Journal of minimally invasive gynecology最新文献

{"title":"The Impact of Minimally Invasive Gynecologic Surgery Subspecialty Training on Outcomes of Myomectomy: A Retrospective Cohort Study","authors":"Rebecca J. Schneyer MD ,&nbsp;Raanan Meyer MD ,&nbsp;Margot L. Barker MD ,&nbsp;Kacey M. Hamilton MD ,&nbsp;Matthew T. Siedhoff MD, MSCR ,&nbsp;Mireille D. Truong MD ,&nbsp;Kelly N. Wright MD","doi":"10.1016/j.jmig.2024.11.013","DOIUrl":"10.1016/j.jmig.2024.11.013","url":null,"abstract":"<div><h3>Study Objective</h3><div>To compare surgical outcomes among patients undergoing minimally invasive myomectomy (MIM) or abdominal myomectomy (AM) with MIGS subspecialists versus general obstetrician/gynecologists (OB/GYNs), and to characterize the complexity of myomectomies by surgeon type.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting</h3><div>Quaternary care institution.</div></div><div><h3>Participants</h3><div>Patients who underwent MIM (laparoscopic or robotic) or AM with a fellowship-trained MIGS subspecialist or general OB/GYN from March 15, 2015 to March 14, 2020.</div></div><div><h3>Interventions</h3><div>Myomectomy.</div></div><div><h3>Results</h3><div>Of 609 myomectomies, 460 (75.5%) were MIM, 404 (87.8%) of which were performed by MIGS subspecialists. The remaining 149 (24.5%) cases were AM, 36 (24.1%) of which were performed by MIGS subspecialists. Compared to general OB/GYNs, MIGS subspecialists excised a greater number of fibroids for both MIM (median 3.0 [range 1.0–30.0] vs 2.0 [1.0–9.0], p &lt;.001) and AM (21.0 [10.0–60.0] vs 6.0 [1.0–42.0], p &lt;.001), and had a greater proportion of uteri &gt;20 weeks size for AM (22.2% vs 3.5%, p = .003). Composite perioperative complication rates were significantly higher for general OB/GYNs than for MIGS subspecialists (29.0% vs 11.8%, adjusted odds ratio [aOR] 2.70, 95% confidence interval [CI] 1.48–4.92). In a subgroup analysis of MIM only, general OB/GYNs had higher rates of composite perioperative complications (28.6% vs 9.9%, aOR 4.51, 95% CI 2.27–8.97), excessive blood loss and/or transfusion (10.7% vs 3.0%, unadjusted odds ratio [OR] 3.92, 95% CI 1.41–10.91), surgery time ≥ 90th percentile (25.0% vs 8.9%, aOR 5.05, 95% CI 2.39–10.64), and conversions to laparotomy (10.7% vs 0.2%, unadjusted OR 48.36, 95% CI 5.71–409.93). For AM only, there were no significant differences in perioperative complication rates between groups.</div></div><div><h3>Conclusion</h3><div>Fellowship-trained MIGS subspecialists had improved surgical outcomes for MIM compared to general OB/GYNs, with fewer conversions to laparotomy, reduced surgery time, and less blood loss, while outcomes for AM were similar by surgeon type. MIGS subspecialists excised a greater number of fibroids regardless of surgical approach, highlighting a level of comfort in complex benign gynecology beyond endoscopic surgery at our institution.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 3","pages":"Pages 220-228"},"PeriodicalIF":3.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780322","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":"International Societies","authors":"","doi":"10.1016/S1553-4650(25)00043-3","DOIUrl":"10.1016/S1553-4650(25)00043-3","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 3","pages":"Page A2"},"PeriodicalIF":3.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143578732","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 Sonographic Characteristics of Isolated Fallopian Tube Torsion","authors":"Rina Tamir Yaniv MD ,&nbsp;Eyal Ravid MD ,&nbsp;Nufar Halevy MD ,&nbsp;Ron Schonman MD ,&nbsp;Ofer Markovich MD ,&nbsp;Nissim Arbib MD ,&nbsp;Yair Daykan MD ,&nbsp;Merav Sharvit MD","doi":"10.1016/j.jmig.2024.10.017","DOIUrl":"10.1016/j.jmig.2024.10.017","url":null,"abstract":"<div><h3>Objective</h3><div>Isolated fallopian tube torsion (IFTT) presents a challenging preoperative diagnosis. This study investigated the specific sonographic characteristics of IFTT and compared them to the characteristics of ovarian and adnexal torsion.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting</h3><div>Tertiary level gynecological ultrasound unit.<strong>:</strong> 225 women operated for suspected isolated ovarian, fallopian tube or adnexal torsion (ovary and tube) were included.</div></div><div><h3>Interventions</h3><div>Electronic medical records of patients diagnosed with torsion at our ultrasound unit from 2001 to 2018 were retrieved. Inclusion criteria were women operated for suspicion of isolated ovarian, fallopian tube or adnexal torsion (involving both ovary and tube), with a preoperative sonogram performed in our tertiary level gynecologic ultrasound unit. Patients operated after a sonographic examination in the emergency department were excluded.</div></div><div><h3>Measurements</h3><div>Patients were divided into 4 groups according to their laparoscopic diagnosis: IFTT, ovarian torsion, adnexal torsion or no torsion.</div><div>The sonographic characteristics of the groups were compared and the diagnosis was confirmed according to laparoscopy findings.</div></div><div><h3>Main results</h3><div>IFTT was reported in 28/225 (12.4%) cases. Ovarian volume was significantly lower in IFTT (29.2 ± 44 cm³⁾ compared to ovarian torsion (111 ± 143 cm³, p = .037). There were fewer cases of ovarian edema in IFTT compared to ovarian torsion (12/22 (54.5%) vs. 54/63 (85.7%) respectively, p = .001). IFTT was associated with paraovarian cyst significantly more often than with ovarian torsion (13/24 (54.2%) vs. 4/75 (5.3%), respectively; p = .003). There was no difference in whirlpool sign rate and location between all forms of torsion. The sensitivity, specificity, Positive predictive value and Negative predictive value for IFTT were 88.4%, 83.3%, 95.8%, and 62% respectively.</div></div><div><h3>Conclusion</h3><div>IFTT has distinct sonographic characteristics, including normal ipsilateral ovary, paraovarian cyst, and whirlpool sign. Awareness of these features may improve the diagnosis of IFTT and promote faster and more efficient treatment. Further studies are needed to establish these characteristics.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 3","pages":"Pages 270-278"},"PeriodicalIF":3.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502278","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 Ovarian Reserve and Recurrence Rate After DWLS Diode Laser Ovarian Endometrioma Vaporization (OMAlaser): A Prospective, Single-Arm, Multicenter, Clinical Trial","authors":"Maurizio Nicola D'Alterio MD ,&nbsp;Luigi Nappi MD, PhD ,&nbsp;Salvatore Giovanni Vitale MD, PhD ,&nbsp;Mirian Agus PhD ,&nbsp;Daniela Fanni MD, PhD ,&nbsp;Mario Malzoni MD ,&nbsp;Francesca Falcone MD ,&nbsp;Felice Sorrentino MD, PhD ,&nbsp;Maria Gabriella D'Agate MD ,&nbsp;Giuseppe Scibilia MD ,&nbsp;Liliana Mereu MD, PhD ,&nbsp;Paolo Scollo MD, PhD ,&nbsp;Stefano Angioni MD, PhD","doi":"10.1016/j.jmig.2024.10.021","DOIUrl":"10.1016/j.jmig.2024.10.021","url":null,"abstract":"<div><h3>Study Objective</h3><div>To evaluate the effectiveness of the Dual Wavelength Laser System (DWLS) diode laser on the treatment of ovarian endometrioma (OMA), with ablation and vaporization of the cystic capsule without performing the stripping technique, in terms of ovarian reserve and recurrence rate.</div></div><div><h3>Design</h3><div>Prospective, single-arm, multicenter, clinical trial.</div></div><div><h3>Setting</h3><div>Multicenter University Hospital.</div></div><div><h3>Patients</h3><div>Seventy patients with symptomatic OMA.</div></div><div><h3>Interventions</h3><div>Patients underwent surgery for primary unilateral or bilateral symptomatic OMA treated with DWLS diode laser vaporization. Following surgical intervention, patients were enrolled in a 12 months surveillance protocol featuring regular clinical assessments aimed at detecting ovarian reserve, pregnancy rate and any recurrence of the cyst and/or symptomatic relapse.</div></div><div><h3>Measurements and Main Results</h3><div>Antimullerian hormone (AMH) levels at the 3-month follow-up exhibited a significant difference from the baseline (p = .034), demonstrating a return to nearly presurgical values in the subsequent months. Antral follicle count (AFC) of the operated ovary showed a significant increase after treatment at the 6-month and 12-month follow-up (p = 0.005 and p = 0.002, respectively). Pregnancies were documented in 48.3% (14/29) of infertile patients who underwent treatment. OMA recurrence was observed in 4 patients (5.7%) at 12 months. No patient exhibited a significant relapse of the analyzed symptoms compared to baseline values.</div></div><div><h3>Conclusion</h3><div>The findings of this study propose that DWLS diode laser presents a good option for treating OMA, demonstrating minimal impact on the surrounding healthy ovarian tissue, favorable pregnancy rate, coupled with low recurrence rates.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 3","pages":"Pages 279-287"},"PeriodicalIF":3.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545970","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":"TOC","authors":"","doi":"10.1016/S1553-4650(25)00045-7","DOIUrl":"10.1016/S1553-4650(25)00045-7","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 3","pages":"Pages A4-A6"},"PeriodicalIF":3.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143578734","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":"The Role of Video-Based Coaching in Gynecologic Surgery: A Tool for Continuous Improvement","authors":"Connor C. Wang MD,&nbsp;Oriana Krivenko MD,&nbsp;Dario R. Roque MD","doi":"10.1016/j.jmig.2025.02.001","DOIUrl":"10.1016/j.jmig.2025.02.001","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 3","pages":"Pages 201-202"},"PeriodicalIF":3.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143577436","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":"Case of Puerperal Sepsis Associated With Hemostatic Surgicel","authors":"Cristobal Rodriguez MD ,&nbsp;Janeth Rodriguez MD ,&nbsp;Gregorio Osoria MD ,&nbsp;Montserrat Vargas MD","doi":"10.1016/j.jmig.2024.08.003","DOIUrl":"10.1016/j.jmig.2024.08.003","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 3","pages":"Pages 212-214"},"PeriodicalIF":3.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142000163","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 Deeper Look at Office Hysteroscopy in Asymptomatic Postmenopausal Patients: Indications and Outcomes of 822 Cases","authors":"Rosario Emanuele Carlo Distefano MD ,&nbsp;Nataša Kenda Šuster PhD ,&nbsp;Mija Blaganje PhD ,&nbsp;Kristina Drusany Starič PhD ,&nbsp;Marco Palumbo PhD ,&nbsp;Maša Lukež Podgornik MD ,&nbsp;Ivan Verdenik PhD ,&nbsp;Katja Jakopič Maček MD","doi":"10.1016/j.jmig.2024.10.015","DOIUrl":"10.1016/j.jmig.2024.10.015","url":null,"abstract":"<div><h3>Study Objective</h3><div>This study aims to assess the prevalence of malignancy and other endometrial pathologies in asymptomatic postmenopausal women referred for office hysteroscopy (OH), identify main referral indications, and assess their relationship with the risk of malignancy. Secondary objectives included evaluating the association between ultrasound variables and malignancy risk and assessing procedure validity, which encompasses duration, feasibility, and patient comfort during OH.</div></div><div><h3>Design</h3><div>Retrospective analysis.</div></div><div><h3>Setting</h3><div>The study was conducted at the Department of Gynecology, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Slovenia's largest tertiary care center.</div></div><div><h3>Participants</h3><div>The cohort consisted of 822 asymptomatic postmenopausal women referred for OH, excluding those with postmenopausal bleeding within the last year.</div></div><div><h3>Interventions</h3><div>Participants underwent OH with or without biopsy.</div></div><div><h3>Measurements and Main Results</h3><div>The main indication for hysteroscopy was ultrasound abnormalities alone, with remaining indications including a combination of ultrasound and clinical findings. Among the cohort, 97.4% exhibited benign findings, while 2.6% were diagnosed with cancer or precancerous lesions. The analysis revealed that patients with indications based on ultrasound and clinical findings suggestive of malignancy had a higher risk of malignancy compared to those with ultrasound alone. In 387 patients with documented ultrasound variables, inhomogeneous endometrial appearance (OR: 8.2, 95% CI: 2.4–27.9, p &lt; .001) and significant liquid content within the uterine cavity (OR: 10.2, 95% CI: 3.6–28.9, p &lt; .001) exhibited strong associations with malignancy. Analysis of the procedure revealed a high feasibility rate (87.8%), with a median duration of 13.7 minutes and a median Visual Analog Scale pain score after the procedure of 3/10.</div></div><div><h3>Conclusion</h3><div>The prevalence of endometrial cancer and precancerous lesions in asymptomatic postmenopausal patients is likely low, with most intrauterine pathologies being benign. Our study demises the utility of routine endometrial surveillance for this population in the absence of specific risk factors. A holistic approach, considering individualized assessments and factors beyond endometrial thickness, is crucial in interpreting ultrasonic findings.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 3","pages":"Pages 258-264"},"PeriodicalIF":3.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502272","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":"Comparing the efficacy of laparoscopic pectopexy and laparoscopic sacrocolpopexy for pelvic organ prolapse: A systematic review and meta-analysis.","authors":"Mohammadamin Parsaei, Alireza Hadizadeh, Shiva Hadizadeh, Azadeh Tarafdari","doi":"10.1016/j.jmig.2025.02.014","DOIUrl":"https://doi.org/10.1016/j.jmig.2025.02.014","url":null,"abstract":"<p><strong>Objective: </strong>To assess and compare the efficacy of laparoscopic pectopexy and laparoscopic sacrocolpopexy in managing pelvic organ prolapse.</p><p><strong>Data sources: </strong>A systematic search of PubMed, Web of Science, Scopus, and Embase was conducted on July 3, 2024, using the search terms \"Pectopexy\" AND \"Laparoscop*\" with no publication date restrictions. Additional sources included citation screening and searches in Google Scholar and ProQuest.</p><p><strong>Methods of study selection: </strong>We included all peer-reviewed, English full-text articles comparing intraoperative, short-term (up to six months), or long-term (six to twelve months) outcomes for laparoscopic pectopexy and sacrocolpopexy in pelvic organ prolapse management.</p><p><strong>Tabulation, integration, and results: </strong>Our electronic search identified 269 records, of which 11 were deemed eligible after thorough screening. No additional eligible articles were found through a manual search. The final review included 11 studies, comprising 1,043 patients across four randomized controlled trials, six retrospective studies, and one prospective cohort. Meta-analyses using a random-effects model. Findings showed lower operation time (Hedges's g = -.978 [-1.629, -.327]; p = .003) and blood loss (Hedges's g = -.658 [-1.160, -.155]; p = .010) in pectopexy, with comparable organ injury rates (p > .05) between procedures. Short-term results showed a shorter hospitalization duration for pectopexy (Hedges's g = -.213 [-.426, -.000]; p = .049), while post-surgery outcomes like urinary tract infection, and voiding dysfunction were similar across groups (p > .05). All long-term outcomes were comparable, including apical prolapse recurrence, mesh-related complications, pelvic organ prolapse quantification system scores, constipation, urgency, stress urinary incontinence, dyspareunia, and patient satisfaction (p > .05).</p><p><strong>Conclusion: </strong>This review highlights that laparoscopic pectopexy, despite its theoretical technical advantages, shows comparable intraoperative organ injury rates and similar urinary, defecation, and sexual function outcomes to laparoscopic sacrocolpopexy. However, pectopexy is linked to shorter operative times, less blood loss, and reduced post-operative hospitalization.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536924","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":"Laparoendoscopic Single Site Surgery for Adnexal Torsion in the Third Trimester of Pregnancy.","authors":"Rongmin Wang, Ting Jiang, Changen Xu, Xiaoxia Liu","doi":"10.1016/j.jmig.2025.02.011","DOIUrl":"https://doi.org/10.1016/j.jmig.2025.02.011","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476578","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}