Journal of minimally invasive gynecology最新文献

{"title":"Robot-Assisted Exploration of the Alcock Canal: A Novel Surgical Technique.","authors":"Khashayar Shakiba, Kateryna Kolesnikova","doi":"10.1016/j.jmig.2024.07.004","DOIUrl":"10.1016/j.jmig.2024.07.004","url":null,"abstract":"<p><strong>Study objective: </strong>To demonstrate a safe and reproducible surgical approach to the Alcock canal with a full decompression of the pudendal nerve.</p><p><strong>Design: </strong>The technique is demonstrated step-by-step with narrated video footage.</p><p><strong>Setting: </strong>Pudendal neuralgia, a condition causing debilitating pelvic pain, is traditionally managed through a transgluteal incision [1,2]. This surgical approach offers limited visualization and ability for nerve decompression [3]. With the current technique, a full exposure and decompression of the pudendal nerve was achieved.</p><p><strong>Interventions: </strong>A 44-year-old para 2 presented with burning vaginal pain radiating to the left groin that was aggravated with sitting. She underwent a robotic-assisted left sacrospinous ligament transection and fasciotomy of the obturator internus muscle for suspected pudendal neuralgia. The surgery was performed with 3 robotic ports using the da Vinci Xi robotic system.</p><p><strong>Conclusion: </strong>With the enhanced access to the pudendal nerve provided by the novel surgical technique demonstrated in this study, a more comprehensive nerve decompression can be performed. This technique was successfully applied to a patient with pudendal neuralgia. There were no immediate intra- or postoperative complications. In short-term follow-up, the patient had significant relief of preoperative symptoms. Although all surgical procedures for pudendal neuralgia have a risk of pudendal nerve and vessel injury [4], the presented technique has the potential to limit these risks by providing an enhanced view of the relevant anatomy. Future adaptation and refinement of this technique may contribute to the advancement of the surgical management of pudendal neuralgia. VIDEO ABSTRACT.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":"985"},"PeriodicalIF":3.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141555003","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":"Vaginal Packing After Pelvic Floor Reconstructive Surgery: Does the Soaking Agent Used for Packing (Bupivacaine, Estrogen or Saline) Impact Postoperative Pain Scores?","authors":"Humara Edell, Xinglin Li, Polina Myrox, Amanda Michael, Courtney Jolliffe, Tamara Abraham, Alex Kiss, Xingshan Cao, Louise-Helene Gagnon, Janet Bodley, Rose Kung, Patricia Lee","doi":"10.1016/j.jmig.2024.09.004","DOIUrl":"10.1016/j.jmig.2024.09.004","url":null,"abstract":"<p><strong>Study objective: </strong>Vaginal packing is traditionally placed after pelvic floor reconstructive surgery (PFRS) to prevent hematoma formation. We seek to determine if there is a difference in postoperative pain scores after PFRS if vaginal packing is soaked with estrogen cream, bupivacaine, or saline. The primary outcome was pain as measured by a visual analog scale at 2 hours, 6 hours, and 1 day postoperatively. Secondary outcomes include changes in hemoglobin, urinary retention and length of stay (LOS) in hospital.</p><p><strong>Design: </strong>Prospective cohort study.</p><p><strong>Setting: </strong>Tertiary care academic teaching hospital. All PFRS is performed by fellowship-trained urogynecologists.</p><p><strong>Participants: </strong>Consenting patients undergoing PFRS.</p><p><strong>Interventions: </strong>At the completion of surgery, gauze packing soaked with either estrogen cream, 0.25% bupivacaine with 1% epinephrine, or normal saline was placed inside the vagina and removed on postoperative day 1.</p><p><strong>Measurements and main results: </strong>We included 210 patients (74 estrogen, 66 bupivacaine, 70 saline). There was no significant difference in mean postoperative pain scores between the groups (estrogen, bupivacaine, saline-soaked vaginal packs respectively) at 2 hours (2.66 ± 2.25, 2.30 ± 2.17, 2.24 ± 2.07; p = .4656), 6 hours (2.99 ± 2.38, 2.52 ± 2.30, 2.36 ± 2.01; p = .2181) or on postoperative day 1 (1.89 ± 2.01 vs 2.08 ± 2.15 vs 2.44 ± 2.19; p = .2832) as measured by visual analog scale scores (0-10). There was no difference in the secondary outcomes of change in pre/postoperative hemoglobin (21.8 ± 10.73g/L, 20.09 ± 11.55 g/L, 21.7 ± 9.62g/L, p = .68), urinary retention (37%, 45% and 48%, p = .45), LOS (1.05 ± 0.46 days, 1.02 ± 0.12, 1.03 ± 0.24, p = .97) or in-hospital opioid usage during admission (represented in morphine milligram equivalents [median (IQR1, IQR3)], Kruskal-Wallis test): 11.25 mg (0, 33), 7.5 mg (0, 22.5) and 15 mg (0, 33.88) p = .41.</p><p><strong>Conclusion: </strong>There was no difference found between soaking vaginal packing with estrogen cream, bupivacaine, or saline after PFRS with respect to postoperative pain scores, LOS, in-hospital opioid usage, or urinary retention. Saline-soaked packing is an equivalent alternative to estrogen or bupivacaine vaginal packing.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":"1050-1056"},"PeriodicalIF":3.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289355","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":"Regarding: A Controversial Old Topic Revisited: Should Diagnostic Hysteroscopy Be Routinely Performed Prior to the First IVF Cycle? A Systematic Review and Updated Meta-Analysis.","authors":"Xiaoyan Wang, Yurong Wu","doi":"10.1016/j.jmig.2024.07.023","DOIUrl":"10.1016/j.jmig.2024.07.023","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":"1057-1058"},"PeriodicalIF":3.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141971306","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 Fellowship Affiliation on Urogynecology Training in Obstetrics and Gynecology Residency.","authors":"K Marie Douglass, Kaitlin D Crawford, Tajnoos Yazdany","doi":"10.1016/j.jmig.2024.08.004","DOIUrl":"10.1016/j.jmig.2024.08.004","url":null,"abstract":"<p><strong>Objective: </strong>To compare characteristics of Urogynecology training and number of \"Incontinence and Pelvic Floor\" cases logged between Obstetrics and Gynecology (OB/GYN) residencies affiliated and those not affiliated with Urogynecology fellowships.</p><p><strong>Design: </strong>A retrospective descriptive analysis was performed of OB/GYN residency programs, their Urogynecology training, and association with Urogynecology fellowship programs during the 2023 to 2024 academic year. Program websites for Accreditation Council for Graduate Medical Education (ACGME)-accredited OB/GYN residency programs were reviewed to determine availability, timing, and length of Urogynecology training. ACGME data for \"Incontinence and Pelvic Floor\" cases were analyzed by training year and association with Urogynecology fellowship programs from the 2012-2013 to 2022-2023 academic year. Data was analyzed using SPSS.</p><p><strong>Setting: </strong>This research was conducted at Harbor-UCLA Medical Center.</p><p><strong>Participants: </strong>None.</p><p><strong>Interventions: </strong>None.</p><p><strong>Results: </strong>Information was obtained for 85.9% of programs. Nearly all (97.0%) had dedicated Urogynecology rotations, and 64.4% had rotations in >1 year of training. Association with Urogynecology fellowship did not affect the availability of Urogynecology training overall nor the overall number of rotations. Urogynecology rotations occurred most often in the third (PGY3) year of residency, though 43.6% of programs had training for junior (PGY1, PGY2) residents. Residencies with associated Urogynecology fellowships were more likely to have a rotation for PGY2 residents and for junior residents overall. From 2012 to 2023, the number of \"Incontinence and Pelvic Floor\" cases declined by 36.3%, with trainees at residencies not affiliated with Urogynecology fellowships logging more cases than those at a fellowship-affiliated residency.</p><p><strong>Conclusion: </strong>While the majority of OB/GYN residencies have dedicated Urogynecology training, most rotations are for senior residents. Training programs associated with Urogynecology fellowships are more likely to expose junior residents to the field, but their trainees log fewer \"Incontinence and Pelvic Floor\" cases overall. Earlier exposure may enrich surgical training and help residents prepare for their careers, whether in Urogynecology or as a generalist.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":"1004-1010"},"PeriodicalIF":3.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141988175","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":"Assessment of Education and Management of Endometriosis Among Colorectal Surgeons and Residents.","authors":"Gabriella Rivera Ortiz, Gabriela C Poles, Janet A Foote, Ashley Gubbels","doi":"10.1016/j.jmig.2024.08.009","DOIUrl":"10.1016/j.jmig.2024.08.009","url":null,"abstract":"<p><strong>Study objective: </strong>To identify the type of endometriosis education and surgical training colorectal surgery residents are exposed to during training. To determine the current surgical management of endometriosis among recently graduated colorectal surgeons and their level of comfort.</p><p><strong>Design: </strong>A qualitative cross-sectional study was performed. An anonymous questionnaire was emailed to colorectal surgery residents of 2023 and recent graduates for completion. Data was then extracted and analyzed from REDCap. A chi-square test was performed on the primary outcome variables.</p><p><strong>Setting: </strong>A REDCap electronic survey was administered through email to each participant.</p><p><strong>Patients: </strong>All colorectal surgery residents in 2023 and recent graduates from Colon and Rectal Surgery subspecialty from 2012 to 2022.</p><p><strong>Interventions: </strong>A 17-item anonymous questionnaire was sent via email through REDCap.</p><p><strong>Measurements and main results: </strong>The survey was completed by 70 participants. Most respondents (58.5%) did not receive formal education on bowel endometriosis. Forty percent of participants (28/70) did not feel they received adequate training for surgical management of bowel endometriosis. In terms of surgical exposure, 3.8% (2) responded they had been involved in >15 bowel endometriosis cases and 18 (25.7%) had been exposed to 1-5 cases during colorectal training. Factors that predicted feeling adequately trained in managing endometriosis included formal endometriosis education (OR 4.70, 95% CI 1.37-16.12, p-value .027) and surgical exposure during training (OR 4.38, 95% CI 1.18-16.26, p-value .014). Additionally, the number of cases exposed during training is highly correlated with feeling adequately trained.</p><p><strong>Conclusion: </strong>More than half of colorectal surgeons did not receive formal education on bowel endometriosis and the majority had only been exposed to 1-5 cases during their colorectal training. An overwhelming majority were interested in further education. This study highlights opportunities for improvement in the exposure to education and surgical management of endometriosis among colorectal surgery trainees.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":"1019-1025"},"PeriodicalIF":3.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142154374","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":"A Case of a Prolapsing Cervical Myoma Managed With Robot-Assisted Total Laparoscopic Hysterectomy.","authors":"R Gina Silverstein, Caroline S Kwon, Natalie Satterfield, Lauren D Schiff","doi":"10.1016/j.jmig.2024.07.014","DOIUrl":"10.1016/j.jmig.2024.07.014","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":"979-980"},"PeriodicalIF":3.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141759285","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":"Tissue Retrieval of Laparoscopically Excised Adnexal Specimens in Gynecologic Surgery: Posterior Culdotomy Versus Abdominal Extraction.","authors":"Toni S Horton, Hannah S Palin, Melinda H Chai, Emily C Craver, Aakriti R Carrubba","doi":"10.1016/j.jmig.2024.08.019","DOIUrl":"10.1016/j.jmig.2024.08.019","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study is to compare intraoperative and postoperative outcomes in women undergoing removal of adnexal structures by either posterior culdotomy or abdominal extraction.</p><p><strong>Design: </strong>This is a retrospective cohort study conducted via medical record review. Demographic, clinical, and operative variables were abstracted from the medical records. Statistical analysis consisted of descriptive statistics, Fisher's exact tests, Wilcoxon rank sum tests, and multivariable logistic regression models.</p><p><strong>Setting: </strong>Single academic tertiary care center between 2010 and 2022.</p><p><strong>Participants: </strong>A total of 718 patients were identified and included in our analysis who underwent minimally invasive ovarian cystectomy or oophorectomy. Patients were excluded if they underwent concomitant hysterectomy.</p><p><strong>Interventions: </strong>Patients underwent minimally invasive oophorectomy or ovarian cystectomy, and specimens were extracted by either abdominal extraction (AE) or culdotomy extraction (CE).</p><p><strong>Measurements and main results: </strong>Of the 718 patients who met inclusion criteria, 127 (17.7%) underwent CE, and 591 (82.3%) underwent abdominal extraction. The CE group had longer operative times (113 minutes vs 96 minutes, p <.001) and higher estimated blood loss (25 mL vs 10 mL, p <.001) compared to the abdominal extraction group. There were more malignancies in the CE than the abdominal extraction group (15.7% vs 8.1%, respectively, p <.001). After adjusting for potential confounders, those who underwent CE were more likely to have 2 or more clinic visits (OR 2.89; 95% confidence interval, 1.66-5.03; p <.001) and call or message the clinic (OR 2.08; 95% confidence interval, 1.35-3.20; p <.001). There were no incidences of cuff dehiscence, cuff cellulitis, or pelvic abscess in either group.</p><p><strong>Conclusion: </strong>Removal of adnexal specimens via abdominal port site or posterior culdotomy incision is a feasible option for specimen extraction and can be individualized based on patient and surgeon preference and patient factors. Those undergoing CE may require more preoperative counseling due to higher rate of postoperative messages seen in our cohort.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":"1026-1033.e2"},"PeriodicalIF":3.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145804","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":"Bringing Our Colorectal Surgical Colleagues Into the Endometriosis Tent.","authors":"Jason A Abbott","doi":"10.1016/j.jmig.2024.10.026","DOIUrl":"https://doi.org/10.1016/j.jmig.2024.10.026","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"31 12","pages":"973-974"},"PeriodicalIF":3.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791796","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":"An Almost Ruptured Interstitial Pregnancy That Was Completely Removed by Laparoscopic Linear Cornuostomy.","authors":"Wenchao Sun, Guier Chen, Zhiwen Chen","doi":"10.1016/j.jmig.2024.06.015","DOIUrl":"10.1016/j.jmig.2024.06.015","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":"977-978"},"PeriodicalIF":3.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141468681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic Buccal Mucosa Grafting for Distal Ureter Stricture Related to Deep Endometriosis.","authors":"Romeo Micu, Dan Boitor-Borza, Nicolae Crisan","doi":"10.1016/j.jmig.2024.08.014","DOIUrl":"10.1016/j.jmig.2024.08.014","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":"981-982"},"PeriodicalIF":3.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142108270","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}