Journal of minimally invasive gynecology最新文献

{"title":"Evaluation of Novel AI Assisted Algorithm for Segmentation of Uterine Fibroids","authors":"S Naval ,&nbsp;DM Anagani ,&nbsp;DU BR ,&nbsp;S Kothamachu","doi":"10.1016/j.jmig.2025.09.007","DOIUrl":"10.1016/j.jmig.2025.09.007","url":null,"abstract":"<div><h3>Study Objective</h3><div>To evaluate uterine and fibroid segmentation performed by an AI-assisted algorithm (Nesa Medtech, Bengaluru - 560085, India) by three experienced clinicians.</div></div><div><h3>Design</h3><div>This study was a prospective validation study. A structured questionnaire was designed to validate the parameters of the uterus and fibroid and to capture the satisfaction rate of AI segmentation among the clinicians.</div></div><div><h3>Setting</h3><div>Uterine fibroid scanned data from different ultrasonography machines (irrespective of make) with less than a maximum fibroid size not exceeding 5 cm with a maximum of 4 fibroids, were segmented by an AI-assisted algorithm.</div></div><div><h3>Patients or Participants</h3><div>A total of 100 patients with uterine fibroids were included in the study.</div></div><div><h3>Interventions</h3><div>NA</div></div><div><h3>Measurements and Primary Results</h3><div>The acquired imaging data were segmented using the AI-assisted algorithm. The uterus and fibroid segmentation of 100 cases was successfully done by this algorithm. The precise size of the uterus and accurate mapping (size, location, and FIGO-type) of the fibroid were appreciated when these segmentation results were validated by 3 experienced clinicians with expertise in ultrasonography. Clinician -1 - was satisfied in 98% of cases, Clinician -2 - was satisfied in 97% of cases, and Clinician -3 - was satisfied in 99% of cases.</div></div><div><h3>Conclusion</h3><div>The AI-assisted algorithm demonstrated strong agreement with expert analysis of the segmentation of the uterus and fibroid by ultrasonography. It appears this novel AI algorithm is promising in fibroid segmentation and its accuracy should be analyzed in future studies. In the future, this AI algorithm could be used for surgical planning.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Pages S2-S3"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334838","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":"Validation of an AI-Based Anatomical Landmark Recognition System for Pelvic Lymph Node Dissection in Gynecologic Surgery","authors":"S Takenaka ,&nbsp;H Matsuzaki ,&nbsp;M Homma ,&nbsp;A Kouno ,&nbsp;Y Nakanishi ,&nbsp;N Takeshita ,&nbsp;H Tanabe ,&nbsp;Y Tsukada","doi":"10.1016/j.jmig.2025.09.008","DOIUrl":"10.1016/j.jmig.2025.09.008","url":null,"abstract":"<div><h3>Study Objective</h3><div>To evaluate whether an AI-based anatomical landmark recognition support system for pelvic lymph node dissection (PLND) can improve the anatomical recognition abilities of gynecologic surgeons with varying levels of surgical expertise.</div></div><div><h3>Design</h3><div>Prospective, multi-arm observer performance study evaluating organ recognition with and without AI support.</div></div><div><h3>Setting</h3><div>A total of 640 laparoscopic video clips were prepared from 10 hysterectomy cases: 320 without AI overlay and 320 with AI. Each set included clips with and without the ureter, obturator nerve, external iliac artery, and vein.</div></div><div><h3>Patients or Participants</h3><div>Twelve gynecologic surgeons were enrolled and stratified into three experience-based groups: Group A (4 laparoscopic board-certified experts), Group B (4 obstetrics and gynecology specialists without laparoscopic certification), and Group C (4 trainees in residency). Each participant provided consent. The study was conducted over a one-month period.</div></div><div><h3>Interventions</h3><div>Participants were first asked to identify key pelvic structures (ureter, obturator nerve, external iliac vessels) in selected video clips without AI assistance. Subsequently, they reviewed the clips with AI-based overlay highlighting the anatomical targets and repeated the identification task.</div></div><div><h3>Measurements and Primary Results</h3><div>Accuracy of anatomical recognition (sensitivity and specificity) was calculated for each group with and without AI support. Across all groups, AI support improved identification of the ureter (mean sensitivity from 47.1% to 67.9%), obturator nerve (65.2% to 78.8%), external iliac artery (83.5% to 91.9%) and vein (71.3% to 90.0%) with all p-values &lt; 0.05. The greatest improvement was observed in the trainee group (Group C), suggesting AI assistance is particularly beneficial for less experienced surgeons.</div></div><div><h3>Conclusion</h3><div>The AI-based anatomical landmark recognition support system for PLND significantly enhanced surgeon’s organ recognition across all experience levels, with the most pronounced benefit observed in trainees. These findings support integrating AI systems into surgical education and real-time intraoperative guidance to improve anatomical understanding and reduce the risk of injury. Further studies in live surgical settings are warranted to assess real-world impact on clinical outcomes.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Page S3"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334839","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":"The Impact of MIGS Subspecialty Training on Surgical Care for Endometriosis","authors":"M Barker ,&nbsp;R Schneyer ,&nbsp;C Thrift ,&nbsp;K Fitzsimmons ,&nbsp;A Manliguez ,&nbsp;R Odum ,&nbsp;O Ezike ,&nbsp;KM Hamilton ,&nbsp;K Ciesielski ,&nbsp;M Siedhoff ,&nbsp;K Wright","doi":"10.1016/j.jmig.2025.09.032","DOIUrl":"10.1016/j.jmig.2025.09.032","url":null,"abstract":"<div><h3>Study Objective</h3><div>To compare surgical management techniques and outcomes of endometriosis surgery between surgeons with or without subspecialty training in MIGS.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting</h3><div>Quaternary care institution in Los Angeles, California.</div></div><div><h3>Patients or Participants</h3><div>Patients who underwent surgery for endometriosis with a fellowship-trained MIGS surgeon, general obstetrician/gynecologist (OB/GYN), or gynecologic-oncologist from 11/1/2013 to 10/31/2023, and had surgical or pathologic documentation of endometriosis were included. OB/GYN and gynecologic-oncologist cases were grouped as “non-MIGS.”</div></div><div><h3>Interventions</h3><div>The primary outcome was the rate of fulguration for treatment of endometriosis. Secondary outcomes included rates of residual endometriosis, repeat endometriosis surgery during study period, rate of hysterectomy or oophorectomy, perioperative complications, and rate of intra-operative consultation.</div></div><div><h3>Measurements and Primary Results</h3><div>1,481 patients were included. 1,311 (88.5%) underwent surgery with MIGS surgeons and 170 (11.5%) with non-MIGS surgeons. Compared to MIGS surgeons, non-MIGS surgeons had higher rates of the following: fulguration rather than excision of endometriosis (70.6% vs. 0.7%; adjusted odds ratio [aOR] 353.3, 95% confidence interval [CI] 168.2-742.2), residual, untreated endometriosis (33.5% vs. 0.6%; aOR 197.7, 95% CI 81.9-477.2), need for repeat endometriosis surgery within the study period (23.5% vs. 6.4%; aOR 4.03, 95% CI 2.44-6.67), and unplanned intraoperative consultation (4.7% vs. 1.3%, p=.001). Rates of oophorectomy did not differ significantly between groups (3.5% vs. 7.0%; aOR 0.55, 95% CI 0.21-1.45), however patients were less likely to undergo hysterectomy in non-MIGS group (1.8% vs. 17.1%; aOR 0.09, 95% CI 0.03-0.29). Rate of composite perioperative complications did not differ between groups (5.9% vs. 7.2%; aOR 1.03, 95% CI 0.51-2.04), despite higher surgical complexity (p&lt;.001) and higher rates of Stage III/IV endometriosis in MIGS group (41.8% vs. 30.6%, p=.006).</div></div><div><h3>Conclusion</h3><div>MIGS surgeons were more likely to optimally treat endometriosis with excision, rather than fulguration compared to non-MIGS surgeons. Their patients also needed fewer re-operations, and despite the increased complexity of the surgical procedures, did not have increased perioperative complications.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Page S25"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334979","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 Management of Cervical Agenesis: A Rare Case Report","authors":"J Dubuisson ,&nbsp;V Crofts","doi":"10.1016/j.jmig.2025.09.109","DOIUrl":"10.1016/j.jmig.2025.09.109","url":null,"abstract":"<div><h3>Study Objective</h3><div>To present the successful laparoscopic management of a rare case of congenital obstructive Mullerian anomaly, identified as partial vaginal aplasia and cervical agenesis.</div></div><div><h3>Design</h3><div>Description of the surgical steps involved in performing a direct laparoscopic utero-vaginal anastomosis to restore the continuity of the genital tract, with a 2-year follow-up.</div></div><div><h3>Setting</h3><div>Clinical examination and laparoscopy were performed under general anesthesia.</div></div><div><h3>Patients or Participants</h3><div>A 13-year-old girl was referred for management of cyclic pelvic pain. Despite not having reached menarche, she exhibited secondary sexual characteristics.</div><div>Magnetic resonance imaging revealed the presence of a uterus with a large hematometra measuring 6.4 × 5.2cm. However, imaging could not conclusively confirm the presence of a proximal vagina and a cervix.</div><div>Due to the failure of hormonal and analgesic therapy to alleviate severe pain, the patient final underwent a mini-invasive surgical procedure.</div></div><div><h3>Interventions</h3><div>The external genitalia appeared normal. A 2cm vaginal cul-de-sac was identified with the absence of the upper two-thirds of the vagina. We were able to gently manually dilated it in order to reach the bulging collection.</div><div>Laparoscopy revealed endometriotic peritoneal lesions with widespread deposits of siderin throughout the abdominal cavity. An enlarged uterus with a hugely dilated isthmic portion (hematometra) was confirmed.</div></div><div><h3>Measurements and Primary Results</h3><div>The patient experienced immediate relief post-operatively. Two months later, an elective vaginoscopy revealed a 3cm long vagina with a permeable opening at the level of the anastomosis. Hysteroscopy indicated an endocervical canal, still dilated, with the presence of mucus. Passage through the endocervix allowed visualisation of a uterus presenting a partial septum. Repeated hysteroscopy at 5 months showed no stenosis and patient reported normal menstrual cycles after 2-year follow-up.</div></div><div><h3>Conclusion</h3><div>Cervical agenesis can be effectively managed conservatively, with long-term success achievable using a direct laparoscopic utero-vaginal anastomosis.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Page S21"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334987","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":"Precise Port Placement: An Analytic Review of Lower Quadrant Anatomy","authors":"C Akesson ,&nbsp;G Mintz ,&nbsp;S Sridhar ,&nbsp;AC Gubbels","doi":"10.1016/j.jmig.2025.09.110","DOIUrl":"10.1016/j.jmig.2025.09.110","url":null,"abstract":"<div><h3>Study Objective</h3><div>Review the key anatomical structures in the lower quadrant as they relate to port placement for laparoscopy, review evidence-based practices for port placement in the lower quadrants, and review presentations of injuries of key nerves in the lower quadrants.</div></div><div><h3>Design</h3><div>Surgical video</div></div><div><h3>Setting</h3><div>Operating room</div></div><div><h3>Patients or Participants</h3><div>N/A</div></div><div><h3>Interventions</h3><div>N/A</div></div><div><h3>Measurements and Primary Results</h3><div>N/A</div></div><div><h3>Conclusion</h3><div>The anatomic structures at risk of injury during lower quadrant port placement include the ilioinguinal, iliohypogastric, genitofemoral, and lateral femoral cutaneous nerves. The nerves in the lower quadrant of the abdomen can safely be avoided during port placement by remaining superior to the anterior superior iliac spine. Injuries to these nerves present with pain or paresthesia in the corresponding nerve distribution.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Page S21"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334988","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":"Above and below Hybrid Hysterectomy: Minimally Invasive Approach to a Prolapsed Uterus","authors":"B Huggins,&nbsp;L Himel,&nbsp;JO Schorge","doi":"10.1016/j.jmig.2025.09.112","DOIUrl":"10.1016/j.jmig.2025.09.112","url":null,"abstract":"<div><h3>Study Objective</h3><div>We present the surgical approach for a minimally invasive hysterectomy utilizing a hybrid above and below method in the setting of uterine inversion due to uterine embryonal rhabdomyosarcoma (ERS).</div></div><div><h3>Design</h3><div>Given the rare presentation of uterine ERS with prolapse and inversion, a minimally invasive hybrid approach was selected.</div></div><div><h3>Setting</h3><div>The patient was placed in dorsal lithotomy position with Allen stirrups. Equipment included a Rumi manipulator, ultrasonic dissection device, Hassan 10-mm trocar, two 5-mm ports, laparoscopic graspers, laparoscopic needle drivers, vascular clips, and 2-O VLOC suture.</div></div><div><h3>Patients or Participants</h3><div>This is a single-case report.</div></div><div><h3>Interventions</h3><div>Complete uterine inversion was seen where only the fallopian tubes and ovaries were appreciated. Attempt from below to relieve the inversion were unsuccessful. Attention was turned to retroperitoneal dissection. This was carried inferiorly all the way to the round ligament, bilaterally. A bilateral salpingectomy was performed. Attention then turned to the utero-ovarian ligaments where a peritoneal window was created under the IP ligament and stretched. The vessels were isolated, then sealed and divided bilaterally. The uterine artery was isolated at its origin and clipped with two 5 mm clips. This was repeated contralaterally. Vaginally, the uterine corpus was amputated with Jorgenson scissors. From above, residual lower uterine segment was able to be reduced. The bladder flap was created. The uterine vessels were then divided bilaterally. The colpotomy was performed and the vaginal cuff was closed using a 2-0 VLOC laparoscopically.</div></div><div><h3>Measurements and Primary Results</h3><div>Literature review revealed that non-puerperal uterine inversion is a rarity. A few case reports have documented successful management of benign inversion through minimally invasive approaches. Rodrigues et al. (2024) reported a case of uterine inversion associated with ERS, but management was performed via laparotomy. To our knowledge, there are no prior reports of minimally invasive management in this setting.</div></div><div><h3>Conclusion</h3><div>This case supports the feasibility of minimally invasive surgery even in complex presentations.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Page S22"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334990","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":"Abdominal Wall Endometriosis: Management Strategies and Surgical Techniques","authors":"S Kegel ,&nbsp;J Sacco ,&nbsp;G Lewis","doi":"10.1016/j.jmig.2025.09.133","DOIUrl":"10.1016/j.jmig.2025.09.133","url":null,"abstract":"<div><h3>Study Objective</h3><div>To review medical and interventional management strategies of abdominal wall endometriosis (AWE) and highlight a case of deep infiltrating pelvic endometriosis with concurrent AWE requiring wide local excision.</div></div><div><h3>Design</h3><div>Surgical video case presentation</div></div><div><h3>Setting</h3><div>Tertiary care academic center</div></div><div><h3>Patients or Participants</h3><div>This is a video case presentation of a 39 yo G0 patient who presented with a longstanding history of pelvic pain and endometriosis. MRI showed deep pelvic endometriosis with multifocal anterior rectal wall infiltration and soft tissue implants along the uterovesical space and rectouterine fascia as well as soft tissue thickening in the left anterior abdominal wall measuring up to 4.5 cm most compatible with AWE. The patient desired surgical management due to the severity of her symptoms, however also desired fertility preservation. The decision was made to proceed with robotic-assisted endometriosis excision and AWE resection.</div></div><div><h3>Interventions</h3><div>Robotic-assisted excision of deep infiltrating endometriosis with bowel resection and open excision of AWE with fascial repair.</div></div><div><h3>Measurements and Primary Results</h3><div>Uncomplicated surgical management of deep infiltrating endometriosis and AWE was performed in a fertility preserving manner. The patient was discharged on postoperative day #3 on norethindrone for further endometriosis suppression. This video reviews techniques for treatment of AWE and highlights opportunities for expanding treatment options of this rare manifestation of endometriosis.</div></div><div><h3>Conclusion</h3><div>While surgical excision has been historically regarded as standard of care for AWE, many adjuvant and non-surgical techniques are emerging to ensure safe and complete excision.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Page S30"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334994","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":"Interventional Radiology Guided Excision of Proximal Oblique Vaginal Septum in Pediatric Patient with Ohvira","authors":"S Ahluwalia ,&nbsp;C Polkinghorn ,&nbsp;J Reis ,&nbsp;L Yu","doi":"10.1016/j.jmig.2025.09.103","DOIUrl":"10.1016/j.jmig.2025.09.103","url":null,"abstract":"<div><h3>Study Objective</h3><div>Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA) typically manifests as a didelphys uterus with an oblique vaginal septum on the same side as the renal anomaly and often presents around the time of menarche. The oblique septum obstructs menstrual egress from one cervix, leading to hematocolpos and distension of the obstructed hemivagina; thus, treatment of OHVIRA requires resection of the vaginal septum. A proximal septum may be more difficult to safely resect due to lack of distention to delineate borders.</div></div><div><h3>Design</h3><div>Single patient video of excision procedure</div></div><div><h3>Setting</h3><div>Tertiary care pediatric hospital in United States</div></div><div><h3>Patients or Participants</h3><div>13-year-old female with known absent right kidney.</div></div><div><h3>Interventions</h3><div>Vaginal septum resection using Interventional Radiology techniques to adequately identify and distend the obstructed hemivagina for safe resection.</div></div><div><h3>Measurements and Primary Results</h3><div>Safe excision of oblique septum obstructing hemivagina, confirmed on vaginoscopy.</div></div><div><h3>Conclusion</h3><div>The resection and repair of OHVIRA can be challenging when the level of obstruction is high with lack of distention to delineate the obstructed hemivagina. Concurrent use of fluoroscopy and ultrasonographic guidance can allow for definitive confirmation of the space and provide a helpful guide for safe repair.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Page S19"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335109","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":"Revolutionizing Rectal Endometriosis Surgery: A Mesentery-Sparing Hand-Sewn Technique","authors":"Y Zhou","doi":"10.1016/j.jmig.2025.09.013","DOIUrl":"10.1016/j.jmig.2025.09.013","url":null,"abstract":"<div><h3>Study Objective</h3><div>To compare functional and economic outcomes of a mesentery tissue-sparing hand-sewn anastomosis versus conventional stapled resection for rectal endometriosis ≥3 cm, focusing on neurovascular preservation and cost-effectiveness.</div></div><div><h3>Design</h3><div>Retrospective propensity score-matched cohort study (2021–2024).</div></div><div><h3>Setting</h3><div>Tertiary referral center specializing in endometriosis surgery.</div></div><div><h3>Patients or Participants</h3><div>57 reproductive-aged women with histologically confirmed rectal endometriosis (hand-sewn group: n=26; stapled group: n=31).</div></div><div><h3>Interventions</h3><div>The innovative hand-sewn technique combined full-thickness excision with layered suturing to maintain submucosal arterioles and lymphatic pathways. Propensity score matching was used to control for age, symptoms, and CA125 levels. Outcome assessed included complications, hospitalization costs, and Low Anterior Resection Syndrome (LARS) scores at 3 months postoperatively.</div></div><div><h3>Measurements and Primary Results</h3><div>The hand-sewn group demonstrated superior surgical efficiency, with a 34% reduction in operative time (222.6±69.3 vs. 336.2±52.3 min, <em>P</em>&lt;0.001), faster bowel recovery (first defecation: 8.5±4.6 vs. 16.9±7.7 days, <em>P</em>&lt;0.001), and fewer complications (3.8% vs. 41.9%, <em>P</em>=0.003), including urinary retention (3.8% vs. 22.6%). Cost savings amounted to 21% ($5,526±1,449 vs. $6,960±925, <em>P</em>&lt;0.001). Preservation of vascular integrity prevented anastomotic ischemia (0% vs. 3.2%), while lymphatic conservation reduced postoperative edema. LARS scores were significantly lower in the hand-sewn group (6.9±5.8 vs. 11.4±8.5, <em>P</em>=0.028).</div></div><div><h3>Conclusion</h3><div>By conserving mesenteric microvasculature and autonomic innervation, the hand-sewn technique effectively reduces neurogenic morbidity and associated costs. Its comprehensive protection of neurovascular-lymphatic structures provides a safer alternative for treating rectal endometriosis. However, long-term outcomes require further validation through multicenter studies.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Pages S11-S12"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335190","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":"Clinical Outcomes and Patient-Reported Symptoms after Essure Removal Surgery: A Systematic Review.","authors":"Liselotte W Maassen, Daniëlle M van Gastel, Mirthe A J M van Erp, Kirsten Bos, Carolien A M Koks, Marlies Y Bongers, Sebastiaan Veersema","doi":"10.1016/j.jmig.2025.10.003","DOIUrl":"https://doi.org/10.1016/j.jmig.2025.10.003","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate clinical outcomes of Essure removal surgery, focusing primarily on symptom reduction and secondarily on indications for removal, quality of life (QoL), surgical technique, and complications.</p><p><strong>Data sources: </strong>PubMed, EMBASE and the Cochrane library were searched.</p><p><strong>Methods of study selection: </strong>Studies reporting outcomes of Essure removal were eligible; case reports and articles not in English or Dutch were excluded. Screening of 401 records identified 18 studies between 2014 and 2024, involving 2,034 women in case series, prospective or retrospective cohorts, and one multicentre prospective study. No randomized controlled trials on this topic exist. Methodological quality was assessed using the JBI Critical appraisal checklist for case series: 16 studies were low, 1 moderate, and 1 high risk of bias.</p><p><strong>Tabulation, integration and results: </strong>Significant symptom improvement, including pain reduction, reduction in abnormal uterine bleeding, and asthenia, was reported in 7 studies. Persisting or worse symptoms were reported. Significant QoL improvements were observed in 5 studies. The most frequent procedure was laparoscopic bilateral salpingectomy with device (52.3%), followed by laparoscopic removal and bilateral salpingectomy with cornua resection (17.5%) and hysterectomy (25.2%), of which 73.4% laparoscopic. The overall complication rate was 6.5% (1.2% intraoperative, 5.3% postoperative).</p><p><strong>Conclusion: </strong>Essure removal surgery is generally safe and the majority of patients report reduced pain, improved symptoms and enhanced QoL. However, persistent or worsening symptoms occur. Evidence quality is limited due to retrospective case series and cohort designs, absence of control groups, and heterogeneous, non-standardized symptom and QoL measures.</p><p><strong>Source of funding: </strong>none REGISTRATION OF SYSTEMATIC REVIEWS: The protocol of this review was prospectively registered on PROSPERO, registration ID: CRD42021225083. The protocol can be accessed via https://www.crd.york.ac.uk/PROSPERO/view/CRD42021225083.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145329506","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}