Journal of minimally invasive gynecology最新文献

{"title":"Primary Malignant Melanoma of the Endocervix Uteri: Hysteroscopic View and Diagnosis of a Rare Yet Very Aggressive Entity","authors":"Davide Dealberti MD ,&nbsp;David Bosoni MD ,&nbsp;Federica Spissu MD ,&nbsp;Guglielmo Stabile MD, PhD","doi":"10.1016/j.jmig.2024.12.008","DOIUrl":"10.1016/j.jmig.2024.12.008","url":null,"abstract":"<div><h3>Study Objective</h3><div>To show the hysteroscopic view and diagnosis of primary malignant melanoma of the endocervix uteri.</div></div><div><h3>Design</h3><div>A 69-year-old nulliparous woman presented at the Emergency Department complaining of postmenopausal abnormal uterine bleeding. She recently underwent a Pap test, which showed Atypical Glandular Cells. Examination showed a normal vulva, vagina, and ectocervix, nodular parameters, and fixed uterus.</div></div><div><h3>Setting</h3><div>Academic Hospital \" Azienda Ospedaliero-Universitaria SS. Antonio e Biagio e Cesare Arrigo\" Alessandria, Italy.</div></div><div><h3>Interventions</h3><div>We performed outpatient hysteroscopy without anesthesia or analgesia using a 3.9 × 5.9 mm rigid hysteroscope and 5 Fr mechanical instruments. Cavity distension was obtained with saline solution and a peristaltic pump [<span><span>1</span></span>]. The procedure lasted 12 minutes without complication.</div><div>Surgical Steps: - Vaginoscopic approach showed normal vagina and atrophic ectocervix.</div><div> <!-->- Cervical stenosis type I [<span><span>2</span></span>] with active bleeding was identified: mechanical adhesiolysis was performed with 5 Fr sharp scissors at 12 and 6 o'clock position.</div><div> <!-->- Entering the canal, we identified a whitish “snowflake-like” swelling of 4 cm, with poor vascularization, occupying the right wall of the caudal part of the endocervix, and a friable bleeding necrotic tissue in the cranial part of the endocervix. Inside the cavity, an endometrial polyp of 1 cm was observed.</div><div> <!-->- Considering the office setting and the clinical conditions of the patient, we performed the excision of the endometrial polyp and multiple biopsies of the lesions, using a 5 Fr grasping forceps.</div><div>The histological exam reported a malignant melanoma. The presence of primary melanoma in other sites was excluded. Staging computerized tomography and magnetic resonance imaging were performed. The patient was staged using the the International Federation of Gynecology and Obstetrics staging system for cervical cancer to stage IV B.</div></div><div><h3>Conclusion</h3><div>This appears to be the first hysteroscopic diagnostic vision of primary malignant melanoma of the endocervix uteri [<span><span>3</span></span>, <span><span>4</span></span>, <span><span>5</span></span>]. Hysteroscopy can be considered as a fundamental diagnostic tool for endocervical lesions.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 4","pages":"Pages 314-315"},"PeriodicalIF":3.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143785623","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":"Spontaneous Uterine Rupture in Pregnancy After Treatment of Asherman Syndrome","authors":"Anouk M. Bos MD ,&nbsp;Karlijn C. Vollebregt MD, PhD ,&nbsp;Miriam F. Hanstede MD","doi":"10.1016/j.jmig.2024.11.003","DOIUrl":"10.1016/j.jmig.2024.11.003","url":null,"abstract":"<div><h3>Study objective</h3><div>Women with Asherman syndrome are at high risk of recurrent adhesions and pregnancy complications. Spontaneous uterine rupture is a rare but life-threatening complication, associated with severe maternal and fetal morbidity and mortality. Uterine ruptures can occur after extended induction of labor or a history of cesarean section, whereas spontaneous uterine rupture in an unscarred uterus is rare. Aim of this study is to evaluate the incidence of spontaneous uterine rupture among women with Asherman syndrome treated by hysteroscopy and without a history of cesarean section.</div></div><div><h3>Design</h3><div>Prospective cohort study.</div></div><div><h3>Setting</h3><div>Asherman Expertise Center of the Spaarne Gasthuis, The Netherlands.</div></div><div><h3>Patients</h3><div>Women were defined by as patients with Asherman syndrome when they had one or more clinical features and the presence of hysteroscopically confirmed intrauterine adhesions.</div></div><div><h3>Interventions</h3><div>Hysteroscopic adhesiolysis and a second-look hysteroscopy two months after the initial procedure.</div></div><div><h3>Measurements and results</h3><div>Data on the severity of adhesions and ongoing pregnancy after treatment were collected prospectively. A total of 428 women with Asherman syndrome were included, 4 women (0.9%) experienced spontaneous uterine rupture. The timing varied, none of the affected women were in active labor and the occurrence of uterine rupture was not related to the severity of adhesions. Ruptures were all found in the fundus. One woman had a history of perforation of the uterine wall located in the fundus. Neonatal outcomes were poor, two cases had intrauterine neonatal death and two cases had long-term lifelong disability. One woman had a second uterine rupture.</div></div><div><h3>Conclusion</h3><div>Women with Asherman syndrome are at risk of uterine rupture, a pregnancy complication with significant consequences that is challenging to predict and may also be associated with history of uterine perforation. Clinicians should be aware of this risk in women treated with hysteroscopic adhesiolysis and consider counseling these patients accordingly prior to treatment.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 4","pages":"Pages 372-377"},"PeriodicalIF":3.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622181","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":"Dutch Nationwide Multicenter Prospective Cohort of Essure-Related Symptomatology After Removal Surgery","authors":"Liselotte W. Maassen MD ,&nbsp;Danielle M. van Gastel MD ,&nbsp;Carolien A.M. Koks MD, PhD ,&nbsp;Judith A.F. Huirne MD, PhD ,&nbsp;Aafke M.H. Koning MD, PhD ,&nbsp;Giuseppe C.M. Graziosi MD, PhD ,&nbsp;Linda S. Bouma MD ,&nbsp;Erik A.H. Knauff MD, PhD ,&nbsp;Ingrid A.A. van Zon-Rabelink MD ,&nbsp;Marlies Y. Bongers MD, PhD ,&nbsp;Sebastiaan Veersema MD, PhD","doi":"10.1016/j.jmig.2024.10.024","DOIUrl":"10.1016/j.jmig.2024.10.024","url":null,"abstract":"<div><h3>Study Objective</h3><div>Essure is a hysteroscopic sterilization device that has been used in the Netherlands since 2003. Essure has received a lot of publicity due to many reported symptoms associated with the device. Because of this, increasing numbers of patients requested surgical removal of Essure devices. There is still limited data available regarding the effect of removal surgery on reported symptoms and patient satisfaction. The aim of this study was to analyze the effect of Essure removal surgery on reported symptoms and quality of life (QoL).</div></div><div><h3>Design</h3><div>Multicenter prospective study in the Netherlands.</div></div><div><h3>Setting</h3><div>Secondary non-teaching hospitals and secondary and tertiary teaching hospitals.</div></div><div><h3>Patients</h3><div>Patients with Essure-associated symptoms and a request for surgical removal of devices.</div></div><div><h3>Interventions</h3><div>Participants were asked to fill out questionnaires at their first clinic visit and 3 and 12 months after removal surgery. Questionnaires included questions regarding patient characteristics, symptoms, and QoL (SF-36). Clinicians also filled in 2 questionnaires regarding peroperative findings, the removal surgery, and post-operative recovery.</div></div><div><h3>Measurements and Main Results</h3><div>A total of, 1248 patients in 32 hospitals were included in the period between May 2016 and April 2019. Mean age was 42.9 years (25–63 years). Most frequent reported symptoms were mood swings (72.4%), fatigue (71.8%), pain in hips, legs, or groins (68.3%) and abdominal pain (62.3%). Essure was predominantly removed by laparoscopic salpingectomy (87.3%). Mean follow-up time was 17 months (± 10.8). 3 and 12 months after removal surgery, all reported symptoms significantly improved. QoL improved significantly in all 9 domains.</div></div><div><h3>Conclusion</h3><div>Essure removal surgery was associated with improvement in reported symptoms and QoL. Patients presenting with Essure-related symptoms, should be offered Essure removal surgery, after considering the patient-specific risks for surgery.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 4","pages":"Pages 358-364"},"PeriodicalIF":3.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545969","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":"Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) in Benign Gynaecology: A Systematic Review of Adnexal, Myomectomy and Prolapse Procedures","authors":"Charlotte Benton-Bryant MD, BMedSci ,&nbsp;Nina Reza Pour MD, DRANZCOG, MRANZCOG ,&nbsp;Jan Baekelandt MD, PhD ,&nbsp;James Elhindi BSc ,&nbsp;Kanchana Ekanyake ,&nbsp;Supuni Kapurubandara MBBS","doi":"10.1016/j.jmig.2024.11.004","DOIUrl":"10.1016/j.jmig.2024.11.004","url":null,"abstract":"<div><h3>Objective</h3><div>Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is utilised for gynecological procedures globally, however evidence to support its application aside from hysterectomy is lacking. A systematic review to determine feasibility and safety profile of vNOTES for benign gynaecology was conducted.</div></div><div><h3>Data Sources</h3><div>A literature search of MEDLINE, EMBASE, CINAHL, SCOPUS, and CENTRAL was conducted, including all types of studies reporting vNOTES for gynecological indications. After excluding cases with concurrent hysterectomy, the review focuses on procedures for benign indications and oncological procedures are reported separately. Patient characteristics and perioperative outcomes were reported, with pooled analysis for sufficiently powered categories.</div></div><div><h3>Methods of Study Selection</h3><div>Fifty-four articles were analyzed, including 7 comparative studies (n = 439) and 1 RCT (n = 34), reporting 2469 cases of vNOTES, including adnexal (tubal and/or ovarian) (43 articles, n = 2261), myomectomy (10 articles, n = 136) and prolapse repair (6 articles, n = 72) in predominantly premenopausal women with BMI &lt;30 kg/m² on pooled analysis.</div></div><div><h3>Tabulation, Integration and Results</h3><div>The overall conversion rate was low (1.38%, n = 34) with procedure specific conversion rates of 0.45 to 6.8% for adnexal procedures, 1.47% for myomectomy and none reported for prolapse repair. Overall complication rates were low (3.44%, n = 85) with no associated mortality. Five (0.20%) adhesion-related rectal injuries at colpotomy were noted, all repaired intraoperatively without long-term sequelae.</div></div><div><h3>Conclusion</h3><div>vNOTES appears feasible based on limited evidence, for uterine-sparing gynecological indications, despite a notable rate of rectal injury at colpotomy. There is a negligible risk of rectal injury observed at conventional laparoscopy and robotically assisted surgery, but similar rate of entry-related gastrointestinal injury. This may be due to the learning-curve or suboptimal case selection, necessitating careful training, assessment, and appropriate patient selection. Surgeons should continue registering prospective vNOTES cases via iNOTESs, to evaluate emerging perioperative trends with global uptake of this novel technique.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 4","pages":"Pages 318-351.e2"},"PeriodicalIF":3.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794809","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":"Presidential Address Presented at the 53rd AAGL Global Congress in New Orleans on the 17th of November 2024","authors":"Michel J. Canis MD, PhD","doi":"10.1016/j.jmig.2025.01.007","DOIUrl":"10.1016/j.jmig.2025.01.007","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 4","pages":"Pages 395-398"},"PeriodicalIF":3.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029079","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 Thoracic Surgeon: “The Icing on the Cake” in the Treatment of Epithelial Ovarian Cancer","authors":"Vincenzo Dario Mandato MD, PhD ,&nbsp;Massimiliano Paci MD ,&nbsp;Lorenzo Aguzzoli MD","doi":"10.1016/j.jmig.2024.08.015","DOIUrl":"10.1016/j.jmig.2024.08.015","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 4","pages":"Pages 299-303"},"PeriodicalIF":3.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142108271","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":"Multiple Accessory Ovaries Combined With Paroophoritic Cyst","authors":"Qinhua Li PhD ,&nbsp;Yuhan Liu MD ,&nbsp;Hong Ye MD","doi":"10.1016/j.jmig.2024.08.022","DOIUrl":"10.1016/j.jmig.2024.08.022","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 4","pages":"Pages 308-309"},"PeriodicalIF":3.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142202300","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 Enucleation Resection of Ovarian Pregnancy","authors":"Ya-chun Yang ,&nbsp;Mei-Chi Lin ,&nbsp;Yeou-Lih Wang ,&nbsp;Shih-Shien Weng","doi":"10.1016/j.jmig.2024.09.005","DOIUrl":"10.1016/j.jmig.2024.09.005","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 4","pages":"Pages 312-313"},"PeriodicalIF":3.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142257655","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":"Is Vaginal Repair a Good Option for Severe Cesarean Scar Defect? Comparison of Women With or Without Residual Myometrium","authors":"Lena Bardet MD ,&nbsp;Quentin Berl MD ,&nbsp;Elodie Debras MD ,&nbsp;Anne-Gaelle Pourcelot MD ,&nbsp;Hervé Fernandez MD, PhD ,&nbsp;Perrine Capmas MD, PhD","doi":"10.1016/j.jmig.2024.10.023","DOIUrl":"10.1016/j.jmig.2024.10.023","url":null,"abstract":"<div><h3>Study Objective</h3><div>To compare outcomes of vaginal surgery in women with moderate or severe symptomatic cesarean scar defect (with or without residual myometrium).</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting</h3><div>Gynecology department of a teaching hospital.</div></div><div><h3>Patients</h3><div>Fifty-three women, between January 2014 and December 2019, underwent vaginal surgery for symptomatic cesarean scar defect: 20 women with moderate defect (with residual myometrium) and 33 with severe defect (without residual myometrium).</div></div><div><h3>Interventions</h3><div>Vaginal surgical approach to repair cesarean scar defect.</div></div><div><h3>Measurements and Main Results</h3><div>surgery by comparing the myometrial residual thickness before and after surgery. The secondary objectives were evaluation of vaginal surgery efficacy on symptoms resolution, per and postoperative courses, and subsequent fertility. Failure rate was evaluated as the need for a second surgery.</div><div>After vaginal surgery, the residual myometrium significantly increased from 2.4 mm ± 0.9 mm to 6.6 mm ± 2.4 mm (p &lt;.01) in the moderate group and from 0 mm to 4.4 mm ± 2.2 mm (p &lt;.01) in the severe group. The prevalence of abnormal uterine bleeding was significantly reduced after surgery in both groups (p &lt;.01). Pelvic pain was significantly reduced only in the moderate group (p &lt;.01). The rate of complications (5% vs 9.1%) and second surgery (15% vs 24.2%) were not significantly different between moderate and severe groups, respectively. The median time to conceive (7 months vs 12 months); pregnancy rates (84.6% vs 68.2%); and live birth rates (76.9% vs 50%) were not statistically significant in the moderate and severe groups respectively, with 90% of pregnancies occurring naturally. Women delivered by cesarean section at 38 weeks of gestation in both groups, and no uterine rupture was reported.</div></div><div><h3>Conclusion</h3><div>Despite the absence of residual myometrium, vaginal repair of severe cesarean scar defect was effective in increasing myometrial thickness, in relieving bleeding symptoms, and in allowing to achieve pregnancy.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 4","pages":"Pages 352-357"},"PeriodicalIF":3.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693083","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 purse-string suture technique for total intracorporeal rectosigmoid end-to-end anastomosis after segmental bowel resection.","authors":"Renato Seracchioli, Stefano Ferla, Agnese Virgilio, Diego Raimondo","doi":"10.1016/j.jmig.2025.03.018","DOIUrl":"https://doi.org/10.1016/j.jmig.2025.03.018","url":null,"abstract":"<p><strong>Objective: </strong>Bowel endometriosis affects 8-12% of women with infiltrating endometriosis, mostly involving the rectum and sigmoid¹. Surgery is preferred when medical therapy fails or is contraindicated. Although segmental resection has shown good outcomes, it carries significant risks of perioperative complications^1-3, partially due to the mini-laparotomy required for specimen retrieval and bowel anastomosis (post-operative pain, wound-related issues, blood loss, hernias). Total intracorporeal laparoscopic anastomosis may reduce them^4,5. While promising, experience with this technique is limited, and there is no consensus on its use. This video showcases our technique for total intracorporeal end-to-end anastomosis using a purse-string suture after bowel resection for endometriosis.</p><p><strong>Design: </strong>Case report and video-description of the surgical technique SETTING: Tertiary level academic hospital INTERVENTION: A 32-year-old woman with severe, symptomatic endometriosis unresponsive to hormone therapy was referred to our hospital. Preoperative evaluation identified a 5cm nodule involving the anterior rectal wall, recto-sigmoid junction, and right utero-sacral ligament, located 10cm from the anal verge. After obtaining informed consent, surgery was scheduled. The recto-sigmoid colon was mobilized using a nerve-sparing approach^1-3,5, followed by resection of the affected segment. The specimen was exteriorized from the right ancillary trocar site, and a total intracorporeal end-to-end colorectal anastomosis was performed without the need for a suprapubic mini-laparotomy, using a circular stapler and a monofilament purse-string suture to secure the anvil. Bowel integrity and residual vascular assessment with near-infrared indocyanine green were performed, and the patient experienced an uneventful recovery, with significant clinical improvement at follow-up.</p><p><strong>Conclusion: </strong>In our experience total intracorporeal anastomosis technique improves minimally invasive surgery for deep endometriosis, avoiding the drawbacks of mini-laparotomy and requires less sigmoid mobilization. The most threatening complication after full-thickness bowel resection is anastomotic leakage, often due to poorly supplied residual horns. Our technique using a purse-string suture during intracorporeal anastomosis, preventing formation of residual horns, can provide greater anvil stability for a secure anastomosis seal.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772540","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}