Journal of minimally invasive gynecology最新文献

{"title":"Nerve-Guided and Tissue Attribute-Oriented Dissection to Improve Anatomical Recognition in Deep Endometriosis: AI-Enhanced Visualization","authors":"Yasuhiro Kawarabayashi MD,&nbsp;Chihiro Hayase MD,&nbsp;Shinji Ogawa MD","doi":"10.1016/j.jmig.2026.02.031","DOIUrl":"10.1016/j.jmig.2026.02.031","url":null,"abstract":"<div><div>To demonstrate nerve-guided dissection as an anatomical orientation strategy and the importance of tissue attributes in reconstructing safe dissection planes in deep endometriosis (DE) surgery, with postoperative AI-enhanced anatomical visualization presented for educational purposes.</div></div><div>To demonstrate nerve-guided dissection as an anatomical orientation strategy and the importance of tissue attributes in reconstructing safe dissection planes in deep endometriosis (DE) surgery, with postoperative AI-enhanced anatomical visualization presented for educational purposes.</div><div><h3>Video Abstract</h3><div><span><span><span><span><span><img></span></span><ul><li><span><span>Download: <span>Download high-res image (457KB)</span></span></span></li><li><span><span>Download: <span>Download full-size image (57KB)</span></span></span></li></ul></span></span></span></div></div><div><span><span><span><span><span><img></span></span><ul><li><span><span>Download: <span>Download high-res image (457KB)</span></span></span></li><li><span><span>Download: <span>Download full-size image (57KB)</span></span></span></li></ul></span></span></span></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"33 10","pages":"Pages 1402-1403"},"PeriodicalIF":2.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147271249","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":"T-Shaped Uterus Metroplasty Is Associated With Increased Live Birth Rate in Women With Recurrent Pregnancy Loss: Evidence From a Matched Case-Control Study","authors":"Andrea Busnelli PhD,&nbsp;Ursula Catena MD,&nbsp;Annalisa Inversetti MD,&nbsp;Greta Barbaro MD,&nbsp;Emma Bonetti Palermo MD,&nbsp;Nicoletta Di Simone PhD","doi":"10.1016/j.jmig.2026.03.035","DOIUrl":"10.1016/j.jmig.2026.03.035","url":null,"abstract":"<div><h3>Study objective</h3><div>To investigate the effect of hysteroscopic metroplasty on spontaneous reproductive outcomes in women with a T-shaped uterus and recurrent pregnancy loss (RPL).</div></div><div><h3>Design</h3><div>Matched case-control study conducted between January 2014 and December 2024.</div></div><div><h3>Setting</h3><div>Two Italian university hospitals.</div></div><div><h3>Patients</h3><div>Women aged 25 to 42 years with primary RPL (≥ 2 first-trimester intrauterine pregnancy losses) and a diagnosis of T-shaped uterus based on Q AZ the Congenital Uterine Malformation by Experts (CUME) criteria. Exclusion criteria included prior uterine surgery, identifiable causes of RPL, or use of assisted reproductive technologies (ART).</div></div><div><h3>Interventions</h3><div>Cases were women who underwent hysteroscopic metroplasty using a standardized surgical protocol combining 3D transvaginal ultrasound and hysteroscopy; controls were matched by age (± 1 year) and did not undergo surgery. The primary outcome was the live birth rate (LBR) within 12 months of spontaneous conception attempts. Secondary outcomes were the clinical pregnancy rate (CPR) and the first trimester pregnancy loss rate (PLR).</div></div><div><h3>Measurements and Main Results</h3><div>A total of 86 women (43 cases and 43 controls) were included. The CPR was similar between cases and controls (67% (95% confidence interval (CI): 53%, 79.5%) vs 77% (95% CI: 62%, 87%) p = .34; crude odds ratio (OR) 1.59, 95% CI: 0.62, 4.13). The first-trimester PLR was significantly lower (31% (95% CI: 17.3%, 49.2%) vs 70% (95% CI: 52.7%, 82.6%), p = .005; crude OR 0.20, 95% CI: 0.07–0.58), and the LBR significantly higher (47% (95% CI: 33%, 61%) vs 21 % (95% CI: 10%, 36%), p = .012; crude OR 3.29, 95% CI: 1.27, 8.48) in the metroplasty group compared to the unoperated group. Adjusted analyses controlling for smoking status and education level confirmed these findings.</div></div><div><h3>Conclusions</h3><div>Hysteroscopic metroplasty may increase the LBR in women with T-shaped uterus and unexplained RPL by reducing the PLR. Randomized controlled trials (RCTs) are needed to confirm causality.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"33 10","pages":"Pages 1481-1487"},"PeriodicalIF":2.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147662782","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":"Major Postoperative Complications After Endometriosis Surgery: Incidence and Outcomes From a Multicenter French Cohort","authors":"Houda Ouafdi MD, PhD,&nbsp;Yohann Dabi MD, PhD,&nbsp;Cyril Touboul MD, PhD,&nbsp;Antoine Elies MD, PhD,&nbsp;Horace Roman MD, PhD,&nbsp;Nicolas Bourdel MD, PhD,&nbsp;Chrystèle Rubod MD, PhD,&nbsp;François Golfier MD, PhD,&nbsp;Arnaud Fauconnier MD, PhD,&nbsp;Pascal Rousset MD, PhD,&nbsp;Isabelle Thomassin-Naggara MD, PhD,&nbsp;Adrien Crestani MD, PhD","doi":"10.1016/j.jmig.2026.03.040","DOIUrl":"10.1016/j.jmig.2026.03.040","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;Surgery is a therapeutic option for patients with deep endometriosis presenting with infertility and/or pain refractory to medical treatment. Major postoperative complications may impair quality of life and delay the initiation of assisted reproductive techniques. However, data on their incidence and outcomes remain limited. The aim of this study is to estimate the incidence and outcomes of major postoperative complications (Clavien-Dindo grade ≥III) following surgery for deep endometriosis in referral centers.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Surgery is a therapeutic option for patients with deep endometriosis presenting with infertility and/or pain refractory to medical treatment. Major postoperative complications may impair quality of life and delay the initiation of assisted reproductive techniques. However, data on their incidence and outcomes remain limited. The aim of this study is to estimate the incidence and outcomes of major postoperative complications (Clavien-Dindo grade ≥III) following surgery for deep endometriosis in referral centers.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;Retrospective multicenter cohort analysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Retrospective multicenter cohort analysis.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting&lt;/h3&gt;&lt;div&gt;Seven French referral centers participating in the ENDOVALIRM cohort.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Seven French referral centers participating in the ENDOVALIRM cohort.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Participants&lt;/h3&gt;&lt;div&gt;A total of 605 women undergoing surgery for deep endometriosis between 2019 and 2020 were included.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;A total of 605 women undergoing surgery for deep endometriosis between 2019 and 2020 were included.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interventions&lt;/h3&gt;&lt;div&gt;Surgical management of deep endometriosis, including gynecologic, digestive, and urinary tract procedures.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Surgical management of deep endometriosis, including gynecologic, digestive, and urinary tract procedures.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The incidence of Clavien-Dindo grade ≥III postoperative complications across all surgical procedures was 4.5% (27/605). Digestive and urinary fistulas were the most common complications (9/27, 33.3%), followed by anastomotic leakages (5/27, 18.5%) and pelvic abscesses (4/27, 14.8%).&lt;/div&gt;&lt;div&gt;Multivariate analysis identified no individual surgical procedure significantly and independently associated with the occurrence of major complications. However, findings should be interpreted cautiously, given the limited number of events.&lt;/div&gt;&lt;div&gt;Overall, 6.8% of patients (41/605) experienced a hospital stay longer than 7 days. Surgical procedures independently associated with prolonged hospitalization were: parametrectomy (OR = 2.0; 95% CI, 1.1–3.7; p = .02), disc resection (OR = 8.3; 95% CI, 2.6–25.9; p &lt; .001), colorectal resection (OR = 5.9; 95% CI, 2.2–16.3; p &lt; .001), and ileocecal or small bowel resection (OR = 4.6; 95% CI, 1.3–16.4; p = .02).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;The incidence of Clavien-Dindo grade ≥III postoperative complications acro","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"33 10","pages":"Pages 1505-1511"},"PeriodicalIF":2.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147622948","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":"Comments on “Understanding the Value of the Uterus: A Nationwide Cross-sectional Survey on Women’s Preferences With Benign Gynecological Conditions”","authors":"Tinghui Xu BM,&nbsp;Yinying Chai BM,&nbsp;Shengliang Qiu PhD","doi":"10.1016/j.jmig.2026.04.019","DOIUrl":"10.1016/j.jmig.2026.04.019","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"33 10","pages":"Pages 1554-1555"},"PeriodicalIF":2.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816335","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":"Serum Interleukin-6 Levels in Endometriosis and Endometriosis-Associated Ovarian Cancer: A Systematic Review and Meta-Analysis Demonstrating a Biological Gradient","authors":"John J. Coté MD, FACOG,&nbsp;Remington D. Coté CPT,&nbsp;Keara Kennedy BS,&nbsp;Matthew S. Block MD, PhD,&nbsp;Robin Farias-Eisner MD, PhD, MBA, FACOG,&nbsp;Ryan W. Walters PhD,&nbsp;Lesley B. Conrad MD, FACOG","doi":"10.1016/j.jmig.2026.06.015","DOIUrl":"10.1016/j.jmig.2026.06.015","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;This study quantifies serum/plasma interleukin-6 levels across the healthy–nonendometriosis, benign–endometriosis–ovarian cancer spectrum, focusing on pooled geometric means stratified by control type.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;This study quantifies serum/plasma interleukin-6 levels across the healthy–nonendometriosis, benign–endometriosis–ovarian cancer spectrum, focusing on pooled geometric means stratified by control type.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Data Sources&lt;/h3&gt;&lt;div&gt;PubMed (MEDLINE;1971-present), Scopus (2004-present), CINAHL (1981-present), and Google Scholar were systematically searched from inception to October 31, 2025. Reference lists of included studies and prior meta-analyses were hand-searched.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;PubMed (MEDLINE;1971-present), Scopus (2004-present), CINAHL (1981-present), and Google Scholar were systematically searched from inception to October 31, 2025. Reference lists of included studies and prior meta-analyses were hand-searched.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods of Study Selection&lt;/h3&gt;&lt;div&gt;All articles with quantitative serum/plasma interleukin-6 data in ovarian cancer and/or endometriosis vs at least one control group (healthy, nonendometriosis benign, or endometriosis) were included. Endometriosis was included as a comparator to permit direct evaluation of the biological gradient across the healthy–benign–endometriosis–ovarian cancer spectrum, the primary objective of this study. Exclusions were tissue or peritoneal fluid-only measurements, nonhuman studies, reviews, editorials, or studies without extractable data. Risk of bias was assessed with the Quality Assessment of Diagnostic Accuracy Studies 2 tool, Risk of Bias in Nonrandomized Studies of Interventions tool, and the Newcastle–Ottawa Scale. Means and standard deviations were log-transformed; results are presented as geometric means approximating medians. Random-effects meta-analyses and meta-regression were performed for each diagnostic category, with exploratory analyses for endometrioid and clear cell subtypes, endometriosis stage, and ovarian cancer stage. This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;All articles with quantitative serum/plasma interleukin-6 data in ovarian cancer and/or endometriosis vs at least one control group (healthy, nonendometriosis benign, or endometriosis) were included. Endometriosis was included as a comparator to permit direct evaluation of the biological gradient across the healthy–benign–endometriosis–ovarian cancer spectrum, the primary objective of this study. Exclusions were tissue or peritoneal fluid-only measurements, nonhuman studies, reviews, editorials, or studies without extractable data. Risk of bias was assessed with the Quality Assessment of Diagnostic Accuracy Studies 2 tool, Risk of Bias in Nonrandomized Studies of Interventions tool, and the Newcastle–Ottawa Scale. Means and standard deviations were log-transformed; results are pres","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"33 10","pages":"Pages 1422-1431.e4"},"PeriodicalIF":2.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148295199","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":"Focal and Diffuse Adenomyomectomy: A Systematic Review of Comparative Outcomes From Published Studies Including 3397 Patients","authors":"Ahmet Kale MD,&nbsp;Ebru Kale MD,&nbsp;Sevil Çankaya MD,&nbsp;Elif Begüm Kale MD,&nbsp;Selman Aktaş PhD,&nbsp;Sıla Kale MD,&nbsp;Taner Usta MD,&nbsp;Engin Oral MD","doi":"10.1016/j.jmig.2026.05.021","DOIUrl":"10.1016/j.jmig.2026.05.021","url":null,"abstract":"<div><h3>Objective</h3><div>To compare focal and diffuse adenomyomectomy in terms of clinical characteristics, surgical complexity, postoperative outcomes, and reproductive results.</div></div><div><h3>Data Source</h3><div>PubMed/MEDLINE, Web of Science, and Embase databases were searched from inception to October 2025 using keywords including “adenomyosis,” “adenomyomectomy,” “focal adenomyosis,” “diffuse adenomyosis,” “laparoscopy,” and “laparotomy.” Reference lists of relevant publications were also screened to identify additional studies.</div></div><div><h3>Methods of Study Selection</h3><div>Studies reporting clinical, surgical, or reproductive outcomes after adenomyomectomy for focal or diffuse adenomyosis were included. Data extraction was independently performed by 2 investigators.</div></div><div><h3>Tabulation, Integration, and Results</h3><div>The initial search identified 129 articles. After screening, 43 studies were included in the comparative review. A total of 3397 patients were analyzed, including 1460 who underwent focal adenomyomectomy and 1937 who underwent diffuse adenomyomectomy. Dysmenorrhea and primary infertility were more frequent in patients with diffuse adenomyosis, whereas dyspareunia, chronic pelvic pain, and dyschezia were more common in the focal group. Laparoscopic surgery was more frequently performed for focal adenomyosis, whereas laparotomy was more often required for diffuse adenomyomectomy. Intraoperative blood loss and the weight of excised adenomyotic tissue were significantly greater in diffuse adenomyomectomy. Complete relief of dysmenorrhea and menorrhagia occurred more frequently after diffuse adenomyomectomy. Pregnancy, live birth, and term delivery rates were also higher following diffuse adenomyomectomy. Obstetric complications, including uterine rupture and postpartum hemorrhage, were comparable between the groups.</div></div><div><h3>Conclusion</h3><div>Focal and diffuse adenomyomectomy represent 2 distinct surgical approaches reflecting different patterns of adenomyotic involvement and operative complexity. Focal adenomyomectomy is more often amenable to minimally invasive techniques and targeted excision of localized lesions. In contrast, diffuse adenomyomectomy is generally associated with more extensive surgery and complex uterine reconstruction and may be associated with greater symptom improvement and favorable reproductive outcomes, based on reported outcomes across studies. Despite differences in surgical complexity, obstetric outcomes following conception appear largely comparable between groups.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"33 10","pages":"Pages 1409-1421"},"PeriodicalIF":2.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148150240","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":"Metronidazole Plus Cefazolin Compared With Cefazolin Alone for Surgical Site Infection Prophylaxis in Patients Undergoing Hysterectomy: A Systematic Review","authors":"Monica M. Jackson MD,&nbsp;Logan R. Eckhardt MD,&nbsp;Michael Zamani MS,&nbsp;Nora Watson PhD,&nbsp;Paul Levett MSc, MA Ed,&nbsp;Scott P. Endicott MD","doi":"10.1016/j.jmig.2026.01.029","DOIUrl":"10.1016/j.jmig.2026.01.029","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;To evaluate whether adding metronidazole to cefazolin for hysterectomy is more effective in the prevention of surgical site infection than the existing recommendation of cefazolin alone.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;To evaluate whether adding metronidazole to cefazolin for hysterectomy is more effective in the prevention of surgical site infection than the existing recommendation of cefazolin alone.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Data Sources&lt;/h3&gt;&lt;div&gt;MEDLINE, ClinicalTrials.gov, EMBASE, Cochrane Library, and Web of Science were searched until October 16, 2024. The following words made up the search strategy: hysterectomy, cefazolin, metronidazole, and surgical site infection, and their variants.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;MEDLINE, ClinicalTrials.gov, EMBASE, Cochrane Library, and Web of Science were searched until October 16, 2024. The following words made up the search strategy: hysterectomy, cefazolin, metronidazole, and surgical site infection, and their variants.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods of Study Selection&lt;/h3&gt;&lt;div&gt;Our search identified 987 studies, which were uploaded to Covidence for review management; 302 duplicates were automatically removed. A team of two reviewers screened 685 studies, and a third reviewer resolved conflicts. Studies were included if they 1) consisted of peer-reviewed research published between 1980 and 2024, 2) assessed patients undergoing hysterectomy by any route, 3) compared cefazolin to cefazolin and metronidazole, and 4) reported the primary outcome of surgical site infection within 30 days of the procedure.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Our search identified 987 studies, which were uploaded to Covidence for review management; 302 duplicates were automatically removed. A team of two reviewers screened 685 studies, and a third reviewer resolved conflicts. Studies were included if they 1) consisted of peer-reviewed research published between 1980 and 2024, 2) assessed patients undergoing hysterectomy by any route, 3) compared cefazolin to cefazolin and metronidazole, and 4) reported the primary outcome of surgical site infection within 30 days of the procedure.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Tabulation, Integration, and Results&lt;/h3&gt;&lt;div&gt;Five studies with a total of 5838 participants met eligibility criteria; two were randomized controlled trials (RCTs) and three were observational (retrospective cohort studies). The two RCTs, each used vaginal metronidazole and the three observational studies each used intravenous (IV) metronidazole. The RCTs each found a qualitatively lower risk of surgical site infection (SSI) with vaginal metronidazole, compared to cefazolin alone (odds ratios [ORs] 0.28 and 0.43). Observational studies consistently found similar ORs for lower risk of SSI with IV metronidazole compared to cefazolin alone (OR range 0.40–0.63). These large effect sizes were statistically significant in only the two largest studies, reflecting the limited statistical power of several individual studies because of the low absolute frequencies of infections.&lt;/div","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"33 10","pages":"Pages 1541-1548.e1"},"PeriodicalIF":2.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145994317","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":"Double Trouble: Primary Heterotopic Pregnancy with Early Rupture","authors":"Vanessa Murad MD,&nbsp;Dilkash Kajal MD,&nbsp;Nigel Pereira MD","doi":"10.1016/j.jmig.2026.01.033","DOIUrl":"10.1016/j.jmig.2026.01.033","url":null,"abstract":"&lt;div&gt;&lt;div&gt;A 34-year-old G1P0 patient presented to the emergency room (ER) at 7-weeks with cramping and vaginal spotting for 12 hours. Her pregnancy was conceived naturally. Serum β-human chorionic gonadotropin (β-hCG) level on arrival was 83 200 IU/L. Transvaginal ultrasonography (TVUS) of the pelvis showed an intrauterine and concomitant right tubal ectopic pregnancy (&lt;span&gt;&lt;span&gt;Fig. 1&lt;/span&gt;&lt;/span&gt;, &lt;span&gt;&lt;span&gt;Fig. 2&lt;/span&gt;&lt;/span&gt;). Both embryos of the heterotopic pregnancy showed cardiac activity (&lt;span&gt;&lt;span&gt;Fig. 2&lt;/span&gt;&lt;/span&gt;). A moderate amount of free fluid was noted (&lt;span&gt;&lt;span&gt;Fig. 1&lt;/span&gt;&lt;/span&gt; and &lt;span&gt;&lt;span&gt;Supplemental Video 1&lt;/span&gt;&lt;/span&gt;), concerning for tubal rupture. The patient underwent an uncomplicated laparoscopic right salpingectomy (&lt;span&gt;&lt;span&gt;Fig. 3&lt;/span&gt;&lt;/span&gt;A). Serum β-hCG levels on post-operative day (POD) 1 and 5 were 97 100 and 126 946 IU/L, respectively. The patient has an ongoing clinical intrauterine pregnancy at 13 weeks currently (&lt;span&gt;&lt;span&gt;Fig. 3&lt;/span&gt;&lt;/span&gt;B).&lt;/div&gt;&lt;div&gt;Heterotopic pregnancy is defined as the coexistence of an intrauterine pregnancy (IUP) and an ectopic pregnancy (EP), most commonly tubal [&lt;span&gt;&lt;span&gt;1&lt;/span&gt;&lt;/span&gt;]. Its incidence in natural conceptions is 1 in 30 000 [&lt;span&gt;&lt;span&gt;1&lt;/span&gt;&lt;/span&gt;,&lt;span&gt;&lt;span&gt;2&lt;/span&gt;&lt;/span&gt;], though rates are increasing with assisted reproductive technologies and conditions affecting tubal function [&lt;span&gt;&lt;span&gt;2&lt;/span&gt;&lt;/span&gt;,&lt;span&gt;&lt;span&gt;3&lt;/span&gt;&lt;/span&gt;]. The diagnosis of a heterotopic pregnancy is challenging because of the presence of an IUP may lower suspicion for a concurrent EP [&lt;span&gt;&lt;span&gt;3&lt;/span&gt;&lt;/span&gt;,&lt;span&gt;&lt;span&gt;4&lt;/span&gt;&lt;/span&gt;], and presenting symptoms are often nonspecific [&lt;span&gt;&lt;span&gt;1&lt;/span&gt;&lt;/span&gt;,&lt;span&gt;&lt;span&gt;3&lt;/span&gt;&lt;/span&gt;], as in this case. Ultrasonography remains the cornerstone of diagnosis [&lt;span&gt;&lt;span&gt;5&lt;/span&gt;&lt;/span&gt;,&lt;span&gt;&lt;span&gt;6&lt;/span&gt;&lt;/span&gt;], and a careful, systematic evaluation of both adnexa is essential even when a normal IUP is already identified [&lt;span&gt;&lt;span&gt;6&lt;/span&gt;&lt;/span&gt;]. Management depends on maternal stability and gestational viability [&lt;span&gt;&lt;span&gt;3&lt;/span&gt;&lt;/span&gt;]. Laparoscopy is the standard of care in stable patients and provides excellent maternal and pregnancy outcomes [&lt;span&gt;&lt;span&gt;1&lt;/span&gt;&lt;/span&gt;,&lt;span&gt;&lt;span&gt;3&lt;/span&gt;&lt;/span&gt;,&lt;span&gt;&lt;span&gt;4&lt;/span&gt;&lt;/span&gt;]. Non-surgical options, such as ultrasound-guided injections into the ectopic sac, are highly selective; typically, when the ectopic gestation is accessible, the patient is stable, and surgical risk is high [&lt;span&gt;&lt;span&gt;3&lt;/span&gt;&lt;/span&gt;,&lt;span&gt;&lt;span&gt;7&lt;/span&gt;&lt;/span&gt;]. Systemic methotrexate is contraindicated because of the toxicity to the coexisting IUP [&lt;span&gt;&lt;span&gt;3&lt;/span&gt;&lt;/span&gt;].&lt;/div&gt;&lt;/div&gt;&lt;div&gt;A 34-year-old G1P0 patient presented to the emergency room (ER) at 7-weeks with cramping and vaginal spotting for 12 hours. Her pregnancy was conceived naturally. Serum β-human chorionic gonadotropin (β-hCG) level on arrival was 83 200 IU/L. Transvaginal ult","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"33 10","pages":"Pages 1398-1400"},"PeriodicalIF":2.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145994273","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":"Navigating Collateral Pathways: Laparoscopic Management of a Hypervascular Anticoagulated Pelvis","authors":"Samuel Raine MD,&nbsp;Gabrielle Whitmore MD","doi":"10.1016/j.jmig.2026.02.006","DOIUrl":"10.1016/j.jmig.2026.02.006","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"33 10","pages":"Pages 1386-1387"},"PeriodicalIF":2.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146149897","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":"3D Modeling of a Myometrially Embedded Intrauterine Device","authors":"Richard Hsu MD,&nbsp;Jacquelyn Stephens MD,&nbsp;Christopher Kliethermes MD,&nbsp;Jay M. Berman MD","doi":"10.1016/j.jmig.2026.02.028","DOIUrl":"10.1016/j.jmig.2026.02.028","url":null,"abstract":"<div><h3>Objective</h3><div>To describe a novel technique for visualizing deeply embedded intrauterine devices (IUDs) using three-dimensional (3D) models generated from standard ultrasound imaging, and to demonstrate how these models enhance perioperative planning and patient counseling and understanding.</div></div><div><h3>Setting</h3><div>A single-site academic tertiary care medical center.</div></div><div><h3>Participant</h3><div>A 31-year-old G2P1011 presented with a deeply embedded levonorgestrel IUD placed six weeks postpartum after cesarean delivery. Multiple removal attempts failed due to deep myometrial embedment.</div></div><div><h3>Interventions</h3><div>Longitudinal transvaginal ultrasound images (403 slices) were used to construct a volumetric dataset. Using 3D modeling software, the volume was segmented into labeled regions; thresholding isolated the uterus and IUD based on pixel intensity, enabling precise spatial analysis. Noise reduction and translucency adjustments improved visualization of IUD depth and orientation. The patient-specific 3D model was then incorporated into a structured counseling session.</div></div><div><h3>Conclusion</h3><div>With increasing global IUD use and recognition of malposition and deep embedment, there is a need for adjunctive tools to complement established imaging modalities [<span><span>1</span></span>]. In the absence of dedicated 3D ultrasound, reconstruction of a patient-specific 3D model from existing 2D ultrasound data using open-source software was technically feasible in this single case and aided both surgical planning and patient counseling [<span><span>2</span></span>]. Clinical 3D ultrasound remains the preferred modality when available, but 2D-derived 3D modeling may serve as a niche adjunct when repeat imaging is undesirable and existing datasets can be leveraged. Deeply retained or fractured IUDs are unpredictable, often requiring complex surgical planning with hysteroscopic, laparoscopic, or combined approaches [<span><span>3</span></span>, <span><span>4</span></span>, <span><span>5</span></span>] Further comparative studies are needed to assess reproducibility, practicality, and impact on clinical outcomes.</div></div><div><h3>Video Abstract</h3><div><span><span><span><span><video><source></source></video></span><span><span>Download: <span>Download video (28MB)</span></span></span></span></span></span></div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"33 10","pages":"Page 1401"},"PeriodicalIF":2.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146213428","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}