Journal of minimally invasive gynecology最新文献

{"title":"Accessory Obturator Nerve During vNOTES Pelvic Lymphadenectomy","authors":"","doi":"10.1016/j.jmig.2024.06.001","DOIUrl":"10.1016/j.jmig.2024.06.001","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141293466","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 Reinterpretation of Paracolpium in Radical Hysterectomy: New Insights into Its Surgical Implication","authors":"","doi":"10.1016/j.jmig.2024.06.012","DOIUrl":"10.1016/j.jmig.2024.06.012","url":null,"abstract":"<div><h3>Objective</h3><div>To reinterpret the surgical anatomy of paracolpium in radical hysterectomy and to explore its implications for the surgery.</div></div><div><h3>Setting</h3><div>The term “paracolpium” first defined by Fothergill in 1907, is essential in radical hysterectomy. However, several challenges remain unresolved. These include: (1) inconsistent terminology in relation to its defined attributes; (2) the lack of consensus on anatomical landmarks; (3) unclear associations with the cardinal and sacral ligaments; and (4) the critical implications and requirements of paracolpium resection in radical hysterectomy practices.</div></div><div><h3>Participants</h3><div>A patient in her 60s diagnosed with stage IB2 cervical cancer was enrolled in a clinical trial and assigned to the laparoscopic surgery group. A step-by-step, narrated video demonstration.</div></div><div><h3>Interventions</h3><div>During the procedure, post-excision of the uterosacral, cardinal, and vesicovaginal ligaments, we identified a ligament-like structure situated between the middle third of the vagina and the pelvic wall. We have termed this structure the “paracolpium ligament.” A detailed anatomical description was performed, outlining its crucial attachments:</div><div> <!-->• Medial attachment: middle third of the vagina</div><div> <!-->• Lateral attachment: tendinous arch of the pelvic fascia (TAPF)</div><div> <!-->• Cranial attachment: cardinal-uterosacral ligaments confluence</div><div> <!-->• Caudal attachment: pubococcygeus muscle fascia</div><div> <!-->• Dorsal: paravaginal space</div><div> <!-->• Ventral: pararectal space</div><div>To ensure a safe dissection, the paracolpium ligament was exposed by removing anterior and posterior fat tissue. The extent of surgical resection was adapted based on the tumor's location. Extensive resection of the paracolpium ligament was essential when the tumor was localized to one side of the vagina to ensure complete removal of the disease; otherwise, preservation of the ligament was considered feasible.</div></div><div><h3>Conclusion</h3><div>In this video, we meticulously name and define the “paracolpium ligament,” providing groundbreaking insights into its anatomical and surgical implications in radical hysterectomy. Our findings contribute to a better understanding of surgical anatomy for cervical cancer.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141468680","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":"Retroperitoneal Cystic Endometriosis Incidentally Found at Time of Hysterectomy","authors":"","doi":"10.1016/j.jmig.2024.06.006","DOIUrl":"10.1016/j.jmig.2024.06.006","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141399704","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 Intrauterine Device Complication Due to Cervical Fibroid: A Laparoscopic Approach","authors":"","doi":"10.1016/j.jmig.2024.06.009","DOIUrl":"10.1016/j.jmig.2024.06.009","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141427075","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":"Comparison of Recurrence and Survival Between Patients With Pathological Stage I Epithelial Ovarian Cancer After Laparoscopic or Laparotomic Surgery: Retrospective Analysis of a Propensity-Matched Cohort","authors":"","doi":"10.1016/j.jmig.2024.07.005","DOIUrl":"10.1016/j.jmig.2024.07.005","url":null,"abstract":"<div><h3>Objective</h3><div>To compare oncologic outcomes after laparoscopic or laparotomic surgery to treat epithelial ovarian carcinoma in FIGO Stage I.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting</h3><div>Gynecological cancer ward in a tertiary hospital.</div></div><div><h3>Participants</h3><div>A total of 85 patients with FIGO Stage I epithelial ovarian carcinoma who underwent laparoscopic staging surgery and 206 who underwent laparotomic staging surgery at West China Second Hospital, Sichuan University (Chengdu, China) between January 1, 2013 and December 31, 2019.</div></div><div><h3>Interventions</h3><div>Laparoscopic surgery or laparotomic staging surgery.</div></div><div><h3>Results</h3><div>Before propensity score-based matching, the laparotomy group showed higher prevalence of preoperative elevated CA125 level (48.5% vs 35.3%, p = .045) and tumors &gt;15 cm (27.2% vs 5.9%, p &lt;.001). Multivariate analysis associated higher body mass index with better overall survival (adjusted HR 0.83, 95% CI 0.70–0.99, p = .043). Among propensity score-matched patients (82 per group) who were matched to each other according to propensity scoring based on age, body mass index, CA125 level, largest tumor diameter, FIGO stage, history of abdominal surgery, and American Society of Anesthesiologists grade, the rate of progression-free survival at 5 years was similar between the laparoscopy group (87.1%, 95% CI 79.3–95.7%) and the laparotomy group (90.9%, 95% CI 84.7–97.6%, p = .524), as was the rate of overall survival at 5 years (93.9%, 95% CI 88.0–100.0% vs 94.7%, 95% CI 89.8–99.9%, p = .900). Regardless of whether patients were matched, the two groups showed similar rates of recurrence of 9–11% during follow-up lasting a median of 54.9 months.</div></div><div><h3>Conclusions</h3><div>Rates of recurrence and survival may be similar between laparoscopy or laparotomy to treat Stage I epithelial ovarian cancer. Since laparoscopy is associated with less bleeding and faster recovery, it may be a safe, effective alternative to laparotomy for appropriate patients.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141616593","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":"Risk Factors and Prediction Nomogram of Local Regeneration After Ultrasound-Guided Microwave Ablation of Uterine Fibroids","authors":"","doi":"10.1016/j.jmig.2024.07.020","DOIUrl":"10.1016/j.jmig.2024.07.020","url":null,"abstract":"<div><h3>Study Objective</h3><div>To explore the risk factors associated with local regeneration of the treated uterine fibroids (UFs) after microwave ablation (MWA) and to develop a nomogram model for predicting the risk of local regeneration.</div></div><div><h3>Design</h3><div>Retrospective study.</div></div><div><h3>Setting</h3><div>The Eighth Affiliated Hospital of Sun Yat-Sen University.</div></div><div><h3>Patients</h3><div>Patients with UFs who underwent MWA at our hospital between October 2020 and April 2023 were included.</div></div><div><h3>Intervention</h3><div>MWA was used for the treatment of UFs.</div></div><div><h3>Measurements and Main Results</h3><div>A total of 47 patients with 68 fibroids were included into this study. Over a median follow-up of 13 months (interquartile range, 8–22 months), local regeneration occurred in 11 UFs. The clinical and imaging characteristics of these patients were recorded and compared. Risk factors for local regeneration were determined through univariate and multivariate Cox regression analysis. Multivariate analysis revealed that the fertility desires, larger size of UFs (≥95.3 cm³), and hyperenhancement of UFs on contrast-enhanced ultrasound were independent risk factors for local regeneration after MWA. A predictive nomogram was constructed to predict the local regeneration after MWA of UFs. The concordance index (C-index) (C-index, 0.924; internal validation C-index, 0.895) and the 1- and 2-year area under the curve values (0.962, 0.927) all indicated that the nomogram had good predictive performance. Calibration and decision curve analysis curves further confirmed the model's accuracy and clinical utility.</div></div><div><h3>Conclusion</h3><div>Fertility desires, larger size of UFs, and hyperenhancement on contrast-enhanced ultrasound were independent predictors of UFs local regeneration after MWA in our study. The nomogram constructed based on the abovementioned independent risk factors may help predict which UFs will develop local regeneration after MWA.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889478","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 Fate of the Abstract: Presentation and Publication Characteristics of Abstracts Presented at the Society of Gynecologic Surgeons Annual Scientific Meetings 2013 to 2020","authors":"","doi":"10.1016/j.jmig.2024.07.007","DOIUrl":"10.1016/j.jmig.2024.07.007","url":null,"abstract":"<div><h3>Study Objective</h3><div>To evaluate what proportion of abstracts presented at the Society of Gynecologic Surgeons (SGS) Annual Scientific Meetings went on to be published in publicly available journals.</div></div><div><h3>Design</h3><div>Retrospective observational study.</div></div><div><h3>Setting</h3><div>Single organization.</div></div><div><h3>Participants</h3><div>Abstracts (oral presentations, oral posters, video presentations, nonoral posters) presented at the SGS Annual Scientific Meeting from 2013 to 2020.</div></div><div><h3>Interventions</h3><div>Variables were collected pertaining to abstract authors, study type, timing of the session presented, and journal factors. To identify possible publications, abstracts were cross-referenced in PubMed and Google Scholar.</div></div><div><h3>Measurements and Main Results</h3><div>A total of 912 abstracts were reviewed: 155 oral presentations, 184 oral posters, 79 video presentations, and 490 nonoral posters. 45.8% of abstracts went on to publication in a peer-reviewed journal. Most abstracts (75.0%) were published from institutions with a fellowship presence and at a university-based program (71.5%). The five most represented institutions presented 27.5% of all abstracts during an SGS session. Oral presentations were more likely than oral posters to be structured as randomized controlled trials (20% vs 9%, p = .028), and to be published in a journal with a higher impact factor (6.36 ± 11.74 vs 3.88 ± 2.72, p = .031). Type of presentation and fellowship presence significantly affected the likelihood of abstract publication (oral presentation OR 0.73, 95% CI [0.466, 1.141], p = .167; video OR 0.14, 95% CI [0.075, 0.261; nonoral poster OR 0.30, 95% CI [0.204, 0.439]; p &lt; .001; fellowship OR 1.62, 95% CI [1.167, 2.237], p = .004).</div></div><div><h3>Conclusion</h3><div>Over 8 years of the SGS Annual Scientific Meeting, the rate of abstract publication was 45.8%. Abstract origination from an academic institution with a fellowship program significantly affected the likelihood of publication. Abstract presentation at a society meeting is a prestigious opportunity, and prioritization of resources and elimination of barriers should be encouraged to further promote progression of these projects to publication.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141603783","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":"Assessment of the Pelvic Pain Experienced by Infertile Women is of Prime Importance for Diagnosing Endometriosis","authors":"","doi":"10.1016/j.jmig.2024.07.010","DOIUrl":"10.1016/j.jmig.2024.07.010","url":null,"abstract":"<div><h3>Objective</h3><div>To provide evidence regarding the significance of painful symptoms among women suffering from infertility.</div></div><div><h3>Design</h3><div>An observational retrospective cross-sectional study.</div></div><div><h3>Settings</h3><div>University hospital-based research center.</div></div><div><h3>Patients</h3><div>Infertile patients aged between 18 and 42 years surgically explored for benign gynecological conditions between 01-2004 and 12-2020.</div></div><div><h3>Interventions</h3><div>For each patient, a standardized questionnaire was completed during a face-to-face interview conducted by the surgeon in the month preceding the surgery. Preoperative assessment the pain symptoms was recorded. Pain intensity was assessed with a 10cm visual analog scale (VAS). The pain was considered to be severe when the VAS score was ≥ 7.</div></div><div><h3>Measurements and Main Results</h3><div>Surgery was performed in 839 infertile women. 451 women had severe pelvic pain. Infertile patients with severe pain significantly more often had endometriosis (67.4% versus 30.7% respectively; p &lt;.001) than infertile women without severe pelvic pain, and especially deep infiltrating lesions (43.2% versus 8.5% respectively; p &lt;.001). Moreover, these women more often had intestinal endometriosis lesions (28.4% vs 1.8%; p &lt;.001). After multivariable regression analysis, the presence of endometriosis, irrespective of the phenotype (superficial lesions (OR1.84 [1.19–2.86] and/or ovarian endometrioma OR 2.79 [1.70–4.59] and/or deep infiltrating endometriosis OR 4.49 [2.69–7.51]), and the presence of at least one intestine endometriosis lesion (OR6.49 [2.69–7.51] were significantly associated with severe pelvic pain.</div></div><div><h3>Conclusion</h3><div>Severe pelvic pain is significantly associated with endometriosis and especially deep infiltrating lesions in a population of infertile women. These results demonstrate the importance of thorough questioning regarding pelvic pain symptoms during the initial management of infertile patients.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141734379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic-Assisted Fertility-Sparing Surgery for Growing Teratoma Syndrome of the Ovary: Experience From a Tertiary Center","authors":"","doi":"10.1016/j.jmig.2024.07.018","DOIUrl":"10.1016/j.jmig.2024.07.018","url":null,"abstract":"<div><h3>Study Objective</h3><div>The main objective is to evaluate the feasibility of laparoscopic fertility-sparing surgery in women with growing teratoma syndrome.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting</h3><div>Chinese tertiary university hospital.</div></div><div><h3>Patients</h3><div>Patients with growing teratoma syndrome who underwent fertility-sparing surgery between January 2015 and August 2023.</div></div><div><h3>Interventions</h3><div>Baseline characteristics and surgical outcomes were evaluated, including clinical information, surgical procedures, operative time, intraoperative blood loss, complications, length of hospital stay, and follow-up information.</div></div><div><h3>Measurement and Main Results</h3><div>Twenty-six patients with ovarian growing teratoma syndrome underwent fertility-sparing surgery: 12 had laparoscopic surgery and 14 underwent laparotomic surgery. In the laparoscopic group, the median age of the patients during initial management of immature teratoma or mixed malignant ovarian germ cell tumor was 14.0 years (interquartile range, 13.0–24.5 years). Eleven patients were nulliparous. The primary ovarian tumor was pure immature teratoma in 10 patients and mixed ovarian germ cell tumor in 2 patients. Complete laparoscopic tumor resection was achieved in 11 patients. Patients in the laparoscopic group had shorter median operative time (76.5 vs 180.0 minutes, p = .001), lower estimated blood loss (20.0 vs 400.0 mL, p &lt;.001), and decreased postoperative hospital stay (2.0 vs 7.0 days, p &lt;.001) compared with laparotomic surgery. There was no conversion to laparotomy and no perioperative complications. Histologic examination confirmed mature teratoma in all cases. During a median follow-up of 21.9 months (interquartile range, 7.6–44.9 months), 11 patients were alive without disease and 1 was alive with disease. One pregnancy was achieved postoperatively.</div></div><div><h3>Conclusion</h3><div>Laparoscopic fertility-sparing surgery may represent a feasible option in well-selected patients with ovarian growing teratoma syndrome. Surgery should be performed in gynecologic oncology centers by experienced staff trained in endoscopic procedures. More research and long-time follow-up are needed to determine the oncologic outcomes and safety of laparoscopic surgery in this population.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141792676","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":"Evaluation of Ovarian Reserve and Recurrence Rate After DWLS Diode Laser Ovarian Endometrioma Vaporization (OMAlaser): A Prospective, Single-arm, Multicenter, Clinical Trial.","authors":"Maurizio Nicola D'Alterio, Luigi Nappi, Salvatore Giovanni Vitale, Mirian Agus, Daniela Fanni, Mario Malzoni, Francesca Falcone, Felice Sorrentino, Maria Gabriella D'Agate, Giuseppe Scibilia, Liliana Mereu, Paolo Scollo, Stefano Angioni","doi":"10.1016/j.jmig.2024.10.021","DOIUrl":"https://doi.org/10.1016/j.jmig.2024.10.021","url":null,"abstract":"<p><strong>Study objective: </strong>To evaluate the effectiveness of the Dual Wavelength Laser System (DWLS) diode laser on the treatment of ovarian endometrioma (OMA), with ablation and vaporization of the cystic capsule without performing the stripping technique, in terms of ovarian reserve and recurrence rate.</p><p><strong>Design: </strong>Prospective, Single-arm, Multicenter, Clinical Trial SETTING: Multicenter University Hospital.</p><p><strong>Patients: </strong>Seventy patients with symptomatic OMA.</p><p><strong>Interventions: </strong>Patients underwent surgery for primary unilateral or bilateral symptomatic OMA treated with DWLS diode laser vaporization. Following surgical intervention, patients were enrolled in a 12 months surveillance protocol featuring regular clinical assessments aimed at detecting ovarian reserve, pregnancy rate and any recurrence of the cyst and/or symptomatic relapse.</p><p><strong>Measurements and main results: </strong>Antimullerian hormone (AMH) levels at the 3-month follow-up exhibited a significant difference from the baseline (p=0.034), demonstrating a return to nearly presurgical values in the subsequent months. Antral follicle count (AFC) of the operated ovary showed a significant increase after treatment at the 6-month and 12-month follow-up (p=0.005 and p=0.002, respectively). Pregnancies were documented in 48.3% (14/29) of infertile patients who underwent treatment. OMA recurrence was observed in 4 patients (5.7%) at 12 months. No patient exhibited a significant relapse of the analyzed symptoms compared to baseline values.</p><p><strong>Conclusion: </strong>The findings of this study propose that DWLS diode laser presents a good option for treating OMA, demonstrating minimal impact on the surrounding healthy ovarian tissue, favorable pregnancy rate, coupled with low recurrence rates.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545970","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}