Journal of minimally invasive gynecology最新文献

{"title":"MEDL Score: A Novel MRI Protocol That Can Predict Endometriosis With High Accuracy","authors":"J Siufi Neto ,&nbsp;MP Andres ,&nbsp;CC Barbisan ,&nbsp;K Seidel ,&nbsp;Y Ota ,&nbsp;YO Tanaka ,&nbsp;M Yamamoto ,&nbsp;R Takubo ,&nbsp;M Carrick ,&nbsp;J Matsushima ,&nbsp;MS Abrão","doi":"10.1016/j.jmig.2024.09.069","DOIUrl":"10.1016/j.jmig.2024.09.069","url":null,"abstract":"<div><h3>Study Objective</h3><div>In a previous research, we established a novel MRI protocol for evaluating the severity of endometriosis called MEDL. In the present study, we revised the protocol to evaluate the severity of endometriosis using MRI in comparison to laparoscopy.</div></div><div><h3>Design</h3><div>An observational retrospective study.</div></div><div><h3>Setting</h3><div>A tertiary hospital.</div></div><div><h3>Patients or Participants</h3><div>71 patients diagnosed with endometriosis were enrolled in this study. All patients underwent clinical evaluation, pre-operative MRI, and laparoscopic surgery.</div></div><div><h3>Interventions</h3><div>The MEDL score is a novel MRI scoring system developed using a two (Absent/Present) or three-category (None/Mild/Severe) system to measure the disease severity and level of adhesions between organs due to endometriosis. All pre-operative MRIs were evaluated by three independent radiologists using MEDL score to assess disease severity and the anatomical location of the adhesions. All recorded surgeries were evaluated by two independent surgeons to map the lesions and their adhesion severity. All results were submitted for statistical analysis to determine the agreement rate between MRI and laparoscopic mapping.</div></div><div><h3>Measurements and Main Results</h3><div>For adhesion between organs and lesion severity on the uterine wall, the agreement rate (kappa) between MRI and laparoscopy finding was calculated. The results of adhesion between organs were 0.80∼0.97 for Present/Absent and 0.72∼0.97 for None/Mild/Severe (n=67∼69). The results of lesion severity on the uterine wall were 0.70∼0.96 for Present /Absent and 0.64∼0.96 for None/Mild/Severe (n=65∼69). For the three-category evaluation of all items, the total score was calculated for each patient, with None=0, Mild=1, Severe=2, and the Spearman's rank correlation coefficient between laparoscopy and MRI total scores was 0.81(n=61).</div></div><div><h3>Conclusion</h3><div>The results showed that pre operative MRI under the MEDL score had a high agreement compared to laparoscopy and can be used to accurately map endometriotic lesions. This is a promising method applicable not only to assess disease severity but in the near future might be used to measure drug therapy response before and after treatment.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"31 11","pages":"Pages S1-S2"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658266","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":"Board Of Directors-Ed Calendar","authors":"","doi":"10.1016/S1553-4650(24)00779-9","DOIUrl":"10.1016/S1553-4650(24)00779-9","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"31 11","pages":"Page A1"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142586735","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 Use of Foley Catheters in Hysteroscopy Combined With Laparoscopy for the Treatment of Post-Cesarean Section Uterine Diverticulum","authors":"X Liang","doi":"10.1016/j.jmig.2024.09.035","DOIUrl":"10.1016/j.jmig.2024.09.035","url":null,"abstract":"<div><h3>Study Objective</h3><div>To evaluate the effectiveness and utility of a Foley catheter as an innovative support tool in managing a large and rare cesarean scar diverticulum during laparoscopic repair, aiming to address post-cesarean section complications related to prolonged menstruation.</div></div><div><h3>Design</h3><div>This video demonstrates a combined laparoscopic and hysteroscopic surgical technique, with a special emphasis on using the Foley catheter as a support tool to enhance the surgical field and precision. Once the diverticulum is located via hysteroscopy, the Foley catheter is deployed to stabilize and delineate the diverticulum, followed by precise dissection and repair of the diverticulum walls under laparoscopy.</div></div><div><h3>Setting</h3><div>The procedure was conducted in a high-tech operating room at a university hospital.</div></div><div><h3>Patients or Participants</h3><div>The patient is a 35-year-old woman with a history of one cesarean section who had been experiencing prolonged menstrual bleeding for one year. Diagnostic imaging showed a large and rare cystic structure measuring 30mm x 30mm on the right side of the uterus.</div></div><div><h3>Interventions</h3><div>A Foley catheter was inserted into the diverticulum under hysteroscopic guidance to act as a mechanical scaffold, which enhanced visualization and stability of the diverticulum during laparoscopic surgery. This was followed by the precise dissection and repair of the diverticulum walls, improving the safety and effectiveness of the surgery.</div></div><div><h3>Measurements and Main Results</h3><div>Postoperative assessments indicated a significant reduction in menstrual bleeding and resolution of the diverticulum issues. The use of the Foley catheter provided essential structural support, enabling more effective manipulation and treatment of the scar tissue.</div></div><div><h3>Conclusion</h3><div>This case highlights the pivotal role of the Foley catheter in managing a large and rare cesarean scar diverticulum. It introduces a new surgical technique that could offer an effective surgical option for managing post-cesarean section complications, providing a replicable and effective method for managing similar cases.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"31 11","pages":"Page S16"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658001","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 Self-Harm Among Individuals Diagnosed With Endometriosis: A Population-Based Cohort Study","authors":"P Thiel ,&nbsp;O Bougie ,&nbsp;J Pudwell ,&nbsp;J Shellenberger ,&nbsp;MP Velez ,&nbsp;A Murji","doi":"10.1016/j.jmig.2024.09.072","DOIUrl":"10.1016/j.jmig.2024.09.072","url":null,"abstract":"<div><h3>Study Objective</h3><div>To assess the association between endometriosis and the composite outcome of self-harm, which included suicide, intentional self-harm, and drug overdose.</div></div><div><h3>Design</h3><div>A population-based retrospective matched cohort study.</div></div><div><h3>Setting</h3><div>We used linked administrative data from a government-administered single-payer provincial healthcare system in Ontario, Canada between January 1, 2010, to July 1, 2022.</div></div><div><h3>Patients or Participants</h3><div>Women age 18 to 50 years with a first-time diagnosis of endometriosis.</div></div><div><h3>Interventions</h3><div>None.</div></div><div><h3>Measurements and Main Results</h3><div>Endometriosis exposure was determined using a validated set of diagnostic codes from physician billing and from outpatient and in-hospital visits. Individuals with endometriosis were matched 1:2 on age, sex, geography, and history of self-harm to unexposed individuals without a history of endometriosis. To account for psychiatric care utilization in the 2-years prior to study entry, we also matched endometriosis patients to controls based on a psychiatric utilization gradient score (0-no psychiatric utilization; 1-outpatient; 2-emergency care; and 3-hospital admission). The primary outcome was a composite of the first occurrence of suicide, intentional self-harm, or overdose. Secondary outcomes were the individual components of the composite. Cox regression models were used to generate hazard ratios with adjustment for all baseline covariates including in other comorbidities, income quintile, infertility, immigration status.</div><div>We included 168,159 individuals: 56,053 diagnosed with endometriosis (40.7% medically, 59.3% surgically) and 112,106 unexposed individuals. Compared to unexposed, patients with endometriosis were at increased risk of the composite outcome of self-harm (aHR 1.42, 95%CI 1.27–1.59, cumulative incidence of 2.47% vs 1.75%). Endometriosis conferred increased risk of intentional self-harm (aHR 1.37, 95%CI 1.22–1.54) and overdose (aHR 1.42, 95% CI 1.29–1.56) but not for suicide (aHR 1.21, 95%CI, 0.62–2.35), although only 42 suicide events were recorded over the study period.</div></div><div><h3>Conclusion</h3><div>A diagnosis of endometriosis is associated with an increased risk of self-harm. Mental health screening in the endometriosis population is warranted with targeted interventions for self-harm prevention.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"31 11","pages":"Page S4"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658181","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":"Evaluation of Rectal Endometriosis Treatment With HIFU Versus Surgery: A Comparative Retrospective Bicentric Study","authors":"G Dubernard ,&nbsp;C Devantay ,&nbsp;CA Philip ,&nbsp;S Warembourg ,&nbsp;E Nguyen-BA ,&nbsp;T Dennis ,&nbsp;B Merlot ,&nbsp;H Roman","doi":"10.1016/j.jmig.2024.09.074","DOIUrl":"10.1016/j.jmig.2024.09.074","url":null,"abstract":"<div><h3>Study Objective</h3><div>Comparing rectal endometriosis treatment with HIFU and surgery in terms of symptoms at 6 months and treatments-related morbidity.</div></div><div><h3>Design</h3><div>Comparative retrospective, bicentric study in 2 endometriosis reference centers.</div></div><div><h3>Setting</h3><div>Patients operated by HIFU or laparoscopic resection in the operating room under anesthesia.</div></div><div><h3>Patients or Participants</h3><div>120 patients, including 60 patients in each arm, were treated and followed for 6 months.</div></div><div><h3>Interventions</h3><div>Endo-rectal HIFU treatment versus laparoscopic surgery of rectal endometriosis nodule.</div></div><div><h3>Measurements and Main Results</h3><div>Patients’ symptomatology was assessed with questionnaires prior to receiving treatment then again 6 months later using questionnaires: gynecological and digestive symptoms (VAS), health status (MOSSF-36), fecal incontinence (WEXNER), constipation (KESS) and overall sexual health (FSFI). We also assessed the morbidity of both treatments according to the Clavien-Dindo classification. 120 patients, 60 in each group, received HIFU or rectal surgery. Rectal nodules characteristics were comparable in both groups. In the HIFU and surgery groups, Clavien-Dindo grade 2 and 3 complication rates were respectively 3.3% vs. 21.7% (p=0.002) and 0% vs. 10% (p=0.01). Hospitalization duration was also significantly shorter for HIFU group (1 day vs. 3 days, p&lt;0.001). In the HIFU group, significative improvement was observed in acute pelvic pain/dysmenorrhea, dyspareunia, diarrhea, rectal spasms, pain during bowel movement and urinary urgency. In the surgical arm, significative improvement was observed in acute pelvic pain/dysmenorrhea, diarrhea, rectal spasms and pain during bowel movement. In both groups, we can witness an improvement in FSFI, KESS and WEXNER scores and health status at 6 months.</div></div><div><h3>Conclusion</h3><div>HIFU treatment enables significant reduction in the risk of postoperative complications while allowing at least similar symptoms and quality of life outcomes and could be used as an alternative to surgical treatment for suitable patients. Long-term complications and relapse risks require further research.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"31 11","pages":"Page S5"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658182","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 There More Than Meets the Eye? Pattern of Visible and Occult Peritoneal Endometriosis in Patients with Pelvic Pain","authors":"G Namazi ,&nbsp;N Chauhan ,&nbsp;S Knapp ,&nbsp;M Stuparich ,&nbsp;J Cruz ,&nbsp;S Nahas ,&nbsp;S Behbehani","doi":"10.1016/j.jmig.2024.09.075","DOIUrl":"10.1016/j.jmig.2024.09.075","url":null,"abstract":"<div><h3>Study Objective</h3><div>Pattern of visible and occult peritoneal endometriosis in patients with pelvic pain undergoing complete peritonectomy(CP).</div></div><div><h3>Design</h3><div>Retrospective observational.</div></div><div><h3>Setting</h3><div>Academic medical center.</div></div><div><h3>Patients or Participants</h3><div>Patients with chronic pelvic pain undergoing a laparoscopic or robotic CP between 2018-2024. Patients with stage four endometriosis were excluded. A pilot analysis of 56 patients are included in this study.</div></div><div><h3>Interventions</h3><div>Minimally invasive CP with documentation of intraoperative location of endometriosis performed by fellowship-trained surgeons experienced in endometriosis excision. CP was defined as excision of left and right pelvic brims, pelvic side-walls, ovarian fossae, uterosacral ligaments, posterior cul-de-sac and bladder peritoneum.</div></div><div><h3>Measurements and Main Results</h3><div>Records were coded as 1(surgeon positive) or 0(surgeon negative) and 1(pathology positive) and 0(pathology negative). Discordance was calculated (surgeon positive-pathology negative=1; pathology negative-surgeon positive=-1). 89.3% of patients (28.7% of total regions) had at least one instance of discordance. In 61.6% of those cases, the operative report identified areas of suspected endometriosis, but the pathology showed no endometriosis. Of those cases 47.8% showed evidence of fibrosis or chronic inflammation. Hormonal medication and history of previous surgery were not related to surgeon positive/pathology negative discordance (chi-square, <em>p</em> = .07). In the other 38.4% of discordant cases, the operative report did NOT identify areas of suspected endometriosis, but the pathology report DID identify endometriosis. The area with the most identified endometriosis was the left ovarian fossa (80% positive pathology).</div></div><div><h3>Conclusion</h3><div>Evidence for surgical excision of endometriosis for improving pain is robust. Debate regarding the optimal technique continues. Our findings further support the emerging data suggesting the role of CP given that even with expert, well-trained eyes, microscopic endometriosis can be missed. Furthermore, presence of fibrosis or chronic inflammation in nearly half of the cases where the pathology report did not show endometriosis is an intriguing finding. Studies are needed to assess the role of CP in reducing the risk of repeated surgical interventions.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"31 11","pages":"Page S5"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658183","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":"Surgical Approach to a Type 8 Vaginal Myoma in the Endopelvic Fascia","authors":"M Keslar,&nbsp;N Pillalamarri,&nbsp;E Crihfield","doi":"10.1016/j.jmig.2024.09.066","DOIUrl":"10.1016/j.jmig.2024.09.066","url":null,"abstract":"<div><h3>Study Objective</h3><div>To review the literature for the prevalence of vaginal myomas and to demonstrate a case of isolated vaginal myoma excision.</div></div><div><h3>Design</h3><div>Case report with surgical videos.</div></div><div><h3>Setting</h3><div>Tertiary care hospital.</div></div><div><h3>Patients or Participants</h3><div>One patient.</div></div><div><h3>Interventions</h3><div>Patient was a 39 y/o G2P2 with vaginal fullness and bleeding that was found to have a 6 cm vaginal myoma that was filling the vaginal vault and was attached only to the anterior vagina based on office exam and vaginoscopy. MRI was performed and demonstrated a vaginal myoma with no other myomas, though location of the attachment on imaging was not clear. Plan was made for vaginal approach to excision, and this was performed with both hysteroscopy and cystoscopy to inspect possible involvement of surrounding structures. Key steps of procedure included use of vasopressin to assist with hemostasis, blunt dissection in the myoma capsule planes to remove myoma without injuring surrounding structures, and suture plication after excision to repair the endopelvic fascia and vaginal mucosa.</div></div><div><h3>Measurements and Main Results</h3><div>Vaginal myoma was removed successfully with no injury to nearby urethra or bladder. Vaginal wall defect was repaired successfully in the style of an anterior vaginal repair with good restoration of normal anatomy noted postoperatively and at post-op visit. Surgical techniques are reviewed in the surgical video.</div></div><div><h3>Conclusion</h3><div>Isolated type 8 vaginal myomas are rare and identifying their attachments to surrounding structures prior to excision is crucial, but vaginal approach to excision can be safely performed with care being taken to not injure surrounding structures and with endopelvic fascia repair performed after removal.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"31 11","pages":"Page S7"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658214","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":"Diaphragmatic Endometriosis Adjacent to Pericardium and Heart, a Mullerian Defect Removed by En Bloc Peritonectomy","authors":"I Chiminacio ,&nbsp;C Obrzut ,&nbsp;A Nishimura ,&nbsp;JF Petry ,&nbsp;H Sabadin","doi":"10.1016/j.jmig.2024.09.134","DOIUrl":"10.1016/j.jmig.2024.09.134","url":null,"abstract":"<div><h3>Study Objective</h3><div>To present a form of diaphragmatic endometriosis in the central tendon area near to the pericardium and heart removed en bloc by peritonectomy. And to discuss the Mullerian origin of endometriosis based on the sites of involvement.</div></div><div><h3>Design</h3><div>Edited didactic video showing en bloc peritonectomy applied to the removal of diaphragmatic and pelvic endometriosis.</div></div><div><h3>Setting</h3><div>Laparoscopic surgery using the latest generation of ultrasonic scissors for dissection and peritonectomy.</div></div><div><h3>Patients or Participants</h3><div>24 yo patient with intense pelvic, abdome and chest pain, presenting with grade IV AAGL endometriosis and diaphragmatic lesions near to pericardium and heart.</div></div><div><h3>Interventions</h3><div>Considering the location and distribution of the endometriosis lesions following a pattern called the Mullerian Path track and the layers of connective tissue below the peritoneum, the technique of en bloc removal by extensive peritonectomy was applied to all affected areas in the pelvis (Toldt's fascia, left parametrium, rectum and rectum), right parametrium, right iliac fossa and appendage, above the right kidney and in the diaphragm, including the central tendon area near the pericardium and heart.</div></div><div><h3>Measurements and Main Results</h3><div>As could be seen in the video, endometriosis follows a distribution path of probable Mullerian embryonic origin that is completely related to the simultaneous construction of the colon in the process of gastrulation. This determines the involvement of the pelvis and the right diaphragm that can reach close to the heart. It is also possible to see the usefulness of en bloc removal with peritonectomy using the ultrasonic device via the laparoscopic route. It can also be seen that endometriosis forms extensive \"marble-like\" lesions within the connective tissue, as opposed to simply spots on the surface of the peritoneum.</div></div><div><h3>Conclusion</h3><div>The technique presented seems effective and safe both for diaphragmatic lesions, including those close to the pericardium and heart, and for pelvic endometriosis. The technique may also be reproduced.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"31 11","pages":"Page S34"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658150","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 Impact of Body Mass Index on Surgical Complications in Minimally Invasive Hysterectomy for Adenomyosis","authors":"C Liao ,&nbsp;RJ Schneyer ,&nbsp;KN Wright","doi":"10.1016/j.jmig.2024.09.131","DOIUrl":"10.1016/j.jmig.2024.09.131","url":null,"abstract":"<div><h3>Study Objective</h3><div>To determine the impact of BMI on 30-day postoperative complications for patients undergoing minimally invasive hysterectomy (MIH) for adenomyosis in the United States.</div></div><div><h3>Design</h3><div>A cohort study of prospectively collected data.</div></div><div><h3>Setting</h3><div>American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2012 – 2020.</div></div><div><h3>Patients or Participants</h3><div>Patients with adenomyosis undergoing MIH.</div></div><div><h3>Interventions</h3><div>Minimally invasive hysterectomy.</div></div><div><h3>Measurements and Main Results</h3><div>Patients who underwent MIH for adenomyosis were classified into BMI subgroups based on the WHO classification system. Postoperative minor and major complications occurring within 30 days, defined according to the Clavien-Dindo classification, were compared across the BMI subgroups.</div><div>A total of 14,879 patients were included in the cohort. Higher BMI classes were associated with longer operative times (range 110.5-135.6 minutes, p&lt;0.001).</div><div>The overall rate of complications ranged 7.1%-10.9% between groups, with the highest in the underweight group. There was a significant difference in the rates of any and major complications between groups (p=0.006 and p=0.020 respectively). When analyzing specific complications, higher BMI was associated with increased risk of superficial surgical site infection (p&lt;0.001). Risks of septic shock or death were highest in the obesity class 3 group, but remained low (0.2% for both complications in obesity class 3).</div><div>In multivariable regression analysis comparing low and high BMI groups (&lt;/≥BMI 37.6), higher BMI was associated with increased odds for major complications [aOR 95% CI =1.29 (1.01-1.66)]. There was no significant association between low and high BMI and minor complications.</div><div>In multivariable regression analysis comparing BMI subgroups, BMI categories were not independently associated with any, minor, or major complications compared to the normal BMI category.</div></div><div><h3>Conclusion</h3><div>After adjusting for confounding factors, BMI ≥37.6 is independently associated with increased risk of major complications, but not with minor complications. Stratification by BMI groups did not reveal increased risk groups. These findings are reassuring and can help counsel and prepare patients for surgery.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"31 11","pages":"Page S33"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658152","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":"Performance Evaluation of AI-Powered Pelvic Lymph Nodes Dissection Support System","authors":"S Takenaka ,&nbsp;H Matsuzaki ,&nbsp;Y Nakanishi ,&nbsp;M Homma ,&nbsp;N Takeshita ,&nbsp;H Tanabe ,&nbsp;Y Tsukada","doi":"10.1016/j.jmig.2024.09.088","DOIUrl":"10.1016/j.jmig.2024.09.088","url":null,"abstract":"<div><h3>Study Objective</h3><div>The objective was to build a pelvic lymph node dissection support system using AI, evaluate the performance of the model, and verify whether this model provides an additional effect on physician organ recognition ability.</div></div><div><h3>Design</h3><div>This is a retrospective cohort study.</div></div><div><h3>Setting</h3><div>Using image data from 263 cases of pelvic lymphadenectomy from a national multi-center surgical database (111 gynecology, 118 colorectal, 34 urology), totaling 19,301 images, we constructed four organ recognition models (ureter, obturator nerve, external iliac artery/vein) using Feature Pyramid Networks (FPN). Subsequently, total of 1,920 videos were then created, including videos with and without each organ present.</div></div><div><h3>Patients or Participants</h3><div>Four obstetricians and gynecologists, two colorectal surgeons, two urologists.</div></div><div><h3>Interventions</h3><div>In the performance evaluation test, the accuracy of each organ was measured as Dice coefficient. In the additional evaluation test, surgeons were tested to determine the presence or absence of the organs and their locations in the videos without AI support. Next, the same test was conducted using videos with AI support.</div></div><div><h3>Measurements and Main Results</h3><div>In the performance evaluation test, the Dice coefficients were: ureter 0.700, nerve 0.835, artery 0.864, vein 0.862. In the additional effect test, sensitivity increased significantly for all organs except the artery: ureter +20.0% (43.4% → 63.4%), nerve +7.2% (68.4% → 75.6%), artery +5.9% (69.7% → 75.6%), and vein +11.5% (69.1% → 80.6%). Specificity also improved: ureter +4.4% (86.9% → 91.3%), nerve +7.5% (85.3% → 92.8%), artery +1.9% (93.4% → 95.3%), and vein +7.9% (83.4% → 91.3%), with no decline due to AI support.</div></div><div><h3>Conclusion</h3><div>The AI model showed a notable enhancement in surgeons' organ recognition ability. Future tests will involve surgeons of varying skill levels across three specialties to validate the model.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"31 11","pages":"Pages S19-S20"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658436","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}