Journal of minimally invasive gynecology最新文献

{"title":"The Broad Ligament Window: A Novel Surgical Technique for Laparoscopic Abdominal Cerclage","authors":"W Nolan ,&nbsp;R Barbaresso ,&nbsp;S Parikh ,&nbsp;R Paya Pasic","doi":"10.1016/j.jmig.2025.09.124","DOIUrl":"10.1016/j.jmig.2025.09.124","url":null,"abstract":"<div><h3>Study Objective</h3><div>To present a novel approach to laparoscopic abdominal cerclage</div></div><div><h3>Design</h3><div>Surgical video presentation</div></div><div><h3>Setting</h3><div>Academic Hospital</div></div><div><h3>Patients or Participants</h3><div>Patients undergoing laparoscopic abdominal cerclage placement</div></div><div><h3>Interventions</h3><div>Laparoscopic abdominal cerclage placement</div></div><div><h3>Measurements and Primary Results</h3><div>Video presentation</div></div><div><h3>Conclusion</h3><div>The Broad Ligament window is an advantageous approach to placement of laparoscopic abdominal cerclage</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Page S28"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334647","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":"Ectopic Pregnancy in a Rudimentary Horn: A Case Report","authors":"L Diamond ,&nbsp;C Warshafsky ,&nbsp;D Hylton ,&nbsp;J Kroft ,&nbsp;P Lee","doi":"10.1016/j.jmig.2025.09.125","DOIUrl":"10.1016/j.jmig.2025.09.125","url":null,"abstract":"<div><h3>Study Objective</h3><div>This video i) provides background on the incidence, pathophysiology, diagnosis, and management of rudimentary horn ectopic pregnancies, ii) presents a case of a rudimentary horn pregnancy at our academic centre, and iii) demonstrates the surgical technique for management.</div></div><div><h3>Design</h3><div>Case report.</div></div><div><h3>Setting</h3><div>A tertiary care centre.</div></div><div><h3>Patients or Participants</h3><div>A previously healthy 36-year-old gravida four, para one female.</div></div><div><h3>Interventions</h3><div>Transvaginal ultrasound and magnetic resonance imaging were used for diagnosis. The patient underwent laparoscopic excision of the pregnant rudimentary horn.</div></div><div><h3>Measurements and Primary Results</h3><div>The procedure was uncomplicated with minimal blood loss.</div></div><div><h3>Conclusion</h3><div>Rudimentary horn pregnancies carry a significant risk of morbidity and mortality, with a greater than 50% chance of rupture and significant hemorrhage. Therefore, surgical management should be considered.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Page S28"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334648","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":"Preoperative Hypoalbuminemia and Surgical Complications in Benign Minimally Invasive Hysterectomy","authors":"Y Yagur ,&nbsp;G Levin ,&nbsp;O Ezike ,&nbsp;K Ciesielski ,&nbsp;R Meyer","doi":"10.1016/j.jmig.2025.09.022","DOIUrl":"10.1016/j.jmig.2025.09.022","url":null,"abstract":"<div><h3>Study Objective</h3><div>To evaluate the association between preoperative hypoalbuminemia (&lt;3.5 g/dL) and postoperative complications in patients undergoing minimally invasive hysterectomy for benign conditions.</div></div><div><h3>Design</h3><div>A prospective cohort study used data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2012 to 2020.</div></div><div><h3>Setting</h3><div>Multi-institutional data collected through the NSQIP database across various U.S. hospitals.</div></div><div><h3>Patients or Participants</h3><div>A total of 69,325 patients met the inclusion criteria, with 65,920 (95.1%) in the normal preoperative albumin level group (≥3.5 g/dL) and 3,405 (4.9%) exhibiting preoperative hypoalbuminemia.</div></div><div><h3>Interventions</h3><div>No experimental intervention. Data analysis focused on comparing 30 days postoperative outcomes between albumin level groups.</div></div><div><h3>Measurements and Primary Results</h3><div>Information collected included demographics data, preoperative data, operative indication and postoperative complications. The primary outcome was the incidence of any postoperative complication, further classified as major or minor using the Clavien-Dindo classification. Patients with hypoalbuminemia had significantly higher complication rates overall (10.5% vs. 6.9%, p&lt;0.001), including minor (8.0% vs. 4.7%, p&lt;0.001) and major (3.4% vs. 2.8%, p=0.022) complications. Hypoalbuminemia was significantly associated with increased risks of reintubation, blood transfusion, surgical site infection, and pneumonia. Multivariable logistic regression confirmed hypoalbuminemia as an independent risk factor for any complications (aOR 1.39, 95% CI 1.23–1.56) and minor complications (aOR 1.52, 95% CI 1.32–1.72). When stratifying into five groups of albumin level, higher preoperative albumin levels were associated with a progressive reduction in complication risks.</div></div><div><h3>Conclusion</h3><div>Preoperative hypoalbuminemia is an independent predictor of postoperative complications in minimally invasive hysterectomy for benign conditions. Routine preoperative nutritional assessment and optimization, including correction of hypoalbuminemia, should be considered to reduce perioperative morbidity. Further research is needed to assess the effectiveness of such interventions in the perioperative setting and the long-term complications.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Pages S14-S15"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334808","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":"Insurer Influence on Benign Hysterectomy Claims: Trends in Prior Authorization and Denials","authors":"P Maghsoudlou,&nbsp;AC Fitzgerald,&nbsp;G Namazi,&nbsp;MO Ajao,&nbsp;LP King","doi":"10.1016/j.jmig.2025.09.025","DOIUrl":"10.1016/j.jmig.2025.09.025","url":null,"abstract":"<div><h3>Study Objective</h3><div>To assess the financial and demographic impact of prior authorization and denial practices for hysterectomy procedures at a large academic institution, with a focus on potential racial and socioeconomic disparities introduced by insurer policies.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting</h3><div>Tertiary-care academic medical center.</div></div><div><h3>Patients or Participants</h3><div>All patients with submitted insurance claims for benign hysterectomy between October 2016 and February 2022 were identified. Claims were categorized as “denied” if they remained denied after all levels of appeal, and “approved” if the patient underwent a hysterectomy procedure during this period. The two groups were mutually exclusive. Gynecologic oncology cases and patients with a primary address outside of Massachusetts were excluded.</div></div><div><h3>Interventions</h3><div>Undergoing a hysterectomy procedure for benign indications or receiving a final denial for hysterectomy.</div></div><div><h3>Measurements and Primary Results</h3><div>Among 2,410 patients, 118 were denied and 2,292 approved. Denials were more common among patients with private insurance versus public (95.8% vs. 74.0%, p &lt; 0.001). One commercial insurer (Insurer A) accounted for 55.9% of denials but only 11.1% of approvals, suggesting that denials were driven more by insurer policy than clinical or demographic factors. Insurers B and C accounted for 17 (14.4%) and 16 (13.6%) of the total denials, respectively. There were no statistically significant differences in denial rates based on race or Social Vulnerability Index (SVI) (p &gt; 0.05), though Black patients were overrepresented among denied cases (19.5% vs. 15.6%). A map plotting denials across Massachusetts in relation to SVI revealed clustering in higher-vulnerability areas, particularly urban centers such as Boston and Brockton. While quantitative differences in SVI were not significant, spatial patterns raise concerns about disproportionate impact on vulnerable communities.</div></div><div><h3>Conclusion</h3><div>Prior authorization for benign hysterectomy adds limited clinical value while creating barriers to care. Denials were primarily influenced by insurer policies and disproportionately affected privately insured patients. Policy reform is needed to reduce administrative burden and promote equitable access.</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":"145334814","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 of Uterine Rupture after Laparoscopic Myomectomy: Korean National Health Insurance Data","authors":"H Song ,&nbsp;YW Kim ,&nbsp;SY Hur ,&nbsp;J Paek ,&nbsp;MJ Song","doi":"10.1016/j.jmig.2025.09.005","DOIUrl":"10.1016/j.jmig.2025.09.005","url":null,"abstract":"<div><h3>Study Objective</h3><div>To evaluate the association between a history of myomectomy and obstetric complications, and to investigate whether risks vary by surgical approach.</div></div><div><h3>Design</h3><div>This population-based cohort study included singleton primiparous women who delivered between January 1, 2006, and December 31, 2022.</div></div><div><h3>Setting</h3><div>Logistic regression models were used to estimate adjusted odds ratios (aORs) for various obstetric outcomes, controlling for potential confounders. Additional subgroup analyses were conducted based on the surgical approach: laparotomy, laparoscopy, or vaginal myomectomy.</div></div><div><h3>Patients or Participants</h3><div>Among 237,531 women initially identified, those with missing body mass index (BMI) data were excluded, resulting in a final analytic cohort of 199,826. Participants were categorized into myomectomy (n = 8,675) and non-myomectomy (n = 191,151) groups. This patients were originated from Korean National Insurance data.</div></div><div><h3>Interventions</h3><div>NA</div></div><div><h3>Measurements and Primary Results</h3><div>A history of myomectomy was associated with increased risks of multiple obstetric complications, including mild and severe preeclampsia (aOR 1.48 and 1.69, respectively), placenta previa (aOR 1.73), preterm labor (aOR 1.23), PPROM (aOR 1.22), and threatened abortion (aOR 1.26; all p &lt; 0.001). Interestingly, the risk of uterine rupture was significantly lower in the myomectomy group (aOR 0.70, 95% CI 0.58–0.84). Stratified analysis revealed that laparotomy was associated with the highest complication burden, while vaginal and laparoscopic myomectomy showed relatively lower or neutral risk profiles.</div></div><div><h3>Conclusion</h3><div>Myomectomy increases the risk of adverse obstetric outcomes; however, because minimally invasive surgical approaches do not increase the rate of uterine rupture, minimally invasive myomectomy remains a feasible option for women of reproductive age.</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":"145334836","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":"Dysmenorrhea: A Key Symptom in Endometriosis and Its Overlap with Chronic Inflammatory Bowel Diseases (IBD)","authors":"C Exacoustos ,&nbsp;F Iacobini ,&nbsp;G Monaco ,&nbsp;M Fiorillo ,&nbsp;B Neri ,&nbsp;L Biancone ,&nbsp;C Russo","doi":"10.1016/j.jmig.2025.09.028","DOIUrl":"10.1016/j.jmig.2025.09.028","url":null,"abstract":"<div><h3>Study Objective</h3><div>To assess, through a multidisciplinary approach, the presence, type, and location of pelvic endometriosis in IBD patients with related symptoms, and to compare endometriosis localizations between ulcerative colitis (UC) and Crohn’s disease (CD).</div></div><div><h3>Design</h3><div>Prospective observational study.</div></div><div><h3>Setting</h3><div>Second-level gynecological ultrasound Unit and Endometriosis Center in Italy, University Hospital.</div></div><div><h3>Patients or Participants</h3><div>Eighty-two consecutive patients included from 2020 to 2024.</div></div><div><h3>Interventions</h3><div>We included 82 premenopausal IBD patients with symptoms suggestive of endometriosis (e.g., dysmenorrhea, dyspareunia, dyschezia, dysuria, HMB), referred for transvaginal ultrasound (TVS) assessment. Endometriosis presence, type, and site were recorded. IBD patients without specific symptoms were excluded. Controls were endometriosis patients without IBD, matched 1:4 by age (±5 years) and BMI (±1 kg/m²).</div></div><div><h3>Measurements and Primary Results</h3><div>Endometriosis was detected in 51/82 (62.2 %) IBD patients with compatible symptoms: 30 (58.8%) had UC and 21 (41.2%) had CD. In our IBD population 71/82 (86.6%) patients had dysmenorrhea. These women had a higher percentage of endometriosis compared to women without dysmenorrhea (67.6% vs 27.3%, p=0.01). Dysmenorrhea, dyspareunia and HMB were significantly more frequent in IBD patients with endometriosis compared to IBD patients without endometriosis (94.1% vs 74.2%, p=0.01; 68.6% vs 41.9%, p=0.01; 68.6% vs 41.9%, p=0.01). In particular lateral DIE was significantly more frequent in UC patients compared to CD ones (86.7% vs 42.9%, p=0.001), instead posterior DIE was significantly more frequent in CD patients compared to UC ones (57.1% vs 26.7%, p=0.03). DIE was more frequent in IBD patients with endometriosis compared to the control group, patients with endometriosis but without IBD (90.2% vs 77.5% p=0.04), while endometrioma was more frequent in the control group (43.1% vs 27.5% p=0.04).</div></div><div><h3>Conclusion</h3><div>Endometriosis was common in patients with IBD and compatible symptoms, with dysmenorrhea frequently reported. TVS can aid in identifying endometriosis and improving management in this group.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Pages S23-S24"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334969","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 Role of Somatic Mutations in Endometriosis: Pathogenesis, Progression and Fibrogenesis (Systematic Review)","authors":"LV Adamyan ,&nbsp;L Pivazyan ,&nbsp;AA Stepanian ,&nbsp;M Yurkanova ,&nbsp;E Zarova ,&nbsp;M Knuznetsova ,&nbsp;K Mailova ,&nbsp;D Trofimov","doi":"10.1016/j.jmig.2025.09.029","DOIUrl":"10.1016/j.jmig.2025.09.029","url":null,"abstract":"<div><h3>Study Objective</h3><div>To systematically review and analyze the role of somatic mutations in the pathogenesis of endometriosis, their association with fibrogenesis, and their potential as diagnostic biomarkers and therapeutic targets.</div></div><div><h3>Design</h3><div>Systematic review of original research articles and systematic reviews published up to January 7, 2025, following PRISMA guidelines.</div></div><div><h3>Setting</h3><div>Laboratory-based genomic studies analyzing patient-derived endometriotic tissue samples, primarily formalin-fixed, paraffin-embedded specimens, using high-sensitivity next-generation sequencing (NGS) and laser-capture microdissection (LCM) techniques to enrich epithelial components.</div></div><div><h3>Patients or Participants</h3><div>742 women with confirmed endometriosis and 410 control subjects (ages 21–56), from studies evaluating somatic mutations across various morphologic subtypes of endometriosis including ovarian endometriomas, deep infiltrating endometriosis, and superficial peritoneal lesions.</div></div><div><h3>Interventions</h3><div>Not applicable (systematic review of genomic studies).</div></div><div><h3>Measurements and Primary Results</h3><div>Primary outcomes included the identification and characterization of somatic mutations and their correlation with fibrogenesis and oxidative stress markers. Frequent mutations were found in oncogenic and tumor suppressor genes such as ARID1A, PIK3CA, KRAS, and PTEN. These mutations were enriched in the epithelial component of lesions and correlated with enhanced fibrogenic signaling pathways, including PI3K/AKT and TGF-β. Evidence suggests a contribution of oxidative stress to mutagenesis, promoting lesion persistence and fibrosis.</div></div><div><h3>Conclusion</h3><div>Somatic mutations may contribute to the pathogenesis and fibrogenesis of endometriosis and could serve as biomarkers for diagnosis, classification, and targeted therapy development. However, a definitive cause-effect relationship remains to be clarified. Future longitudinal studies integrating genomic and epigenomic analyses are essential to translate these findings into clinical practice and precision medicine approaches.</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":"145334971","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 \"Ureteral Raincoat\". the Ceccaroni Ureteral Wrapping with Omental Free Flap after Parametrial Surgery for Deep Endometriosis","authors":"M Ceccaroni ,&nbsp;G D'Ancona ,&nbsp;G Roviglione","doi":"10.1016/j.jmig.2025.09.111","DOIUrl":"10.1016/j.jmig.2025.09.111","url":null,"abstract":"<div><h3>Study Objective</h3><div>To describe an innovative minimally invasive technique consisting in the ureteral wrapping by omental free flap in order to reduce the risk of postoperative ureteral fistula. Secondary objective is to didactically demonstrate different ureterolysis settings during surgery for severe form of endometriosis.</div></div><div><h3>Design</h3><div>Didactic surgical video article. Patients’ consent to present and publish the video has been obtained.</div></div><div><h3>Setting</h3><div>Postoperative ureteral fistula still represents one of the most serious complications after ureteral surgery performed due to severe form of endometriosis. It is largely perceived as a frustrating event, since to date, no techniques or tools exist to avoid such risk and the extensive knowledge of the anatomy is not enough to prevent from this complication. Exploiting the intrinsic properties of the omentum, used as free flap to wrap the ureter, the risk of ureteral fistula can be reduced without increasing surgical risks for patients.</div></div><div><h3>Patients or Participants</h3><div>Women undergoing ureteral surgery due to severe form of endometriosis.</div></div><div><h3>Interventions</h3><div>Surgery starts with the omental retrieve, paying attention to tailor the amount of tissue harvested according to the length of ureter to be wrapped. Then, the caudad portion of the flap is secured to peritoneum of Douglas pouch. Once the omentum has been fixed, the flap is stretched and passed under the ureter. The cranial portion of the flap is fixed to pelvic peritoneum and the ureter is then progressively wrapped through an interrupted or running suture. Same surgical steps are performed on the contralateral ureter in case of bilateral ureteral wrapping.</div></div><div><h3>Measurements and Primary Results</h3><div>106 patients underwent ureteral wrapping from 2020 to 2025. Preliminary results showed no postoperative ureteral fistula with an additional operative time of 26 ± 2.3 minutes.</div></div><div><h3>Conclusion</h3><div>This minimally invasive technique can be considered safe and effective in reducing the risk of postoperative ureteral fistula although further randomized clinical trial are needed to confirm these results.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Page S22"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334989","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":"Evaluating AIDriven 3D Surgical Models for Laparoscopic Strategy in Complex Endometriosis","authors":"K Thott ,&nbsp;D Godbole","doi":"10.1016/j.jmig.2025.09.014","DOIUrl":"10.1016/j.jmig.2025.09.014","url":null,"abstract":"<div><h3>Study Objective</h3><div>Posterior compartment endometriosis carries up to 50% reoperation rates due to missed lesions. We evaluated whether AIgenerated 3D surgical models improve operative planning, anatomical validation, and intraoperative preparedness in complex, bowelinvolving disease.</div></div><div><h3>Design</h3><div>Prospective pilot study using structured surgeonreported outcomes and intraoperative validation across consecutive cases.</div></div><div><h3>Setting</h3><div>Multisite minimally invasive gynecology programs adopting the XENA surgical intelligence platform.</div></div><div><h3>Patients or Participants</h3><div>20 consecutive laparoscopic surgeries for suspected or confirmed moderatetosevere endometriosis.</div></div><div><h3>Interventions</h3><div>Preoperative review of patientspecific, AIgenerated 3D surgical models derived from standard pelvic MRI datasets.</div><div>The XENA platform transforms MRI data into operative planning maps tailored for surgical use—providing spatial insight to complement radiologic interpretation.</div></div><div><h3>Measurements and Primary Results</h3><div>Operating surgeons revised their laparoscopic approach in 9/20 cases (45%) after reviewing the 3D model, predominantly to adjust bowel or ureteric dissection strategy.</div><div>• Intraoperative validation confirmed 18/20 models (90%) accurately reflected surgical anatomy, reducing exploratory maneuvers.</div><div>• In 12/20 procedures (60%), surgeons noted that 3D models enabled more precise planning of dissection planes around critical pelvic structures.</div></div><div><h3>Conclusion</h3><div>AIdriven 3D surgical models demonstrate early clinical impact in highcomplexity endometriosis—particularly with bowel involvement—by enhancing planning precision and intraoperative orientation. These pilot data support integration of surgical intelligence platforms like XENA into preop workflows. A multicenter validation study is in protocol development.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Page S12"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335191","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":"Precision in Endometrioma Surgery: Fellowship Training Predicts Ovarian Preservation and Guideline Adherence","authors":"J Clay ,&nbsp;A Newark ,&nbsp;Y Meng ,&nbsp;M Martin ,&nbsp;M Billow","doi":"10.1016/j.jmig.2025.09.019","DOIUrl":"10.1016/j.jmig.2025.09.019","url":null,"abstract":"<div><h3>Study Objective</h3><div>To evaluate the association between surgeon subspecialty training and ovarian preservation in endometrioma surgery and assess adherence to guideline-based management.</div></div><div><h3>Design</h3><div>Retrospective multicenter cohort study (2012–2024) with multivariable logistic and ordinal regression.</div></div><div><h3>Setting</h3><div>Five sites (academic and regional); procedures performed via minimally invasive or abdominal approach, low lithotomy positioning. Ergonomics varied.</div></div><div><h3>Patients or Participants</h3><div>18–50yo with histologically confirmed endometrioma (N=319), identified using diagnostic and procedural codes and confirmed by chart review. IRB-approved, de-identified data utilized.</div></div><div><h3>Interventions</h3><div>Demographics, surgeon training, and perioperative details were abstracted, including surgical approach, procedures, blood loss, operative time, complications. Guideline adherence was assessed using a 2-point composite score based on ACOG, ASRM, and ESHRE: 1 point for minimally invasive approach; 1 point for cystectomy. Oophorectomy scored 1 point only if prior endometrioma cystectomy on the same ovary. In bilateral cases with mixed management, scoring was based on the oophorectomy side. Higher scores indicated greater adherence.</div></div><div><h3>Measurements and Primary Results</h3><div>The cohort included MIGS(148), REI(85), OBGYN(51), GynOnc(34), and UROGYN(1). Ovarian preservation was more common among REI(88.2%) and MIGS(83.8%) vs GynOnc(67.6%) and OBGYN(60.8%). Adherence scores were higher in REI(1.9) and MIGS(1.7) vs GynOnc(1.3) and OBGYN(1.1). MIGS and REI were grouped for analysis based on shared training in endometriosis care and compared to a combined group of OBGYN, GynOnc. MIGS/REI training (aOR 11.65, 95% CI 4.87–27.89), fertility desire(aOR 5.31), and younger age(aOR 0.90/year) predicted ovarian preservation; prior surgery reduced odds(aOR 0.38). MIGS/REI training also predicted higher adherence(OR 1.47), and more frequent ureterolysis(OR 5.13) and endometriosis excision(OR 21.15). There were no significant differences in patient demographics or complications across groups. Model AUC = 0.90. Sensitivity analyses confirmed findings.</div></div><div><h3>Conclusion</h3><div>MIGS and REI fellowship training are associated with higher rates of ovarian preservation and guideline adherence. These findings illustrate how subspecialty training improves precision in endometriosis care and support the development of training-informed metrics for future progress and AI-driven clinical decision tools.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Page S13"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335201","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}