrous adhesion extending from the prepuce clitoridis to the posterior fourchette (Fig. 1). In accordance with the patient's cultural requirement for hymenal preservation, hysteroscopic-guided surgical separation was performed.</p><p><strong>Setting: </strong>Department of Gynecology, The Second People's Hospital of Guiyang.</p><p><strong>Interventions: </strong>Intraoperative inspection verified intact hymenal integrity and patent urethral meatus, with no subadhesion tissue identified (see supplemental video). The procedure successfully restored normal vulvovaginal anatomy (Fig. 2) without damage to the hymen, and this was important to the patient. Postoperative recovery proceeded without complications, with no adhesion recurrence observed at an 18-month follow-up (Fig. 3).</p><p><strong>Conclusion: </strong>Labial adhesions may be congenital or acquired, predominantly occurring in prepubertal females [1]. Although labia minora adhesions have been well documented with an incidence rate of 1.8% to 3.5% [2] and standardized treatment protocols have been proposed [3], labia majora fusion remains a rare clinical entity. Potential complications include dyspareunia, urinary retention, and recurrent infections [4]. The 19-year latency period from traumatic injury to therapeutic intervention represents the longest documented persistence of labia majora adhesion searching PubMed. Hysteroscopic visualization facilitated targeted anatomical dissection through natural orifices, achieving the dual objectives of complete adhesiolysis and hymenal preservation essential for cultural compliance, a distinct advantage over conventional probe-guided approaches [5]. This technique's capacity to resolve extensive fibrous fusion without damage to the hymen or deeper vaginal structures suggests that endoscopic methods may address both anatomical and sociocultural needs in selected patients, pending validation through multicenter longitudinal studies.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743106","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":"Quadratus Lumborum Block for Total Laparoscopic Hysterectomy: A Systematic Review and Meta-analysis.","authors":"Jin Wu, Yuanfang Ou, Yi Gu, Xiaofeng Zhou, Huiyu She, Yifan Qin","doi":"10.1016/j.jmig.2025.03.012","DOIUrl":"10.1016/j.jmig.2025.03.012","url":null,"abstract":"<p><strong>Objective: </strong>No regional blockade techniques are considered standard of care for total laparoscopic hysterectomy (TLH). Quadratus lumborum block (QLB), a novel fascial plane block, has emerged as a potential option; however, its analgesic efficacy in TLH remains unclear.</p><p><strong>Data sources: </strong>We conducted a comprehensive search across multiple databases, including Medline PubMed, Embase, the Cochrane Central Register of Controlled Trials, and Web of Science. No filters or language restrictions were imposed.</p><p><strong>Methods of study selection: </strong>The Population, Intervention, Comparison, and Outcomes framework in this review was as follows: (1) adult patients undergoing TLH; (2) QLB as the intervention; (3) comparison with no block or placebo; (4) primary outcome: 24-hour postoperative intravenous morphine-equivalent consumption; secondary outcomes: postoperative pain at 2, 4, 6, 12, and 24 hours, and the incidence of postoperative nausea and vomiting (PONV); (5) randomized controlled trials. Meta-analyses, including subgroup and sensitivity analyses, were conducted using a random-effects model.</p><p><strong>Tabulation, integration, and results: </strong>This analysis included 8 trials with 540 patients. QLB significantly reduced postoperative 24-hour intravenous morphine-equivalent consumption following TLH (mean difference: -4.61 mg; 95% confidence interval: -7.13 to -2.09; p <.001; I² = 57%), though the reduction was below the minimal clinically important difference (MCID) of 10 mg. The static pain scores at 2, 6, and 12 hours, as well as dynamic pain scores at 2, 6, and 24 hours postoperatively, were significantly lower in the QLB group than in the control group. However, only the 2-hour postoperative dynamic pain score (mean difference = 1.19) exceeded the MCID of 1. No statistically significant differences were observed in the incidence of PONV.</p><p><strong>Conclusion: </strong>QLB statistically reduced postoperative opioid consumption and pain scores at certain time points after TLH, but only the 2-hour dynamic pain score exceeded the MCID with no improvement in PONV, suggesting limited clinical benefit of QLB in TLH.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743098","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 Multicenter, Randomized Controlled Trial to Assess Video-based Surgical Coaching in Gynecology.","authors":"Brenna E Swift, Charlotte Axelrod, Anouk Benseler, Anna Kobylianskii, Danielle Vicus, Stephane Laframboise, Melissa Walker, Mara Sobel, Evan Tannenbaum","doi":"10.1016/j.jmig.2025.03.001","DOIUrl":"10.1016/j.jmig.2025.03.001","url":null,"abstract":"<p><strong>Study objective: </strong>To evaluate the effect of video-based coaching on technical skill development in surgical education.</p><p><strong>Design: </strong>Randomized controlled trial with video-based coaching (intervention group) in addition to standard surgical curriculum or the standard surgical curriculum alone (control group).</p><p><strong>Setting: </strong>Laparoscopic vaginal vault closure in the operating room at 3 academic hospitals.</p><p><strong>Participants: </strong>Senior Obstetrics and Gynecology residents (year 3-5) on their chief resident or gynecologic oncology rotation.</p><p><strong>Interventions: </strong>All residents were recorded performing laparoscopic closure of the vaginal cuff prior to randomization. Surgical coaching sessions followed the Wisconsin Surgical Coaching Framework over 30 minutes on Zoom with one surgical coach. All residents were recorded subsequently performing the same surgical technical skill. Blinded, expert surgeons performed the video assessment using the OSATS, GOALS, and global rating scale. The mean change in operative time and the mean change in video-assessment score between the 2 video-recorded attempts were compared between groups. Qualitative semi-structured interviews were conducted to understand the residents' perspective on video-based surgical coaching.</p><p><strong>Measurements and main results: </strong>Twenty residents participated with 10 in the coaching and 10 in the control group. Mean operative time to complete the suturing task was reduced by 32.8% (SD = 21.3%) in the coached group vs 7.2% (SD = 25.1%) in the control group (p = .025). There was no significant change in surgical assessment scores within the coached or control group. Residents identified the core components of a surgical coaching program to include: (1) the resident: focused skill development, (2) the coach: focused on feedback, (3) and the coaching program: a structured activity. Residents envisioned monthly coaching with the opportunity for deliberate practice, the importance of a positive relationship between the coach and coachee, and the importance of faculty development in surgical coaching.</p><p><strong>Conclusion: </strong>Video-based surgical coaching is an effective tool to enhance technical skill development in surgical education.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730449","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":"Factors Associated With Spontaneous Conception Leading to Live Birth in Infertility Patients After Endometriosis Surgery.","authors":"Anthony D Nguyen, Hannah L Marshall, Meg W Sidle, Veronica D Galaviz, Peter L Sticco, Keith T Downing","doi":"10.1016/j.jmig.2025.03.010","DOIUrl":"10.1016/j.jmig.2025.03.010","url":null,"abstract":"<p><strong>Study objective: </strong>To determine factors associated with spontaneous conception leading to live birth in infertility patients after endometriosis surgery.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Multi-hospital health system of Catholic Health in Long Island, NY.</p><p><strong>Participants: </strong>Infertility patients, between ages 18 and 45, who underwent endometriosis surgery with complete excision or ablation with or without excision and continued follow-up care for at least 1 year between January 1^st, 2016 and March 31^st 2022.</p><p><strong>Main results: </strong>Of the 100 patients, 50 achieved spontaneous conception and 40 achieved live birth within 1 year of surgery. Age less than 35 at the time of surgery was found to have an increased likelihood of live birth (RR 3.1, 95% CI 1.3-7.2). Being overweight (RR 1.0, 95% CI 0.4-2.2) or obese (RR 1.2, 95% CI 0.4-3.1) did not affect the likelihood of live birth. Surgery within 24 months of infertility diagnosis did not increase the likelihood of a successful delivery (RR 2.0, 95% CI 0.9-4.5). The pregnancy rate for AAGL Stage I, II, III, IV endometriosis were 42% (18/32), 32% (8/25), 46% (6/13), 42% (8/19) respectively. The logistic regression model indicated that live birth after spontaneous conception was significantly associated with younger age at the time of surgery and complete excision of endometriosis. Patients were 3.2 times (95% CI 1.3-7.8) more likely of having a live birth if they were less than 35 years old at the time of surgery. Complete excision of endometriosis conferred a 4.1-fold (95% CI 1.1-14.9) increased likelihood of a live birth.</p><p><strong>Conclusion: </strong>Two factors increased the likelihood of live birth after endometriosis surgery: age at the time of surgery and complete excision of endometriosis. We cautiously recommend patients attempting spontaneous conception find an endometriosis surgeon proficient in excisional techniques. If they are under 35, there may be additional benefit from surgery.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700738","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":"Non-Communicating Rudimentary Horn Pregnancy.","authors":"Giuliana Rivera Casul, Thomas Gallant","doi":"10.1016/j.jmig.2025.03.008","DOIUrl":"10.1016/j.jmig.2025.03.008","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692384","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":"Gynecologic Findings in Hereditary Leiomyomatosis and Renal Cell Carcinoma Syndrome (HLRCC).","authors":"María T Ortiz-Fullana, Courtney Poston, Mariana Gonzalez, Katrin Arnolds","doi":"10.1016/j.jmig.2025.03.004","DOIUrl":"10.1016/j.jmig.2025.03.004","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670193","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":"Impact of Surgeon Characteristics on Endometriosis Surgery Outcomes.","authors":"Olga Bougie, Ally Murji, Maria P Velez, Jessica Pudwell, Jonas Shellenberger, Jamie Kroft","doi":"10.1016/j.jmig.2025.03.003","DOIUrl":"10.1016/j.jmig.2025.03.003","url":null,"abstract":"<p><strong>Study objective: </strong>This study aimed to evaluate the association between surgeon characteristics and postoperative surgical outcomes, including rates of complications, recurrence of symptoms, fertility outcomes, and need for reoperation for individuals undergoing surgical management of endometriosis.</p><p><strong>Design: </strong>Population cohort study.</p><p><strong>Setting: </strong>Ontario, Canada.</p><p><strong>Patients: </strong>83787 Ontario patients, who are biologically identified as women, aged 18 to 50 who had an initial diagnosis of endometriosis (ICD-9-617 or ICD-10-N80) between April 1, 2002 and March 31, 2018.</p><p><strong>Interventions: </strong>Surgeon volume of endometriosis cases, grouped into 4 categories: 6 or fewer in the prior year (low volume), 7 to 11 (moderate volume), 12 to 23 (high volume), and 24 or more (highest volume). A modified exposure variable defined by surgeon's volume of complex endometriosis surgery (based on Ontario Health Insurance Plan billing code) in the year before the index surgery was also used.</p><p><strong>Measurements and main results: </strong>The primary outcome was the rate of reoperation within 30 days of index surgery and over the duration of follow-up in the study. Secondary outcomes were postoperative complications, the rate of infertility consults, and the live birth rate following endometriosis surgery. The majority of patients (80.3%) underwent surgery with a low-volume surgeon. In the 30-day postoperative period, the lowest rate of postoperative complication was noted among the highest-volume surgeons (5.5%). There was a significantly reduced risk of complications among high-volume surgeons compared to low-volume surgeons (aHR 0.84, 95% CI 0.74-0.96). Higher-volume surgeons tended to refer patients for fertility assessment and these patients also had a higher chance of achieving a live birth postoperatively. Patients who underwent surgery with a high volume of complex endometriosis surgeon, were less likely to undergo repeat surgery (17.8% vs 32.9%, aHR 0.80 [0.72-0.88]), including all the surgery types examined.</p><p><strong>Conclusion: </strong>Our study suggests the majority of patients undergoing surgery for endometriosis have surgery with a low-volume surgeon. Postoperative outcomes were impacted by surgeon volume, suggesting that there is a need to define criteria for surgical competency. Ongoing work to define surgeon characteristics and skills required to perform different types of endometriosis surgery is encouraged.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649281","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":"Prolapsing Ureterocele Presenting as Benign Vulvar Mass in Nulliparous Female.","authors":"Mark Xu, Benjamin M Daniel, Randy Casals, Amr El Haraki","doi":"10.1016/j.jmig.2025.03.006","DOIUrl":"10.1016/j.jmig.2025.03.006","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649284","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}