Journal of minimally invasive gynecology最新文献

{"title":"Torsion Time; A Retrospective Cohort Study to Assess Surgeon Gender Bias for Time to Operating Room with Ovarian Torsion.","authors":"Lauren Roth, Wesley Nilsson, Alexis Newmark, Jonathan Shepherd","doi":"10.1016/j.jmig.2025.08.032","DOIUrl":"https://doi.org/10.1016/j.jmig.2025.08.032","url":null,"abstract":"<p><strong>Study objective: </strong>To assess the impact of surgeon gender on the timing of surgical intervention for ovarian torsion.</p><p><strong>Design: </strong>This is a multi-center retrospective study of patients 18-50 years old, diagnosed with ovarian torsion between January 2012 and July 2023, and who underwent surgical management.</p><p><strong>Setting: </strong>Multi-center, retrospective observational study.</p><p><strong>Patients or participants: </strong>Patients undergoing surgery for ovarian torsion.</p><p><strong>Interventions: </strong>The primary outcome was the time from emergency room presentation to the operating room (OR) based on the surgeon's gender. Secondary analyses included the effects of attending surgeon seniority, gender of the diagnosing clinician, time of day, and the post-graduate year (PGY) of the trainee evaluating the patient.</p><p><strong>Measurements and main results: </strong>We included 141 subjects with ovarian torsion. The patients averaged 32±8.7 years old with a BMI of 30±7.9 and were predominantly white (54.6%) or black (19.1%). They were more often operated on by a female attending surgeon (57.4%) and initially seen by a female clinician (55.3%). Median time from presenting to the ED to entry in the OR was 396 minutes [IQR=254.5 to 627.5]. Most surgeries were performed 7am-7pm (61.7%) by attending physicians in practice >10 years (63.8%). Using linear regression models, neither the gender of the diagnosing physician (β=0.016, p=0.90) nor the operating physician (β=-0.036, p=0.78) impacted the time to OR entry. Increasing BMI reduced time to the OR by 2.6 minutes per unit (β=-0.017, p=0.03).and increasing PGY was associated with faster OR entry times, with patients arriving to the OR 31 minutes faster per PGY(β=-0.114, p=0.01).</p><p><strong>Conclusion: </strong>Surgeon gender does not appear to impact OR timing for ovarian torsion cases. With a retrospective trial design and multiple comparisons, the findings of faster OR entry with increasing resident PGY and with increasing BMI should be seen as hypothesis-generating conclusions.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008357","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":"Initial results in the automatic visual recognition of endometriosis lesions by artificial intelligence during laparoscopy: a proof-of-concept study.","authors":"Antoine Netter, Saman Noorzadeh, Fanny Duchateau, Henrique Abrao, Michel Canis, Adrien Bartoli, Nicolas Bourdel, Saman Noorzadeh, Julie Desternes, Julien Peyras, Jean-Luc Pouly, Mauricio S Abrão, Attila Bokor, Ulrik Bak Kirk, Aubert Agostini, Blandine Courbiere","doi":"10.1016/j.jmig.2025.08.027","DOIUrl":"https://doi.org/10.1016/j.jmig.2025.08.027","url":null,"abstract":"<p><strong>Objective: </strong>To develop a machine learning method for the automatic recognition of endometriosis lesions during laparoscopic surgery and evaluate its feasibility and performance.</p><p><strong>Design: </strong>Collecting and annotating surgical videos and training, validating, and testing a deep neural network.</p><p><strong>Setting: </strong>Multicenter proof-of-concept study using surgical videos from expert centers in France, Hungary, Brazil, and Denmark.</p><p><strong>Participants: </strong>Surgical video sequences were collected from 112 patients who underwent laparoscopic procedures for suspected endometriosis between January 2020 and August 2023. Sequences with identifiable endometriosis lesions were included, while poor-quality images and sequences with prior surgical manipulation were excluded.</p><p><strong>Interventions: </strong>A deep neural network based on YOLOv5 was trained to detect and classify nine visual classes of endometriosis lesions (superficial black, superficial red, superficial white, superficial subtle, filmy adhesions, dense adhesions, deep endometriosis, ovarian endometrioma, and ovarian chocolate fluid).</p><p><strong>Results: </strong>The model performance was good for the 'superficial black', 'superficial subtle', and 'ovarian chocolate fluid' classes (F1 score = 0.94, 0.74, and 0.75, respectively), acceptable for the 'dense adhesion', 'ovarian endometrioma' and 'deep endometriosis' classes (F1 score = 0.70, 0.63 and 0.632, respectively), and weak for the 'superficial red', 'superficial white', and 'filmy adhesions' classes (F1 score = 0.25, 0.18, 0.16 and 0.02, respectively). However, while these results highlight the model's strong potential in identifying most lesions in at least one frame of each sequence, they underscore the need for further refinement to improve accuracy and precision.</p><p><strong>Conclusion: </strong>This study demonstrates the feasibility of applying artificial intelligence for visual recognition of endometriosis during laparoscopic surgery. While the initial results are encouraging, further development is needed to enhance the model performance and standardize the annotation methods. The integration of AI in surgical practice holds promise for assisting in endometriosis diagnosis and improving surgical outcomes.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006272","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: Hysteroscopy-Guided Endometrial Sampling Diagnostic Performance in Endometrial Intraepithelial Neoplasia Patients.","authors":"Zhiming Zhang, Yue You","doi":"10.1016/j.jmig.2025.08.030","DOIUrl":"https://doi.org/10.1016/j.jmig.2025.08.030","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992544","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: Hysteroscopy-Guided Endometrial Sampling Diagnostic Performance in Endometrial Intraepithelial Neoplasia Patients.","authors":"Tarek Khalife, Kristina A Butler, Sarah L Cohen Rassier","doi":"10.1016/j.jmig.2025.08.031","DOIUrl":"https://doi.org/10.1016/j.jmig.2025.08.031","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992564","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":"Prof Perrine Goussault Capmas, Prof Hervé Fernandez","doi":"10.1016/j.jmig.2025.08.004","DOIUrl":"10.1016/j.jmig.2025.08.004","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957509","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":"Complications Following Laparoscopic Hysterectomy with Concomitant Appendectomy: A National Analysis.","authors":"Yael Yagur, David Rosen, Gabriel Levin, Yosef Nasseri, Moshe Barnajian, Raanan Meyer","doi":"10.1016/j.jmig.2025.08.026","DOIUrl":"10.1016/j.jmig.2025.08.026","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether concomitant appendectomy during laparoscopic hysterectomy (LH) for benign indications is associated with increased short-term postoperative complications.</p><p><strong>Design: </strong>This is a retrospective cohort study based on prospectively collected data.</p><p><strong>Setting: </strong>American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database.</p><p><strong>Participants: </strong>Women undergoing LH for benign gynecologic indications between 2012 and 2022.</p><p><strong>Interventions: </strong>Comparison between patients undergoing LH alone versus LH with concomitant appendectomy. Propensity score matching (1:3) was used to balance covariates, Clavien-Dindo classification was applied to stratify postoperative complications. The primary outcome was the incidence of any postoperative complications occurring within 30 days. Secondary outcomes included total operative time, length of hospital stay, and readmission.</p><p><strong>Results: </strong>After propensity score matching, 5,782 patients were included, 1,459 LH with concomitant appendectomy and 4,323 LH-only. Concomitant appendectomy was associated with an increase in overall postoperative complications (7.8% vs. 6.2%, p=0.037), and higher rate of major complications (3.7% vs. 2.3%, p=0.008). Operative time (152.2 vs. 135.3 minutes, p<0.001) and hospital stay (1.2 vs. 0.8 days, p=0.019) were longer in the appendectomy group. In multivariable regression, concomitant appendectomy remained independently associated with increased odds of any complication (aOR 1.29, 95% CI 1.03-1.63), major complications (aOR 1.63, 95% CI 1.16-2.29). Appendectomy was also associated with increased odds of overnight admission (aOR 1.45, 95% CI 1.22-1.73) and longer hospital stay ≥1 day (aOR 1.61, 95% CI 1.39-1.87) and ≥2 days (aOR 1.36, 95% CI 1.10-1.67).</p><p><strong>Conclusion: </strong>In our study, concomitant appendectomy during LH was associated with an increase in major postoperative complications, operative time and hospital length of stay. Overall increased risk remains low, and the decision to perform appendectomy should be individualized, considering surgical complexity, intraoperative findings, and the clinical context, including patient-specific risk factors and goals of care.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957667","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":"Waste Audit of Robotic Gynecologic Surgery: A Pilot Study.","authors":"Simone A Sasse, Amy C Bleasdale, Justin Zaslavsky, Julia Niemeier, Hannah Karpel, Kathy Huang, Cassandra L Thiel","doi":"10.1016/j.jmig.2025.08.029","DOIUrl":"https://doi.org/10.1016/j.jmig.2025.08.029","url":null,"abstract":"<p><strong>Study objective: </strong>To quantify and characterize waste generated in robotic gynecologic surgery and assess its environmental impact, with the goal of identifying strategies to reduce waste and improve sustainability.</p><p><strong>Design: </strong>Waste audit and life cycle impact assessment of robotic gynecologic surgery.</p><p><strong>Setting: </strong>Single academic institution.</p><p><strong>Patients: </strong>Twenty robotic gynecologic surgery cases, including hysterectomies (n=10), myomectomies (n=6), and tubal, ovarian, or endometriosis surgeries (n=4).</p><p><strong>Interventions: </strong>A detailed waste audit of all surgical waste to categorize materials into municipal solid waste (MSW) and regulated medical waste (RMW), allowing for subsequent life cycle impact assessment.</p><p><strong>Measurements and main results: </strong>The 20 audited cases produced 367.02 kg of MSW and 9.68 kg of RMW, averaging 18.35 kg (standard deviation, SD, 2.63 kg) of MSW and 0.48 kg (SD 0.52 kg) of RMW per case. The largest contributor by weight was surgical gowns and drapes composed of spunbond-meltblown-spunbond (SMS) polypropylene. An average of 0.59 kg (SD 0.25 kg) of recyclable plastics and 11.85 batteries (SD 4.09) per case were discarded as MSW. No RMW met biohazard criteria. Unused surgical supplies accounted for 1.11 kg (SD 0.56 kg) of waste per case. Cases produced an average of 0.70 kg CO₂e (SD 0.27) per minute of operative time, with shorter surgeries producing the most emissions per minute. Cotton products contributed up to almost one-third of an impact category despite accounting for 5% of the total waste by weight.</p><p><strong>Conclusion: </strong>Opportunities to reduce the environmental impact of robotic gynecologic surgeries include reorganizing surgical kits to avoid the unnecessary opening of commonly unused items, increasing reprocessing of single-use devices, properly sorting recyclable plastics and paper products, appropriately using regulated medical waste streams, considering alternative surgical modalities for less complex cases, and exploring reusable or more environmentally-friendly alternatives to cotton and SMS polypropylene products.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957628","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 \"Changes in Sexual Function After Minimally Invasive Hysterectomy in Reproductive-Aged Women: A Systematic Review and Meta-Analysis\".","authors":"Shangqing Wu, Yuling Li, Dongbao Yang","doi":"10.1016/j.jmig.2025.08.020","DOIUrl":"https://doi.org/10.1016/j.jmig.2025.08.020","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957592","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":"Robot-Assisted Laparoscopic Hysterectomy with Artificial Intelligence-Analyzed Imaging.","authors":"Naoyuki Yoshiki, Noriko Oshima, Naoyuki Miyasaka","doi":"10.1016/j.jmig.2025.06.002","DOIUrl":"10.1016/j.jmig.2025.06.002","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293898","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 of Combined Medical and Surgical Treatment for Infected Retained Products of Conception.","authors":"Nati Bor, Gil Zeevi, Adi Litmanovich, Ido Givon, Ran Matot, Adi Borovich, Natav Hendin, Haim Krissi","doi":"10.1016/j.jmig.2025.08.028","DOIUrl":"https://doi.org/10.1016/j.jmig.2025.08.028","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the clinical outcomes of a combined treatment strategy, referred to as the \"Cooling Down Protocol,\" involving medical management with antibiotics followed by elective hysteroscopy for infected retained products of conception (RPOC).</p><p><strong>Design: </strong>Retrospective case series.</p><p><strong>Setting: </strong>Single tertiary university-affiliated medical center.</p><p><strong>Patients: </strong>32 patients treated between 2012 and 2023 with a diagnosis of infected retained products of conception.</p><p><strong>Interventions: </strong>Initial treatment involved antibiotic therapy as part of the Cooling Down Protocol, with elective hysteroscopy performed to ensure complete removal of retained tissue.</p><p><strong>Results: </strong>97% of patients achieved infection resolution. Only one case required urgent surgical intervention due to clinical deterioration. Elective hysteroscopy was performed in 20% of cases, and the overall complication rate was 9.4%, including minor infections, hemorrhage, and pelvic pain. Importantly, the \"minor infections\" referred to post-procedural infections, as all patients initially presented with active infection. No major complications like sepsis or thromboembolic events were observed. The incidence of intrauterine adhesions was 10%, lower than rates for traditional D&C.</p><p><strong>Conclusion: </strong>The study supports the Cooling Down Protocol as a reasonable treatment alternative to more invasive methods, minimizing risks and optimizing patient outcomes.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957677","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}