Journal of minimally invasive gynecology最新文献

{"title":"Design of a Laparoscopic Simulation Model for Retroperitoneal Dissection, Ureterolysis, and Ligation the Uterine Artery at Its Origin","authors":"A. Hillebrand,&nbsp;L. Kao,&nbsp;L. Michel","doi":"10.1016/j.jmig.2025.09.073","DOIUrl":"10.1016/j.jmig.2025.09.073","url":null,"abstract":"<div><h3>Study Objective</h3><div>The purpose of this video is to demonstrate the construction of a low-fidelity laparoscopic simulation model to practice retroperitoneal dissection, ureterolysis, and ligation of the uterine artery at its origin.</div></div><div><h3>Design</h3><div>A low-fidelity laparoscopic simulator was constructed out of supplies purchased from Amazon to be assembled inside the EMIGS LaparoBowl.</div></div><div><h3>Setting</h3><div>The model can be used in any laparoscopic box trainer.</div></div><div><h3>Patients or Participants</h3><div>Trainees and experienced surgeons.</div></div><div><h3>Interventions</h3><div>The participant is asked to complete retroperitoneal dissection with ureterolysis and ligation of the uterine artery.</div></div><div><h3>Measurements and Primary Results</h3><div>The model is a promising educational tool for trainees.</div></div><div><h3>Conclusion</h3><div>Learning how to perform retroperitoneal dissection and ureterolysis to successfully ligate the uterine artery at its origin is a cornerstone skill of the advanced gynecologic surgeon. This low-fidelity laparoscopic simulation model can help trainees learn this skill.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Page S5"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335092","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 Excision of Vaginal Cuff Endometriosis","authors":"R. Bealer ,&nbsp;C.S. Kwon ,&nbsp;E.T. Carey ,&nbsp;R.G. Silverstein","doi":"10.1016/j.jmig.2025.09.074","DOIUrl":"10.1016/j.jmig.2025.09.074","url":null,"abstract":"<div><h3>Study Objective</h3><div>To demonstrate techniques for safe resection of the vaginal cuff in a patient with recurrent endometriosis after hysterectomy.</div></div><div><h3>Design</h3><div>Video demonstration of surgical excision of vaginal cuff endometriosis</div></div><div><h3>Setting</h3><div>Operating room at a tertiary care academic teaching hospital</div></div><div><h3>Patients or Participants</h3><div>Single case study of a patient with recurrent endometriosis involving the vaginal cuff after prior hysterectomy.</div></div><div><h3>Interventions</h3><div>N/A</div></div><div><h3>Measurements and Primary Results</h3><div>This video highlights critical anatomical considerations and key technical principles for the successful excision of endometriotic implants at the vaginal cuff. Emphasis is placed on identifying vital structures, minimizing risk to surrounding tissues, and ensuring complete disease resection.</div></div><div><h3>Conclusion</h3><div>Laparoscopic resection of vaginal cuff endometriosis following hysterectomy is feasible and can be safely performed with attention to pelvic anatomy and surgical technique. This video serves as an educational tool for surgeons managing complex cases of recurrent endometriosis.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Pages S5-S6"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335093","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":"Robotic-Assisted Laparoscopic Excision of Bladder Leiomyoma at Time of Hysterectomy","authors":"J. Wu ,&nbsp;J. Gahan ,&nbsp;A. Song","doi":"10.1016/j.jmig.2025.09.097","DOIUrl":"10.1016/j.jmig.2025.09.097","url":null,"abstract":"<div><h3>Study Objective</h3><div>To describe the minimally invasive surgical management of a symptomatic bladder leiomyoma in a patient undergoing robotic-assisted laparoscopic hysterectomy for uterine fibroids.</div></div><div><h3>Design</h3><div>Descriptive case report with video demonstration of partial cystectomy for excision of bladder leiomyoma.</div></div><div><h3>Setting</h3><div>Tertiary care academic medical center.</div></div><div><h3>Patients or Participants</h3><div>A 49-year-old female with menorrhagia, bulk symptoms, difficulty urinating, and hematuria during menses. Pelvic MRI obtained during workup demonstrated multi-fibroid uterus and an incidental 2.5 cm well-circumscribed bladder mass at the dome.</div></div><div><h3>Interventions</h3><div>After incomplete transurethral resection and pathologic confirmation of bladder leiomyoma, the patient underwent robotic-assisted total laparoscopic hysterectomy with bilateral salpingectomy, cystoscopy, ureteral stent placement, and partial cystectomy. The retropubic space was developed, and the leiomyoma was excised en-bloc through a full-thickness bladder incision. The bladder was closed in two layers.</div></div><div><h3>Measurements and Primary Results</h3><div>The bladder leiomyoma was successfully excised robotically with preservation of adjacent structures. The full-thickness bladder defect was repaired in two layers with watertight closure confirmed by intraoperative leak testing. The patient was discharged on postoperative day one. Foley catheter was removed on postoperative day five without complication.</div></div><div><h3>Conclusion</h3><div>Bladder leiomyomas are rare, accounting for less than 0.5% of bladder tumors. Though uncommon, they can be approached minimally invasively using robotic-assisted surgery. This case demonstrates that careful preoperative imaging, appropriate localization, and familiarity with retropubic anatomy allow for safe excision.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Page S18"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335111","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":"Greening the OR: 10 Steps Towards Sustainability in Gynecologic Surgery","authors":"R Schneyer","doi":"10.1016/j.jmig.2025.09.100","DOIUrl":"10.1016/j.jmig.2025.09.100","url":null,"abstract":"<div><h3>Study Objective</h3><div>The objectives of this video are to review how our activities in operating room are contributing to the climate crisis, to demonstrate strategies for reducing our carbon footprint during gynecologic surgery, and to highlight data supporting these strategies.</div></div><div><h3>Design</h3><div>Educational video highlighting tips and tricks for sustainability in the operating room.</div></div><div><h3>Setting</h3><div>Academic medical center.</div></div><div><h3>Patients or Participants</h3><div>N/A</div></div><div><h3>Interventions</h3><div>We present the following 10 strategies to promote sustainability in the gynecology operating room, with a focus on minimizing single use, disposable products: 1) Reduce glove changes, 2) custom surgical packs, 3) reusable scrub caps, 4) avoid disposable energy devices, 5) stainless steel manipulators, 6) reusable suction irrigators, 7) alternatives to specimen retrieval bags, 8) minimize single-use plastic trocars, 9) avoid advanced access platforms, and 10) make the most of every suture. We demonstrate the assembly and use of various reusable and reprocessed surgical instruments during real surgical cases. We also highlight specific surgical techniques that can reduce waste in the operating room, such as intra-abdominal morcellation, trocar fixation with a retractor, “incision hopping” during myomectomy, and using a mini-laparoscopic approach. Throughout the video, we present data to support our recommendations.</div></div><div><h3>Measurements and Primary Results</h3><div>N/A</div></div><div><h3>Conclusion</h3><div>We have demonstrated evidence-based strategies for reducing our carbon footprint during gynecologic surgery, with a focus on minimizing single use items. Each of these strategies represents a small step, but added together, they can make a big difference in our environmental impact as surgeons.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Page S18"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335118","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":"AI-Generated Patient Education: Rapid Development of a Laparoscopic Hysterectomy Recovery Video Using Readily Accessible Tools","authors":"A Davé","doi":"10.1016/j.jmig.2025.09.135","DOIUrl":"10.1016/j.jmig.2025.09.135","url":null,"abstract":"<div><h3>Study Objective</h3><div>To demonstrate the use of Artificial Intelligence (AI) systems to rapidly generate high-quality, accessible and inclusive patient education materials.</div></div><div><h3>Design</h3><div>Educational video created entirely using inexpensive, web-based AI technologies.</div></div><div><h3>Setting</h3><div>Large Language Model (LLMs), Diffusion Transformers (DiTs), and Deep Learning Models (DLMs) accessed via web-browser</div></div><div><h3>Patients or Participants</h3><div>Author only.</div></div><div><h3>Interventions</h3><div>An interactive, iterative and dynamic process using LLM, DiTs, and DLMs produced a patient education video on laparoscopic hysterectomy recovery. ChatGPT was used to generate a storyboard, scene descriptions and narration script, tailored to video submission guidelines. The narration was voiced using text-to-speech, and visuals were produced using text-to-image and text-to-video platforms.</div></div><div><h3>Measurements and Primary Results</h3><div>Total AI interaction time was ∼6 hours, with rendering queues ranging from 27 seconds to 4 minutes. Recreating the full video in Spanish, Mandarin, and Hindi took ∼30 minutes, with voice synthesis generating multi-minute blocks in under 15 seconds. Policy restrictions on anatomical images varied unpredictably across platforms. Tools with site-specific editing improved visual accuracy. Prompt engineering improved output quality. Costs were limited to a single paid subscription; all other tools used free access.</div></div><div><h3>Conclusion</h3><div>AI technologies can empower physicians to bridge financial resource, linguistic, and time barriers to create engaging, accessible and accurate patient education material. With strategic use, these tools offer scalable potential for rapid, multilingual educational material development.</div><div><strong>Declaration of AI and AI-Assisted Technologies in the Writing Process Statement:</strong> During the preparation of this work the author used ChatGPT, Dall-E, Sora, Kling.ai and Elevenlabs.io in order to enhance accessibility and visual clarity for a non-clinical audience. After using this tool/service, the author(s) reviewed and edited the content as needed and take(s) full responsibility for the content of the publication.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Page S31"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334581","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 Resection of 13-Week Ectopic Pregnancy in Non-Communicating Uterine Horn","authors":"PC Voigt,&nbsp;MP Milad","doi":"10.1016/j.jmig.2025.09.127","DOIUrl":"10.1016/j.jmig.2025.09.127","url":null,"abstract":"<div><h3>Study Objective</h3><div>Demonstrate safety and feasibility of laparoscopic resection of a 13-week ectopic pregnancy in a non-communicating uterine horn.</div></div><div><h3>Design</h3><div>Educational video</div></div><div><h3>Setting</h3><div>Academic medical center</div></div><div><h3>Patients or Participants</h3><div>47 year-old G2P1001 (term vaginal delivery) at 12w6d presenting with ectopic pregnancy of non-communicating uterine horn. This was an undesired pregnancy. Ectopic pregnancy in non-communicating uterine horn discovered after unsuccessful dilation &amp; curettage under ultrasound guidance. MRI confirmed diagnosis. Of note, patient had lifelong history of dysmenorrhea.</div></div><div><h3>Interventions</h3><div>Laparoscopic resection of gravid non-communicating uterine horn, salpingectomy</div></div><div><h3>Measurements and Primary Results</h3><div>N/A</div></div><div><h3>Conclusion</h3><div>Laparoscopic resection of ectopic pregnancy in a non-communicating uterine horn is safe and feasible, even in a later 13-week gestation.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Page S29"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334630","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":"Unifying the Divided: Hysteroscopic Treatment of Robert’s Uterus, a Rare Congenital Challenge","authors":"U Catena ,&nbsp;F Bernardini ,&nbsp;M Zorzi ,&nbsp;A Poli ,&nbsp;E Bonetti ,&nbsp;E La Fera ,&nbsp;F Pozzati ,&nbsp;AC Testa","doi":"10.1016/j.jmig.2025.09.118","DOIUrl":"10.1016/j.jmig.2025.09.118","url":null,"abstract":"<div><h3>Study Objective</h3><div>To describe a minimally invasive hysteroscopic approach for the diagnosis and treatment of Robert’s uterus, a rare congenital uterine anomaly, described as a septate uterus with a non-communicating hemicavity, consisting of a blind uterine horn usually with unilateral hematometra, a contralateral unicornuate uterine cavity and a normally shaped external uterine profile.</div></div><div><h3>Design</h3><div>Stepwise demonstration with video footage of the first miniminally invasive, ultrasound-guided, fully hysteroscopic treatment of Robert’s uterus performed using a 15 Fr bipolar miniresectoscope.</div></div><div><h3>Setting</h3><div>Digital Hysteroscopic Clinic of the Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.</div></div><div><h3>Patients or Participants</h3><div>A 30-year-old woman diagnosed with Robert’s uterus presenting with symptoms related to obstructed uterine anomaly.</div></div><div><h3>Interventions</h3><div>The patient underwent a fully hysteroscopic unification of the uterine cavity. Under transabdominal ultrasound guidance, a 15 Fr mini-resectoscope with a Collins loop was used to progressively incise the uterine septum, establish communication between the hemicavities, and normalize the uterine architecture.</div></div><div><h3>Measurements and Primary Results</h3><div>Postoperative 3D ultrasound confirmed successful unification of the uterine cavity with normalization of intrauterine anatomy. No perioperative complications occurred, and the patient was discharged three hours after the procedure.</div></div><div><h3>Conclusion</h3><div>Robert’s uterus can be effectively managed through a minimally invasive, hysteroscopic approach using a 15 Fr bipolar mini-resectoscope, under transabdominal ultrasonographic guidance. This technique offers a safe and efficient alternative to more invasive surgical options.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Page S27"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334643","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 a Rudimentary Horn Ectopic Pregnancy","authors":"S Mohan,&nbsp;H Chang,&nbsp;G Rivera Casul,&nbsp;T Gallant","doi":"10.1016/j.jmig.2025.09.126","DOIUrl":"10.1016/j.jmig.2025.09.126","url":null,"abstract":"<div><h3>Study Objective</h3><div>To showcase and report on the successful laparoscopic treatment of a rare diagnosis of an ectopic pregnancy in a noncommunicating rudimentary horn in a patient with prior successful, spontaneous, and uncomplicated pregnancy in her known unicornuate uterus.</div></div><div><h3>Design</h3><div>Retrospective Case Study</div></div><div><h3>Setting</h3><div>An urban academic teaching hospital.</div></div><div><h3>Patients or Participants</h3><div>Representative single case study of a patient of an OBGYN, MFM, and MIGS practice who underwent laparoscopic surgical treatment of a rudimentary horn ectopic pregnancy.</div></div><div><h3>Interventions</h3><div>Diagnostic laparoscopy, excision of noncommunicating rudimentary horn and ectopic pregnancy within, right salpingectomy.</div></div><div><h3>Measurements and Primary Results</h3><div>We present a 34 year old G2P1001 with a known unicornuate uterus and non-communicating rudimentary horn who was diagnosed with a rudimentary horn pregnancy at 6 weeks gestational age. MRI imaging revealed no communication between the uterus and horn, leading to hypothesis of peritoneal migration of sperm. After thorough MFM and MIGS subspecialty counseling, the patient underwent laparoscopic resection of the rudimentary horn ectopic pregnancy. Our case highlights the vital role of pre-operative planning with appropriate imaging techniques, preoperative planning to ensure hemostasis, and tenets of appropriate surgical technique to use for safe excision of a rudimentary horn.</div></div><div><h3>Conclusion</h3><div>Rudimentary horn ectopic pregnancies are rare, and risk of uterine rupture is estimated to be as high as 80% for a gravid rudimentary uterine horn, typically occurring before the third trimester, and can result in hemorrhage requiring emergency surgery. We conclude that appropriate preoperative planning and surgical technique are vital in safe treatment of these pregnancies. We highlight the importance of pre-pregnancy counseling in women with uterine anomalies and reinforces the role of minimally invasive surgery in safely managing complex ectopic gestations.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Pages S28-S29"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334653","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":"FMIGS Care Deserts in the United States","authors":"AB McClurg ,&nbsp;ET Carey ,&nbsp;I Ninh ,&nbsp;KA Schaefer ,&nbsp;C Robertson","doi":"10.1016/j.jmig.2025.09.021","DOIUrl":"10.1016/j.jmig.2025.09.021","url":null,"abstract":"<div><h3>Study Objective</h3><div>Access to high-volume benign gynecologic surgeons is associated with better postoperative outcomes. The AAGL Fellowship in Minimally Invasive Gynecologic Surgery (FMIGS) trains high-volume surgeons in complex benign gynecologic conditions. This study aims to identify regions in the United States (U.S.) with limited access to FMIGS surgeons.</div></div><div><h3>Design</h3><div>A cross-sectional geographical analysis of the distribution of FMIGS surgeons across U.S. counties. By combining a census of FMIGS graduates from 2001-2024 with socio-demographic information from 3,108 U.S. Census Bureau counites, we used data visualization and regression analysis to quantify disparities in access to FMIGS services. Geographic access is measured by (1) the number of FMIGS surgeons per 100,000 residents per county, and (2) the distance from each county centroid to the nearest FMIGS surgeon. We also examined how access correlates with socio-demographic variables.</div></div><div><h3>Setting</h3><div>National county census data overlayed with National Provider Identifiers (NPIs) of FMIGS graduates.</div></div><div><h3>Patients or Participants</h3><div>A total of 626 FMIGS graduates were identified from 2001-2024.</div></div><div><h3>Interventions</h3><div>N/A</div></div><div><h3>Measurements and Primary Results</h3><div>FMIGS surgeons were mapped by last NPI charges. Counties were classified by access to surgeons: those with adequate access (&gt;1 FMIGS surgeon), those with limited access (1 FMIGS surgeon), and FMIGS care deserts (counties with no FMIGS surgeon).</div><div>Counties with greater non-Hispanic Black (<em>β = 0.055, p &lt; 0.05)</em> and Asian (<em>β = 1.583, p &lt; 0.01</em> populations were significantly more likely to have access to FMIGS surgeons. Counties with greater of non-Hispanic White (<em>β = -0.045, p &lt; 0.1</em>) and Native American (<em>β = -0.129, p &lt; 0.01</em>) populations were associated with significantly reduced access to FMIGS surgeons. Additionally, lower educational attainment and higher poverty rates correlated with decreased access to FMIGS services.</div></div><div><h3>Conclusion</h3><div>We identified 626 FMIGS surgeons serving tens of millions of Americans needing gynecological surgery during their lifetimes. Rural counties lack access to FMIGS surgeons, potentially impacting patient health outcomes significantly.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Page S14"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334807","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":"Disparities in Access and Wait Times for Urogynecology Procedures: A Comparative Analysis Using the Relative Index of Inequality","authors":"N Dogra ,&nbsp;S Shamiya ,&nbsp;A Allen-Valley ,&nbsp;K Rai ,&nbsp;C Gungor ,&nbsp;T Zigras ,&nbsp;L Rosella ,&nbsp;A Murji ,&nbsp;A Cipolla ,&nbsp;E Miazga","doi":"10.1016/j.jmig.2025.09.009","DOIUrl":"10.1016/j.jmig.2025.09.009","url":null,"abstract":"<div><h3>Study Objective</h3><div>To evaluate socioeconomic disparities in access and surgical wait times for urogynecology procedures compared to benign non-prolapse hysterectomy, using the Relative Index of Inequality (RII).</div></div><div><h3>Design</h3><div>Retrospective cohort study conducted from April 2022 to March 2024, examining surgical access patterns by socioeconomic status (SES) quintiles.</div></div><div><h3>Setting</h3><div>A large hospital network in Ontario, Canada, located in a demographically diverse region serving over 1.5 million residents. Hospital surgical records were linked with area-based SES indices to evaluate urogynecology and benign hysterectomy access patterns.</div></div><div><h3>Patients or Participants</h3><div>Patients undergoing hysterectomy for prolapse or anti-incontinence procedures were included. Exclusions included emergency surgery, patients under 18 years, and non-Ontario residents. SES was assigned using the Ontario Marginalization Index. The comparator group included patients undergoing benign hysterectomy excluding vaginal hysterectomy and prolapse diagnoses.</div></div><div><h3>Interventions</h3><div>We calculated the Relative Index of Inequality (RII), a regression-based measure, used to quantify inequities in access.</div></div><div><h3>Measurements and Primary Results</h3><div>325 urogynecology procedures and 693 benign hysterectomies were included. After excluding extreme outliers (top 5% of wait times), the median wait time was 275 days (IQR 124.8–393.5) for urogynecology versus 92 days (IQR 43.0–197.0) for benign hysterectomy (p &lt; 0.001). RII was higher for urogynecology procedures compared to benign hysterectomy (2.68 versus 1.79), indicating that patients in the lowest SES group underwent urogynecological surgery at rates 2.68 times lower than those in the highest SES group. Highest disparities were observed in hysterectomy with prolapse repair (RII = 3.85).</div></div><div><h3>Conclusion</h3><div>Compared to benign non-prolapse hysterectomy, urogynecology procedures are associated with longer wait times and disproportionate inequity in access by populations from marginalized neighborhoods. These findings highlight the need for equity-focused strategies to improve access to urogynecology care, particularly for patients in lower socioeconomic groups.</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":"145334840","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}