Journal of minimally invasive gynecology最新文献

{"title":"Robotic VRAM Flap for Pelvic Reconstruction: Technical Tips and Pitfalls","authors":"E. Erdemoglu ,&nbsp;A.M. Rebecca ,&nbsp;J. Yi","doi":"10.1016/j.jmig.2025.09.090","DOIUrl":"10.1016/j.jmig.2025.09.090","url":null,"abstract":"<div><h3>Study Objective</h3><div>To demonstrate the surgical steps, key technical pearls and discussion of pitfalls of robotic-assisted vertical rectus abdominis myocutaneous (VRAM) flap reconstruction.</div></div><div><h3>Design</h3><div>This is a surgical video presentation detailing a single case with stepwise narration, supported by intraoperative footage.</div></div><div><h3>Setting</h3><div>in a tertiary academic center using the da Vinci robotic platform. In dorsal lithotomy, robotic trocars placed contralateral to the flap harvest site, including a transumbilical camera port, bilateral lower trocars and and two additional trocars to contralateral side of flap.</div></div><div><h3>Patients or Participants</h3><div>A 46-year-old woman with a history of anal cancer treated with radiation presented with vaginal stenosis and hematocolpos. The patient underwent reconstructive surgery.</div></div><div><h3>Interventions</h3><div>After total hysterectomy and rectovaginal dissection, a right-sided robotic VRAM flap was harvested. Key steps included skin paddle incision, mobilization of the rectus muscle, division below the costal arch, preservation of the inferior epigastric artery above and below arcuate line, creation of the neovagina with tubularized flap anastomosed in a V-pattern, and completing by closure of rectus sheath. Intraoperative pitfalls include injury to the vascular pedicle and excessive flap bulk affecting urinary or rectal function. We discussed strategies to reduce tension and flap volume, such as narrowing the paddle, avoiding full skin paddles, and rotating on the diagonal axis.</div></div><div><h3>Measurements and Primary Results</h3><div>Intraoperative perfusion was confirmed by visual inspection of the flap. The reconstructed neovagina measured approximately 10 cm in length and 4 cm in width. There were no intraoperative complications.</div></div><div><h3>Conclusion</h3><div>Robotic VRAM flap reconstruction offers a well-vascularized flap for pelvic and vaginal reconstruction particularly in patients with prior pelvic radiation. Compared to open surgery, robotic approach preserves the anterior rectus sheath, improves flap viability, and reduces donor site and perineal wound complications. This technique represents an effective, reproducible strategy in complex pelvic reconstruction.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Page S10"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334458","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":"Strategies for Hysteroscopic Removal of the Deeply Embedded Intrauterine Device","authors":"R Schneyer","doi":"10.1016/j.jmig.2025.09.121","DOIUrl":"10.1016/j.jmig.2025.09.121","url":null,"abstract":"<div><h3>Study Objective</h3><div>The objectives of this video are to review key principles and techniques to facilitate hysteroscopic removal the deeply embedded intrauterine device (IUD) and to demonstrate the application of these strategies during three unique cases of deeply embedded IUDs.</div></div><div><h3>Design</h3><div>Educational video highlighting surgical techniques.</div></div><div><h3>Setting</h3><div>Academic medical center.</div></div><div><h3>Patients or Participants</h3><div>We present the following 3 cases of hysteroscopic removal of deeply embedded IUDs: 1) Fractured IUD arm embedded within the cervix, 2) IUD embedded at 3 points within the cervix in a patient with cervical stenosis, and 3) IUD embedded within the tubal ostium.</div></div><div><h3>Interventions</h3><div>We first present the following strategies to set yourself up for success during cases of deeply embedded IUDs: vasopressin injection, cervical dilation with a beveled scope rather than dilators, and use of a pressure bag rather than a fluid management system. We then highlight a variety of surgical techniques that facilitated IUD removal during the 3 patient cases, including the “push and spread” technique with hysteroscopic scissors, rotating the light cord to optimize the position of the scissors, nudging the IUD with the scissors to assess progress with dissection, switching to a smaller hysteroscope in cases of cervical stenosis, using a hysteroscopic morcellator in cases of cervical stenosis, rotational movements with hysteroscopic graspers, and using a Kelly clamp for a stronger grasp on the IUD.</div></div><div><h3>Measurements and Primary Results</h3><div>N/A</div></div><div><h3>Conclusion</h3><div>We have demonstrated a variety of key principles and innovative techniques for hysteroscopic removal of the deeply embedded IUD. Each patient case presented unique challenges that required patience, persistence, and creativity.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Pages S27-S28"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334645","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":"Safe without Suction: RCT Challenges Routine Gastric Decompression in Laparoscopy","authors":"KL Karlson ,&nbsp;MP Milad ,&nbsp;A Gauf ,&nbsp;A Chaudhari ,&nbsp;S Tsai ,&nbsp;L Yang ,&nbsp;PC Voigt ,&nbsp;L Yu ,&nbsp;AA Emeka","doi":"10.1016/j.jmig.2025.09.023","DOIUrl":"10.1016/j.jmig.2025.09.023","url":null,"abstract":"<div><h3>Study Objective</h3><div>The study aims to evaluate the necessity of intraoperative gastric decompression during gynecologic laparoscopy. The primary outcomes include (1) where the lower edge of the stomach resides with or without an orogastric tube and (2) whether experienced surgeons accurately detect group assignment.</div></div><div><h3>Design</h3><div>Double-blind, randomized control trial. Participants undergoing gynecologic laparoscopy with umbilical entry were block-randomized (1:1) to orogastric decompression or none. Upon abdominal entry, the surgeon assessed adequacy of decompression, risk of gastric injury, and measured the distance between entry site and the stomach.</div></div><div><h3>Setting</h3><div>Operating room.</div></div><div><h3>Patients or Participants</h3><div>Low-risk participants undergoing gynecologic laparoscopy with umbilical entry were included. Participants were excluded for a variety of reasons including risk of delayed gastric emptying (e.g., GLP-1 receptor agonist) or suspected gastric insufflation during intubation.</div></div><div><h3>Interventions</h3><div>Intraoperative assessment.</div></div><div><h3>Measurements and Primary Results</h3><div>Of 150 participants enrolled, 139 were included in the study. Participants in the study and control groups did not significantly vary based on age (37.8 vs, 36.8), BMI (27.3 vs 27.9), or procedure type. A total of four complex gynecologic surgeons performed the intraoperative assessment, blinded to the assignment. Stomach decompression was rated “excellent” or “good” in 69% of cases without orogastric tube placement. The stomach was adequately decompressed in 100% of participants who had an orogastric tube and 97% of participants who did not. There were no cases of gastric injury. The surgeon thought an orogastric tube was present in 31.9% (n=23) of participants without gastric intubation. There was a significant difference between groups in percentage of cases with accurate assessment of gastric intubation (p=0.0001). The distance between the umbilicus and inferior aspect of the stomach correlated well with BMI.</div></div><div><h3>Conclusion</h3><div>Routine gastric decompression during gynecologic laparoscopy with umbilical entry is not necessary for low-risk patients. Regardless of placement of an orogastric tube, the stomach was adequately decompressed, without risk of injury, and without immediate postoperative negative experience.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Page S15"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334812","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":"Examining the Impact of a Minimally Invasive Gynecologic Surgery Safety-Net Clinic on Fibroid Surgery: A Retrospective before & after Study","authors":"C Burns ,&nbsp;M Cantave ,&nbsp;C Mulligan ,&nbsp;E Bardawil ,&nbsp;K De Souza ,&nbsp;K Scholl ,&nbsp;M Tepe ,&nbsp;D Wang ,&nbsp;W Ross","doi":"10.1016/j.jmig.2025.09.006","DOIUrl":"10.1016/j.jmig.2025.09.006","url":null,"abstract":"<div><h3>Study Objective</h3><div>The aim of this study was to examine the impact of implementing a minimally invasive gynecologic surgery (MIGS) safety-net clinic on composite major complication rate (intraoperative and postoperative).</div></div><div><h3>Design</h3><div>Retrospective before and after study examining patients undergoing fibroid surgery before (2018-2019) and after (2021-2024) implementation of a MIGS safety-net clinic.</div></div><div><h3>Setting</h3><div>Academic tertiary referral hospital in the Midwest United States.</div></div><div><h3>Patients or Participants</h3><div>416 patients cared for at two OB/GYN safety-net clinics who underwent hysterectomy or myomectomy for symptomatic fibroids (80 patients in the before and 336 in the after subgroup).</div></div><div><h3>Interventions</h3><div>Implementation of safety-net MIGs clinic.</div></div><div><h3>Measurements and Primary Results</h3><div>Average patient age was 44.2±7.3 before and 42.8±7.0 after (p 0.092). Majority of patients self-reported race as Black 77.2% (321/416) and 66.3% (273/416) live in the 79-100%ile most disadvantaged neighborhoods in the country (as measured by the Neighborhood Atlas Area Deprivation Index). Interrupted time series segmented regression analysis adjusting for unbalanced baseline covariates was performed. Composite major complications occurred in 28% (22/80) before vs. 13% (45/336) after. The odds of having a major complication was 57% lower after implementation compared to before (OR 0.43; 95% CI 0.075-2.45). MIGS clinic implementation appeared to increase the odds of having a minimally invasive hysterectomy (59% [47/80] before vs. 72% [242/336] after; OR 2.07; 95% CI 0.46-9.25) and decrease the odds of having an open hysterectomy (34% [27/80] vs. 14% [48/363]; OR 0.56, 95% CI 0.11-2.93), although these did not reach statistical significance. Myomectomy analysis was not performed due to low frequency of procedure performance in the before period.</div></div><div><h3>Conclusion</h3><div>Implementation of a MIGS clinic for patients without previous access led to a clinically meaningful decrease in composite complication rate, increased rate of minimally invasive hysterectomy, and decreased rate of open hysterectomy, although these findings were not statistically significant. A larger sample size is needed to further assess the impact of expanded MIGS access.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Page S2"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334837","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":"Perioperative Considerations for Abdominal Wall Endometriosis","authors":"C.J. Min,&nbsp;S. Guang,&nbsp;C. Arora","doi":"10.1016/j.jmig.2025.09.096","DOIUrl":"10.1016/j.jmig.2025.09.096","url":null,"abstract":"<div><h3>Study Objective</h3><div>To review the pre, intra, and postoperative considerations for the management of abdominal wall endometriosis.</div></div><div><h3>Design</h3><div>Case report.</div></div><div><h3>Setting</h3><div>Tertiary medical center.</div></div><div><h3>Patients or Participants</h3><div>40-year-old G4P0040 with an abdominal wall mass, suspicious for abdominal wall endometriosis, who desired surgical management.</div></div><div><h3>Interventions</h3><div>The patient underwent an abdominal wall endometriosis excision with omental endometriosis excision. Perioperative considerations include:</div><div><strong>Preoperatively:</strong></div><div> <!-->• Obtaining an MRI for surgical planning.</div><div> <!-->• Determining the surgical approach, either laparoscopic or abdominal.</div><div> <!-->• Consulting General Surgery for disease with larger fascial involvement.</div><div> <!-->• Utilizing the rectus to defect ratio.</div><div><strong>Intraoperatively:</strong></div><div> <!-->• Understanding key anatomy of the abdominal wall.</div><div> <!-->• Employing traction/countertraction and circumferential dissection.</div><div> <!-->• Undermining the fascia for a tension-free primary closure.</div><div><strong>Postoperatively:</strong></div><div> <!-->• Instructing the patient to follow activity restrictions for 6 weeks.</div><div> <!-->• Deferring medical management for isolated abdominal wall endometriosis given the lack of evidence for disease suppression.</div></div><div><h3>Measurements and Primary Results</h3><div>The patient was discharged home on postoperative day 1 and was healing well by her postoperative visit.</div></div><div><h3>Conclusion</h3><div>Abdominal wall endometriosis causes significant symptoms for patients, and complex gynecologists must be well versed in its management. Optimization for its excision by the abdominal approach includes obtaining an MRI for planning excision and closure, understanding the anatomy of the abdominal wall, and undermining the fascia for a tension-free primary closure.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Pages S17-S18"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335110","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":"Addition of Metronidazole to Cefazolin for Surgical Site Injection Prophylaxis in Hysterectomy: A Systematic Review and Meta-Analysis","authors":"MM Jackson ,&nbsp;L Eckhardt ,&nbsp;M Zamani ,&nbsp;P Levett ,&nbsp;S Endicott","doi":"10.1016/j.jmig.2025.09.024","DOIUrl":"10.1016/j.jmig.2025.09.024","url":null,"abstract":"<div><h3>Study Objective</h3><div>Through systematic review and meta-analysis, evaluate whether adding metronidazole to cefazolin for hysterectomy is more effective in prevention of surgical site infection than the existing recommendation of cefazolin alone.</div></div><div><h3>Design</h3><div>Systematic review and meta-analysis.</div></div><div><h3>Setting</h3><div>N/A.</div></div><div><h3>Patients or Participants</h3><div>Systematic review of MEDLINE, ClinicalTrials.gov, EMBASE, Cochrane Library, and Web of Science were searched until October 16, 2024 that included the words: hysterectomy, cefazolin, metronidazole, and surgical site infection.</div></div><div><h3>Interventions</h3><div>Studies were included if they 1) consisted of peer-reviewed research published between 1995 and 2024, 2) assessed patients undergoing hysterectomy by any route, 3) compared cefazolin to cefazolin and metronidazole, and 4) reported primary outcome of surgical site infection within 30 days of procedure.</div></div><div><h3>Measurements and Primary Results</h3><div>Five studies with a total of 19,422 participants met eligibility criteria; two were randomized controlled trials and three were retrospective cohort studies. Three studies used intravenous metronidazole while two studies used vaginal metronidazole. The fixed effect meta-analysis from all five studies revealed an overall odds ratio of 0.49 [95% CI: 0.34-0.72] indicating an reduction of 51% in the odds of surgical site infection in those given metronidazole in addition to cefazolin versus cefazolin alone. When stratified by route of administration, the additional use of pre-operative intravenous metronidazole revealed an odds ratio of 0.52 [95% CI: 0.34-0.79] indicating an overall reduction of 48% in the odds of surgical site infection compared to cefazolin alone.</div></div><div><h3>Conclusion</h3><div>Systematic review and meta-analysis of the literature demonstrates that the use of metronidazole in addition to cefazolin reduces the risk of surgical site infection after hysterectomy by any route. Intravenous use of metronidazole in particular is cost-effective and may be the preferred route of administration by both the patient and surgeon.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Page S15"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334813","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":"Parametrial Endometriosis: End-to-End Ureteral Laparoscopic Anastomosis","authors":"A. Cosimi,&nbsp;H.J. Dionisi","doi":"10.1016/j.jmig.2025.09.093","DOIUrl":"10.1016/j.jmig.2025.09.093","url":null,"abstract":"<div><h3>Study Objective</h3><div>The aim of this study is to present a clinical case of a patient with parametrial endometriosis and ureteral involvement.</div></div><div><h3>Design</h3><div>This is a clinical case study that focuses on the detailed description of a patient with parametrial endometriosis and ureteral involvement.</div></div><div><h3>Setting</h3><div>Laparoscopic surgery was performed using a 3D camera with 0° optics. The patient was positioned in low lithotomy, and four accessory trocars were placed laterally. Use of bipolar and ultrasonic energy.</div></div><div><h3>Patients or Participants</h3><div>A 29-year-old woman with no significant medical history and no previous pregnancies presented with dyspareunia and lumbosacral pain lasting four months. An abdominal ultrasound revealed left pelvicalyceal dilation and an adnexal mass consistent with a 4 cm endometrioma. Her kidney function remained normal. A pelvic examination showed specific tenderness at the left parametrial region extending to the pelvic wall. A pelvic MRI was conducted, which reported a hypointense lesion at the left adnexal level measuring approximately 4 cm, along with an irregular fibrotic-appearing lesion associated with ureteral dilation.</div></div><div><h3>Interventions</h3><div>Laparoscopic surgery was performed. The parametrial nodule was completely resected while preserving surrounding anatomical structures, and a left end-to-end ureteral anastomosis was performed, accompanied by the placement of a pigtail catheter.</div></div><div><h3>Measurements and Primary Results</h3><div>A six-month follow-up MRI revealed a lesion-free parametrial area and a normally sized ureter.</div></div><div><h3>Conclusion</h3><div>The prevalence of ureteral endometriosis is approximately 1% and is strongly associated with parametrial involvement. MRI is highly accurate in detecting ureteral endometriosis and should be performed after suspicious ultrasound findings. Surgical treatment is the first-line approach in cases of ureteral obstruction, and laparoscopic end-to-end anastomosis is a viable option when the injury is located far from the vesicoureteral junction.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Page S16"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High Accuracy of Ultrasound with Bowel Preparation in Detecting Ileum, Cecum, and Appendix Endometriosis: A Prospective Cohort","authors":"MP Andres ,&nbsp;MO Goncalves ,&nbsp;LA Mattos ,&nbsp;ML Marani ,&nbsp;MA Bassi ,&nbsp;MS Abrao","doi":"10.1016/j.jmig.2025.09.030","DOIUrl":"10.1016/j.jmig.2025.09.030","url":null,"abstract":"<div><h3>Study Objective</h3><div>To evaluate the diagnostic accuracy of ultrasound with bowel preparation (USBP) in identifying endometriosis in the right iliac fossa (RIF) structures—namely the ileum, cecum, and appendix.</div></div><div><h3>Design</h3><div>a prospective study conducted between 2011 and 2024.</div></div><div><h3>Setting</h3><div>two tertiary hospitals in Brazil</div></div><div><h3>Patients or Participants</h3><div>patients with suspected endometriosis</div></div><div><h3>Interventions</h3><div>all patients underwent USBP and laparoscopic surgery with histological confirmation within three months. For appendix lesions, only those without prior appendectomy were considered. Sensitivity, specificity, positive and negative predictive values, and Kappa coefficients were calculated for each site (ileum, cecum, appendix) and for overall RIF involvement.</div></div><div><h3>Measurements and Primary Results</h3><div>Of 992 cases, 182 (18.3%) had histologically confirmed RIF endometriosis. Overall sensitivity and specificity of USBP for any RIF lesion were 86.0% (CI: 78.8-91.5) and 98.8% (CI: 97.8-99.4), respectively (κ = 0.87). Sensitivity was highest for the ileum (88.2%,[CI: 72.5-96.7], κ = 0.92), followed by the cecum (86.2%,[CI: 72.5-96.7], κ = 0.91), and appendix (70.5%,[(CI: 72.5-96.7], κ = 0.75). Diagnostic performance was not significantly affected by BMI or prior surgery. Lesions ≥0.5 cm were more readily detected.</div></div><div><h3>Conclusion</h3><div>USBP offers a non-invasive, highly accurate method for detecting RIF endometriosis, potentially reducing the need for diagnostic laparoscopy and enabling better surgical planning.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Page S24"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334972","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":"Cervical Stump Fibroid: Approach to Trachelectomy of a Dilated Cervix","authors":"RS Pendse,&nbsp;A Connor,&nbsp;HG Reddy","doi":"10.1016/j.jmig.2025.09.108","DOIUrl":"10.1016/j.jmig.2025.09.108","url":null,"abstract":"<div><h3>Study Objective</h3><div>To highlight preoperative and intraoperative strategies that can facilitate a safe and uncomplicated trachelectomy when the cervix is dilated.</div></div><div><h3>Design</h3><div>Surgical video of a single patient with symptomatic 9cm cervical stump fibroid who underwent laparoscopic trachelectomy.</div></div><div><h3>Setting</h3><div>Surgery was performed in the operating room with patient in dorsal lithotomy and Trendelenburg positioning to enable successful laparoscopy.</div></div><div><h3>Patients or Participants</h3><div>Single case study of a 48 year old female presenting with pelvic pressure and irregular spotting in the setting of a prior supracervical hysterectomy performed for AUB-L. Patient was found to have a 9cm cervical stump fibroid on imaging with evidence of dense adhesions to the anterior abdominal wall and bowel.</div></div><div><h3>Interventions</h3><div>Patient underwent laparoscopic lysis of adhesions, ureteral stenting, extensive enterolysis, appendectomy, and trachelectomy, with successful removal of the cervical stump with the fibroid en bloc.</div></div><div><h3>Measurements and Primary Results</h3><div>Patient tolerated the procedure well, and recovered well postoperatively with complete resolution of presenting symptoms.</div></div><div><h3>Conclusion</h3><div>This case study highlights key preoperative and intraoperative strategies that enabled this successful trachelectomy of a dilated cervical stump.</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":"145334986","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":"Defining the Role of the Gastrointestinal Myoelectrical Activity (GIMA) Biomarker in the Diagnosis of Endometriosis.","authors":"P Tanos ,&nbsp;F Donders ,&nbsp;A Massaro ,&nbsp;S Philippe ,&nbsp;S Karampelas","doi":"10.1016/j.jmig.2025.09.027","DOIUrl":"10.1016/j.jmig.2025.09.027","url":null,"abstract":"<div><h3>Study Objective</h3><div>Our research aimed to validate the gastrointestinal myoelectrical activity (GIMA) biomarkers for detecting endometriosis compared to MRI, transvaginal ultrasonography (TV-US) and laparoscopy using the validated #Enzian classification.</div></div><div><h3>Design</h3><div>MRI and TV-US have limitations in diagnosing superficial endometriosis and show operator and interpreter dependency for deep endometriosis. GIMA biomarkers, such as those measured by the novel EndoSure device, have shown promising preliminary results. Endometriotic lesions secrete prostaglandin E2 (PGE2) and prostaglandin F2α (PGF2α), which generate distinctive motility patterns in the ampulla of Vater and duodenal wall, leading to elevated small bowel myoelectrical energy. EndoSure is a non-invasive, 30-minute clinical decision support tool designed to detect these patterns.</div></div><div><h3>Setting</h3><div>Consecutive patients referred to our specialised endometriosis centre (Brugmann University Hospital, Brussels, Belgium) were enrolled into the study.</div></div><div><h3>Patients or Participants</h3><div>One hundred adult female patients with suspected endometriosis were enrolled between December 2024 and May 2025. The mean age was 30.9 years (SD ±15.5), and mean BMI was 24.2 kg/m² (SD ±9.0).</div></div><div><h3>Interventions</h3><div>Participants were prospectively offered EndoSure testing along with MRI or TV-US. Patients with a positive EndoSure result but negative MRI/TV-US findings also underwent diagnostic laparoscopy.</div></div><div><h3>Measurements and Primary Results</h3><div>Thirty-five patients underwent MRI, 45 underwent TV-US, and 12 underwent diagnostic laparoscopy. EndoSure demonstrated sensitivity of 100%, specificity of 5% and diagnostic accuracy of 96% in detecting both deep and superficial endometriosis (preliminary data, May 2025). Notably, GIMA biomarkers identified superficial endometriosis in cases missed by conventional imaging. Additionally, 60% of patients preferred EndoSure over TV-US (1%).</div></div><div><h3>Conclusion</h3><div>GIMA biomarkers represent a promising new primary screening tool for patients with suspected endometriosis. Further research is warranted to evaluate if the test can improve resource utilization and management in patients with superficial endometriosis.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Page S23"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334993","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}