Journal of minimally invasive gynecology最新文献

{"title":"The Optimal Surgical Approach for Deep Infiltrating Endometriosis Involving Pelvic Nerves (type 1 and 2)","authors":"Nicolas Samartzis MD,&nbsp;Dimitrios Rafail Kalaitzopoulos MD,&nbsp;Laurin Burla MD,&nbsp;Horace Roman MD","doi":"10.1016/j.jmig.2026.02.034","DOIUrl":"10.1016/j.jmig.2026.02.034","url":null,"abstract":"<div><h3>Objective</h3><div>Excision of deep infiltrating endometriosis in the parametrium involving pelvic nerves can be challenging and requires good anatomical knowledge and surgical strategy [<span><span>1</span></span>]. Based on our experience, we have identified two important types of nodule in this compartment, differing in location and the pelvic structures involved, and therefore propose this new classification. This video aims to show a standardized, reproducible method for each type.</div></div><div><h3>Setting</h3><div>The surgeries were performed with the DaVinci Xi system at the IFEMEndo center in Bordeaux, France. Illustrations were produced with Blender and After Effects.</div></div><div><h3>Participants</h3><div>The patients gave consent for publication of the video. The study was approved by the local ethics committee.</div></div><div><h3>Interventions</h3><div>Type 1 nodules are situated medially at the origin of the uterosacral ligaments, with surrounding structures including the ureter, rectum, and sacral roots. These nodules require a medial pelvic approach, starting with ureterolysis and dissection of the rectum and rectovaginal septum if needed. After identifying the hypogastric nerve, the internal iliac vessels are dissected and ligated when necessary. Caudally, the sacral roots and the inferior hypogastric plexus are then located and must be preserved as much as possible during the resection of the nodule.</div><div>Type 2 lesions are found laterally on the pelvic sidewall. The approach begins laterally from the external iliac vessels and proceeds into the lumbosacral space. Identification of the obturator nerve and vessels is followed by further dissection towards the lumbosacral trunk and sciatic nerve. On the anterior side of the nodule, we may encounter the bladder. The lesion is then progressively removed from the sacral roots, sacrospinous ligament, pudendal nerve, and pelvic sidewall.</div></div><div><h3>Conclusions</h3><div>According to our experience, deep infiltrating endometriosis of the parametrium involving the sacral root or lumbosacral trunk and sciatic nerve are two distinct types. A systematic approach helps minimize the risk of inadvertent injury to critical pelvic structures.</div></div><div><h3>Video Abstract</h3><div><span><span><span><span><video><source></source></video></span><span><span>Download: <span>Download video (63MB)</span></span></span></span></span></span></div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"33 10","pages":"Page 1407"},"PeriodicalIF":2.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147306709","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":"Oral Gonadotropin-Releasing Hormone Antagonists for the Treatment of Endometriosis-Associated Pain: A Systematic Review and Meta-Analysis","authors":"Richard Hsu MD,&nbsp;Esther S. Han MD,&nbsp;Monique Farrow MD,&nbsp;Michelle Pacis MD,&nbsp;Sarah Swartz MD,&nbsp;Kathryn Denny MD","doi":"10.1016/j.jmig.2026.04.004","DOIUrl":"10.1016/j.jmig.2026.04.004","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Study Objective&lt;/h3&gt;&lt;div&gt;To evaluate the efficacy of oral gonadotropin-releasing hormone (GnRH) antagonists vs placebo for treatment of endometriosis-associated pain and to compare individual antagonists indirectly for dysmenorrhea and non-menstrual pelvic pain.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;To evaluate the efficacy of oral gonadotropin-releasing hormone (GnRH) antagonists vs placebo for treatment of endometriosis-associated pain and to compare individual antagonists indirectly for dysmenorrhea and non-menstrual pelvic pain.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;Systematic review and meta-analysis of phase 3 randomized, double-blind, placebo-controlled trials of oral GnRH antagonists in people with moderate-to-severe endometriosis-associated pain, with dual screening, standardized data extraction, and risk of bias assessment using the Cochrane Risk of Bias 2 tool.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Systematic review and meta-analysis of phase 3 randomized, double-blind, placebo-controlled trials of oral GnRH antagonists in people with moderate-to-severe endometriosis-associated pain, with dual screening, standardized data extraction, and risk of bias assessment using the Cochrane Risk of Bias 2 tool.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting&lt;/h3&gt;&lt;div&gt;Multicenter phase 3 clinical trials conducted in outpatient gynecology and reproductive health settings across North America, Europe, and other international sites, identified through electronic databases and trial registries from inception through October 2025.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Multicenter phase 3 clinical trials conducted in outpatient gynecology and reproductive health settings across North America, Europe, and other international sites, identified through electronic databases and trial registries from inception through October 2025.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Patients&lt;/h3&gt;&lt;div&gt;A total of 2060 participants with surgically or imaging-diagnosed endometriosis and moderate-to-severe baseline pain, with mean ages of 31 to 35 years, enrolled in five phase 3 trials (ELARIS, SPIRIT 1 and 2, and EDELWEISS-3).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;A total of 2060 participants with surgically or imaging-diagnosed endometriosis and moderate-to-severe baseline pain, with mean ages of 31 to 35 years, enrolled in five phase 3 trials (ELARIS, SPIRIT 1 and 2, and EDELWEISS-3).&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interventions&lt;/h3&gt;&lt;div&gt;The included trials evaluated three oral GnRH antagonist regimens: elagolix 200 mg twice daily without add‑back, relugolix 40 mg once daily combination therapy, and linzagolix 200 mg once daily with add-back. Add-back and combination therapy were defined as co‑administration of estradiol 1 mg and norethindrone acetate 0.5 mg once daily. Each regimen was compared with a matching placebo for treatment durations up to 24 weeks.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;The included trials evaluated three oral GnRH antagonist regimens: elagolix 200 mg twice daily without add‑back, relugolix 40 mg once daily combination therapy, and linzagolix 200 mg once daily with add-back. Add-back and combination therapy were defined ","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"33 10","pages":"Pages 1526-1532.e3"},"PeriodicalIF":2.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774152","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":"Surgery for Pain Symptoms in Women With Isolated Superficial Peritoneal Endometriosis","authors":"Maria Maslenko MD,&nbsp;Yaara Tabib MD,&nbsp;Tal D. Saar MD,&nbsp;Alaa Abu Khattab MD,&nbsp;Uri P. Dior MD, MPH","doi":"10.1016/j.jmig.2026.03.039","DOIUrl":"10.1016/j.jmig.2026.03.039","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Study Objective&lt;/h3&gt;&lt;div&gt;To evaluate the change in overall pain after surgery in participants with suspected isolated superficial peritoneal endometriosis (iSPE), and to identify improvement predictors.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;To evaluate the change in overall pain after surgery in participants with suspected isolated superficial peritoneal endometriosis (iSPE), and to identify improvement predictors.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;Retrospective cohort study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Retrospective cohort study.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting&lt;/h3&gt;&lt;div&gt;Tertiary endometriosis referral center.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Tertiary endometriosis referral center.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Participants&lt;/h3&gt;&lt;div&gt;Women aged 18 to 45 years with endometriosis-associated pain symptoms and negative preoperative imaging for deep infiltrating or ovarian endometriosis who underwent excisional surgery for suspected iSPE between 2019 and 2024.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Women aged 18 to 45 years with endometriosis-associated pain symptoms and negative preoperative imaging for deep infiltrating or ovarian endometriosis who underwent excisional surgery for suspected iSPE between 2019 and 2024.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interventions&lt;/h3&gt;&lt;div&gt;Participants were classified into the endometriosis and no endometriosis groups based on surgical findings. Pain outcomes were assessed at short-term (6–12 weeks), medium-term (12 weeks–12 months), and long-term (&gt;12 months) follow-up, using medical records and a structured postoperative questionnaire.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Participants were classified into the endometriosis and no endometriosis groups based on surgical findings. Pain outcomes were assessed at short-term (6–12 weeks), medium-term (12 weeks–12 months), and long-term (&gt;12 months) follow-up, using medical records and a structured postoperative questionnaire.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Measurements and Main Results&lt;/h3&gt;&lt;div&gt;A total of 250 participants were included; 158 (63.2%) with surgically confirmed iSPE and 92 (36.8%) with no evidence of disease. Baseline characteristics and preoperative symptoms were similar between groups. Participants with iSPE reported significantly greater pain improvement rates at all follow-up intervals (77.7% vs 56.9% at 6–12 weeks; 80.9% vs 54.1% at 12 weeks–12 months; 82.6% vs 52.9% at &gt;12 months; all p &lt;.01). Endometriosis was the strongest independent predictor of postoperative pain improvement at all follow-up intervals (6–12 weeks: OR = 2.6; 95% CI, 1.4–4.7; 12 weeks–12 months: OR = 3.3; 95% CI, 1.0–10.2; &gt;12 months: OR = 4.4; 95% CI, 2.1–9.2). Long-term improvement was more likely with postoperative hormonal therapy and less likely in participants with adenomyosis. Improvement was greatest for dysmenorrhea, nonmenstrual pelvic pain, dyspareunia, and gastrointestinal symptoms.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;A total of 250 participants were included; 158 (63.2%) with surgically confirmed iSPE and 92 (36.8%) with no evidence of disease. Baseline characteristics and preoperative symptoms were similar between groups. ","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"33 10","pages":"Pages 1497-1504"},"PeriodicalIF":2.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147618691","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":"Hysteroscopy Contribution in Unlocated Pregnancy Localization, Diagnosis, and Management","authors":"Elodie Meiranesio MD,&nbsp;Anne Pinton MD, PhD,&nbsp;Richard Paul-Dehlinger MD,&nbsp;Omar Hafez MD,&nbsp;Guillaume Legendre MD, PhD,&nbsp;Félicia Joinau-Zoulovits MD","doi":"10.1016/j.jmig.2026.04.001","DOIUrl":"10.1016/j.jmig.2026.04.001","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;Evaluate diagnostic hysteroscopy (HSC) contribution in early unlocated pregnancy (UP) localization.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Evaluate diagnostic hysteroscopy (HSC) contribution in early unlocated pregnancy (UP) localization.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;A retrospective, observational study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;A retrospective, observational study.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting&lt;/h3&gt;&lt;div&gt;A single tertiary hospital center.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;A single tertiary hospital center.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Participants&lt;/h3&gt;&lt;div&gt;Patients with early nonviable pregnancies, abnormal plasma beta human chorionic gonadotropin (β-hCG) kinetics (at least three measurements), inconclusive ultrasound concerning pregnancy localization, and hemodynamic stability were included. Between May 2023 and July 2024, a total of 31 consecutive patients were eligible, of whom 27 were included in statistical analysis as they strictly met the inclusion criteria for nonviable pregnancy (β-hCG increase of ≤15% within 48 hours).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Patients with early nonviable pregnancies, abnormal plasma beta human chorionic gonadotropin (β-hCG) kinetics (at least three measurements), inconclusive ultrasound concerning pregnancy localization, and hemodynamic stability were included. Between May 2023 and July 2024, a total of 31 consecutive patients were eligible, of whom 27 were included in statistical analysis as they strictly met the inclusion criteria for nonviable pregnancy (β-hCG increase of ≤15% within 48 hours).&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Intervention&lt;/h3&gt;&lt;div&gt;Outpatient diagnostic HSC for early nonviable UP. Diagnostic HSC was performed by vaginoscopy using a rigid hysteroscope under physiological saline, in an outpatient visit, without anesthesia.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Outpatient diagnostic HSC for early nonviable UP. Diagnostic HSC was performed by vaginoscopy using a rigid hysteroscope under physiological saline, in an outpatient visit, without anesthesia.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Diagnostic HSC localized pregnancy in 66.7% of cases (17 intrauterine, 1 cornual) via direct visualization of trophoblastic material. For plasma β-hCG ≥198 international unit/L, HSC detected intrauterine material in 78.3% of cases. Below this threshold, results were inconclusive, either with uterine vacuity or hematometra.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Diagnostic HSC localized pregnancy in 66.7% of cases (17 intrauterine, 1 cornual) via direct visualization of trophoblastic material. For plasma β-hCG ≥198 international unit/L, HSC detected intrauterine material in 78.3% of cases. Below this threshold, results were inconclusive, either with uterine vacuity or hematometra.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Diagnostic HSC appears to be a useful, feasible tool for UP management, allowing the pregnancy localization in about two-thirds of cases. In our study, a β-hCG threshold of 198 international unit/L was associated with the detection of retained pregnancy tissue. However, further studies are needed to confirm its role, benefits, and","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"33 10","pages":"Pages 1512-1518.e2"},"PeriodicalIF":2.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147627988","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 Social Media in Endometriosis: A Systematic Review of Users, Content, Information Quality, and Content Creators","authors":"Chiara Maria Latini MD,&nbsp;Monica Cremonesi JD, MA,&nbsp;Valentina Meschia PharmD, MA,&nbsp;Rosy Matrangolo MA,&nbsp;Ilaria Coro MA,&nbsp;Mathew Leonardi MD, PhD,&nbsp;Michele Vignali MD,&nbsp;Paolo Vercellini MD,&nbsp;Noemi Salmeri MD","doi":"10.1016/j.jmig.2026.06.035","DOIUrl":"10.1016/j.jmig.2026.06.035","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;To systematically review qualitative and quantitative evidence on the role of social media (SM) in endometriosis awareness and disease management.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;To systematically review qualitative and quantitative evidence on the role of social media (SM) in endometriosis awareness and disease management.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Data Sources&lt;/h3&gt;&lt;div&gt;A systematic search was conducted in PubMed and Scopus up to December 28, 2025.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;A systematic search was conducted in PubMed and Scopus up to December 28, 2025.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Original studies investigating the role of SM in endometriosis were included. Exclusion criteria comprised nonoriginal articles, non-English publications, analyses limited to single webpages, and studies lacking relevant data. Methodological quality of individual studies was assessed using the Newcastle–Ottawa Scale (NOS), Mixed Methods Appraisal Tool (MMAT), and Critical Appraisal Skills Programme (CASP) checklist. Four domains were examined: (i) characteristics of SM users, (ii) types of content shared, (iii) information quality, and (iv) type of content creators.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Original studies investigating the role of SM in endometriosis were included. Exclusion criteria comprised nonoriginal articles, non-English publications, analyses limited to single webpages, and studies lacking relevant data. Methodological quality of individual studies was assessed using the Newcastle–Ottawa Scale (NOS), Mixed Methods Appraisal Tool (MMAT), and Critical Appraisal Skills Programme (CASP) checklist. Four domains were examined: (i) characteristics of SM users, (ii) types of content shared, (iii) information quality, and (iv) type of content creators.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Tabulation, Integration, and Results&lt;/h3&gt;&lt;div&gt;Twenty-one studies performed SM content analyses, while 5 used surveys/interviews. SM users were predominantly young women and frequently reported psychological burden, diagnostic delays (&gt;10 years), and negative healthcare experiences. The most commonly reported SM themes were personal experiences (n = 15), symptoms (n = 11), infertility/fertility concerns (n = 10), disease management and treatments (n = 14), emotional support and advocacy (n = 14), and distrust toward healthcare professionals (HCPs) (n = 9). Dysmenorrhea was the most frequently discussed symptom, while surgery, hormonal therapies, and complementary treatments represented the main treatment-related topics. Overall information quality was heterogeneous, with approximately 23% to 30% of content containing misinformation, particularly regarding treatments and alternative therapies. Ten studies evaluated content creators: non-HCPs generated most SM content (80%–95%) and generally showed higher engagement, whereas HCP-generated content demonstrated greater accuracy, reliability, and educational quality.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Twenty-one studies performed SM content analyses, while 5 used surveys/interviews. SM users wer","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"33 10","pages":"Pages 1448-1464.e4"},"PeriodicalIF":2.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471128","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":"Robotic Excision of a Sciatic Nerve Schwannoma and Vascular Entrapment at the Greater Sciatic Foramen with Concomitant Deep Infiltrating Endometriosis Approach.","authors":"Henrique Mendonça Abrao, Paulo Otavio Maluf Perin, Cinthia Callegari Barbisan, Andrea Vidali","doi":"10.1016/j.jmig.2026.09.019","DOIUrl":"https://doi.org/10.1016/j.jmig.2026.09.019","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110649","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":"Defining the Critical View of Safety and Safe Steps for Parametrial Transection in Minimally Invasive Hysterectomy: A Delphi Consensus Study.","authors":"Takayuki Takahashi, Risa Takai, Shin Takenaka, Hikaru Matsuoka, Iori Kisu, Osamu Wada-Hiraike, Yoichiro Yamamoto, Miyuki Harada, Yasushi Hirota, Wataru Yamagami","doi":"10.1016/j.jmig.2026.09.011","DOIUrl":"10.1016/j.jmig.2026.09.011","url":null,"abstract":"<p><strong>Objective: </strong>To establish expert consensus on Critical View of Safety criteria and Safe Steps for parametrial transection during minimally invasive hysterectomy to support injury prevention and blood-loss control.</p><p><strong>Design: </strong>Modified Delphi consensus study.</p><p><strong>Setting: </strong>Nationwide online survey conducted in Japan from February through June 2025.</p><p><strong>Participants: </strong>Thirty-three of 34 invited expert gynecologic laparoscopic surgeons participated (response rate, 97.1%). All 33 completed all four rounds (retention rate, 100%).</p><p><strong>Interventions: </strong>Open-ended item generation (Round 1) was followed by iterative Likert-scale rating and wording refinement (Rounds 2-4). Consensus was defined a priori as a rate of agreement (RoA) ≥70%.</p><p><strong>Results: </strong>Consensus was reached on 20 statements across seven categories, with RoA ranging from 72.7% to 97.0%. Adopted statements included sufficient caudal bladder mobilization (RoA 97.0%), division of the cranial leaves of the vesicouterine ligaments before transection of the lateral parametrial vessels (RoA 78.8%-81.8%), confirmation of the course of the deep uterine vein before transection (RoA 97.0%), and maintaining a safe distance from the ureter when using an energy device (RoA 97.0%). The panel also endorsed adapting the steps leading up to transection according to intraoperative findings (RoA 81.8%-93.9%).</p><p><strong>Conclusion: </strong>This Delphi study established consensus on 20 statements for parametrial transection in minimally invasive hysterectomy. These statements comprise Critical View of Safety criteria, Safe Steps, and general principles and provide intraoperative checkpoints and practical guidance to support prevention of bladder and ureteral injuries, control of blood loss, surgical training, and future evaluation.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075102","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":"Bilateral Salpingo-Oophorectomy at Time of Benign Hysterectomy: A Demographic Analysis in an Integrated Healthcare System.","authors":"Jeitzel M Torres-Rodriguez, Lue-Yen Tucker, Tiffany Guerra, Miranda Ritterman Weintraub, Jesse Brewer, Eve Zaritsky","doi":"10.1016/j.jmig.2026.09.465","DOIUrl":"https://doi.org/10.1016/j.jmig.2026.09.465","url":null,"abstract":"<p><strong>Study objective: </strong>To characterize temporal trends, demographic variations and clinical factors of bilateral salpingo-oophorectomy (BSO) performed during benign hysterectomy among premenopausal women within the Kaiser Permanente Northern California (KPNC) medical centers.</p><p><strong>Design: </strong>Retrospective observational study.</p><p><strong>Setting: </strong>KPNC, a large integrated healthcare delivery organization.</p><p><strong>Patients: </strong>Women, aged 18-50 who underwent a benign hysterectomy within KPNC between 2010 and 2019.</p><p><strong>Intervention: </strong>Concurrent BSO with hysterectomy.</p><p><strong>Measurements and main results: </strong>Procedure codes from KPNC Health Connect database were used to identify surgical techniques and demographic data. A total of 28,080 benign hysterectomies were performed; of which, 87.9% (n=24,686) were minimally invasive hysterectomies. BSO occurred in 13.4% (n=3754) of all cases and the annual incidence decreased from 21.6% to 7.1% over the study period. BSO rates were consistently higher across study years in White women, beginning at 25.4% in 2010 and decreasing to 8.7% in 2019. BSO rates by socioeconomic status/Neighborhood Deprivation Index (NDI) showed a steady decline over the study period with no clinically significant difference between NDI quintiles.</p><p><strong>Conclusion: </strong>This study provides contemporary system-level data describing BSO utilization within an integrated healthcare delivery organization. The decline in premenopausal BSO utilization over the study period, likely reflects evolving clinical practice. Unlike national trends, BSO rates were lower among non-White individuals, and no significant variation in BSO across NDI quintiles were observed.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069341","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":"Minimally Invasive Hemi-Hysterectomy for Symptomatic Uterine Didelphys: Surgical Technique and Fertility-Preserving Considerations.","authors":"Lillian Dyre, Kelsey Stewart, Zaraq Khan, Michael F Neblett","doi":"10.1016/j.jmig.2026.09.014","DOIUrl":"https://doi.org/10.1016/j.jmig.2026.09.014","url":null,"abstract":"<p><strong>Objective: </strong>To describe the step-by-step approach to hemi-hysterectomy in a patient with uterine didelphys to reduce pelvic pain while preserving fertility.</p><p><strong>Setting: </strong>Tertiary academic medical center.</p><p><strong>Participants: </strong>A 32-year-old G0 patient with uterine didelphys, Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA) Syndrome, and chronic pelvic pain. She had previously undergone resection of an oblique vaginal septum for hematocolpos. She presented with persistent pelvic pain requiring multiple emergency room visits, copious white-yellow vaginal discharge and leukocytosis of unknown origin with white blood cell count of 14,000 µL. Exam revealed a hypoplastic left cervix which was thought to be obstructing menstrual flow resulting in chronic pelvic pain.</p><p><strong>Interventions: </strong>Robotic-assisted laparoscopic left hemi-hysterectomy and salpingectomy were performed. The left vaginal cuff was closed with special consideration given to the contralateral right cervix, which remained in situ. A medial defect in the right uterus was closed in multiple layers with appropriate reapproximation. Final diagnostic hysteroscopy was performed and confirmed patency and integrity of the remaining uterine cavity. The surgery and postoperative course were uncomplicated. Her chronic pelvic pain, abnormal vaginal discharge, and leukocytosis of unknown origin resolved after treatment.</p><p><strong>Conclusion: </strong>Hemi-hysterectomy is not a standard treatment for uterine didelphys-associated pelvic pain but may be considered in highly selected patients with persistent symptoms attributable to one hemiuterus after treatment of associated obstructive anatomy and careful exclusion of alternative etiologies. When pursued, meticulous preoperative planning and surgical technique are essential to preserve the contralateral hemiuterus and its reproductive potential.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149061780","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":"Establishing a Uterus Transplantation Program: Institutional and Clinical Framework for Implementation.","authors":"Liza Johannesson, Giuliano Testa","doi":"10.1016/j.jmig.2026.09.017","DOIUrl":"10.1016/j.jmig.2026.09.017","url":null,"abstract":"<p><p>Uterus transplantation (UTx) is an emerging treatment for absolute uterine factor infertility, enabling gestation in individuals without a functional uterus. Since the first live birth in 2014, more than 150 procedures and over 80 live births have been reported worldwide. Unlike conventional solid organ transplantation, UTx is a temporary intervention aimed at restoring reproductive capacity, requiring integration across transplant surgery, reproductive endocrinology, and maternal-fetal medicine. Despite rapid clinical progress, structured guidance for program development remains limited. UTx requires coordinated institutional infrastructure, multidisciplinary team integration, donor and recipient pathways, reproductive medicine systems, perioperative and immunosuppressive protocols, pregnancy management frameworks, and long-term research infrastructure. This invited review provides a standardized framework for establishing a UTx program in the United States, with emphasis on institutional readiness, clinical pathways, ethical considerations, and sustainability.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149030837","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}