Journal of minimally invasive gynecology最新文献

{"title":"Endoscopic Closure of Rectosigmoid Injury with OTS Clip After Laparoscopic Surgery for Extensive Endometriosis.","authors":"Sami Shihada, Michael Oelckers, Gaby Moawad, Rüdiger Klapdor","doi":"10.1016/j.jmig.2024.10.029","DOIUrl":"10.1016/j.jmig.2024.10.029","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142591088","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":"Wound Infiltration with Local Anesthetics Versus Transversus Abdominis Plane Block for Postoperative Pain Management in Gynecological Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Filippo Alberto Ferrari, Beatrice Crestani, Lorena Torroni, Matteo Pavone, Federico Ferrari, Nicolas Bourdel, Massimo Franchi, Stefano Uccella","doi":"10.1016/j.jmig.2024.10.030","DOIUrl":"10.1016/j.jmig.2024.10.030","url":null,"abstract":"<p><strong>Objective: </strong>Postoperative pain management significantly influences recovery speed, hospital stay duration, and healthcare costs. In light of inconsistencies in clinical trial outcomes, we conducted a systematic review and meta-analysis to assess the efficacy of the Transversus Abdominis Plane (TAP) block compared to local anesthetic wound infiltration (WI) for postoperative pain management in gynecological surgery.</p><p><strong>Data sources: </strong>Systematic searches were conducted across PubMed/MEDLINE, ScienceDirect, the Cochrane Library, and Web of Science databases to identify all randomized controlled trials comparing TAP block and WI in adult patients undergoing gynecological surgical procedures. Additionally, the reference lists of the identified studies were manually reviewed. Only studies published in English were eligible for inclusion in the analysis.</p><p><strong>Methods of study selection: </strong>The Population, Intervention, Comparison, and Outcome framework for the review included: (1) adult patients who underwent gynecological surgical procedures; (2) postoperative TAP block as the intervention; (3) comparison with local anesthetic WI; (4) primary outcome: postoperative pain at 1, 4, 12, and 24 hours; secondary outcomes: postoperative opioid consumption, opioid-related side effects, and patient satisfaction. STATA software, version 18 (Stata Corp, College Station, TX, USA), was used for the analysis.</p><p><strong>Tabulation, integration, and results: </strong>A total of 213 papers were initially identified. Of these, 10 randomized controlled trials encompassing a total of 604 patients met the inclusion criteria. The meta-analysis studying minimally invasive surgery showed that TAP block was associated with lower pain scores at rest and 1, 4, 12, and 24 hours compared to the WI group. Furthermore, the TAP block resulted in a reduction in opioid consumption at 24 hours, although there was no significant difference in opioid-related adverse effects. Two studies presented data on patient-reported satisfaction, and a pooled analysis was not feasible due to heterogeneity.</p><p><strong>Conclusion: </strong>TAP block seems to provide better postoperative pain control after laparoscopic gynecologic procedures and reduces opioid use compared to WI in gynecologic surgery.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604121","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":"Does Size Matter? Investigating the Association Between Endometrioma on Pre-Operative Imaging and AAGL Endometriosis Stage","authors":"EE Spurlin ,&nbsp;EC Bardawil ,&nbsp;D Wang ,&nbsp;CM Mulligan ,&nbsp;K de Souza ,&nbsp;W Ross","doi":"10.1016/j.jmig.2024.09.073","DOIUrl":"10.1016/j.jmig.2024.09.073","url":null,"abstract":"<div><h3>Study Objective</h3><div>To investigate the association between the size of endometriomas on pre-operative imaging and the stage and extent of endometriosis based on laparoscopic findings according to the AAGL 2021 Endometriosis Classification.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting</h3><div>High-volume academic gynecologic surgical practice.</div></div><div><h3>Patients or Participants</h3><div>Sixty-nine patients with endometriomas on pre-operative imaging undergoing surgical management of endometriosis from June 2022 to April 2024.</div></div><div><h3>Interventions</h3><div>Preoperative assessment of endometrioma size and laterality on ultrasound and/or MRI.</div></div><div><h3>Measurements and Main Results</h3><div>Sixty-nine patients met the inclusion criteria. The median of days elapsed from imaging date to the date of surgery was 81 [40, 136] days. The mean age of patients was 34±7.3 years. The majority of patients self-reported as Black (17.4%) or White (75.4%) and the mean BMI was 27.8±6.8 kg/m². The most commonly reported symptom was dysmenorrhea (95.7%) while dyschezia (37.7%) and infertility (20.3%) were less common. On pelvic exam, 39.1% had myofascial tenderness, 21.7% had uterosacral nodularity or thickening, and 5.8% had reduced uterine mobility.</div><div>Pre-operative imaging showed median endometrioma size of 49 [30, 62] mm on ultrasound (N=42) and 50 [23, 54] mm on MRI (N=27). Surgical AAGL endometriosis staging found that no patients had stage 1 disease while 79.7% had stage 4 disease. Patients who had endometriomas ≥ 40 mm often had higher surgical complexity as compared to those with smaller endometriomas, including more frequent cul-de-sac obliteration (71.4% vs 48.1%), rectovaginal septum disease (35.7% vs 18.5%), and appendiceal involvement (38.1% vs 11.1%).</div></div><div><h3>Conclusion</h3><div>In this sample, endometriomas on pre-operative imaging, regardless of size, were most frequently connected to stage III or IV endometriosis. For endometriomas ≥40 mm, a higher degree of surgical complexity was frequently encountered. Gynecologic surgeons operating on patients with endometriomas should be prepared to treat complex endometriosis. Understanding this relationship may aid clinicians considering referral to a gynecologic surgical specialists.</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":"142658144","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":"Ureter Reimplantation for Deep Infiltrative Endometriosis","authors":"MK Cantave ,&nbsp;A Kosmacki ,&nbsp;E Vargo ,&nbsp;S Biest ,&nbsp;E Kim ,&nbsp;W Ross","doi":"10.1016/j.jmig.2024.09.137","DOIUrl":"10.1016/j.jmig.2024.09.137","url":null,"abstract":"<div><h3>Study Objective</h3><div>The objective of this video is to demonstrate the surgical technique for ureter re-implantation involving a deep infiltrating endometriotic lesion impinging on the bladder and causing left ureteral obstruction.</div></div><div><h3>Design</h3><div>Surgical video recording of steps to perform left ureter re-implantation after excision of deep infiltrating endometriotic lesion.</div></div><div><h3>Setting</h3><div>Operating Room.</div></div><div><h3>Patients or Participants</h3><div>This is a 37 year old G3P2 female with history of severe dysmenorrhea who presents with left flank pain and found to have moderately severe left hydroureteronephrosis secondary to endometriotic nodule compressing the left ureter.</div></div><div><h3>Interventions</h3><div>Robotic assisted total laparoscopic hysterectomy with bilateral salpingo-ophrectomy and left ureteral re-implantation.</div></div><div><h3>Measurements and Main Results</h3><div>There are a variety of techniques to repair and reimplant the ureter involved in extrinsic ureteral endometriosis. Surgical management of ureteral re-implantation in extrinsic ureteral endometriosis varies depending on location and depth of lesion. Complete excision of endometriotic lesion in this patient required intentional iatrogenic ureteral injury with reimplantation. This video will demonstrate ureter re-implantation with creation of ureteroneocystotomy and bladder hitch.</div></div><div><h3>Conclusion</h3><div>Ureteral re-implantation with ureteroneocystostomy and bladder hitch is an effective surgical management of deep infiltrating extrinsic ureteral endometriosis.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"31 11","pages":"Page S35"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658147","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 an Accessory Cavitated Uterine Malformation (ACUM)","authors":"M Ramaswamy ,&nbsp;Y Youssef ,&nbsp;O Azar ,&nbsp;P Bral","doi":"10.1016/j.jmig.2024.09.116","DOIUrl":"10.1016/j.jmig.2024.09.116","url":null,"abstract":"<div><h3>Study Objective</h3><div>The purpose of this video is to present a case of an Accessory Cavitated Uterine Malformation.</div></div><div><h3>Design</h3><div>Video footage illustrating the surgical removal of a uterine accessory cavity.</div></div><div><h3>Setting</h3><div>Tertiary referral center.</div></div><div><h3>Patients or Participants</h3><div>A 19 yo gravida 0 who presented with pelvic pain for several years, worse with menses. A pre-operative pelvic ultrasound suggested a degenerating myoma measuring 2.8cm as the cause of her pelvic pain. Pathology confirmed presence of endometrial glands within muscle cells.</div></div><div><h3>Interventions</h3><div>Robotic assisted laparoscopic removal of accessory cavity. This involved injecting diluted vasopressin to the base of the accessory mass for vasoconstriction prior to incision and dissection, and suture of defect.</div></div><div><h3>Measurements and Main Results</h3><div>Resolution of pelvic pain in the patient 2 months post-operative</div></div><div><h3>Conclusion</h3><div>Accessory Cavitated Uterine Malformation is an unclassified Mullerian anomaly of unknown true incidence. Surgical Excision can provide resolution of symptoms of pelvic pain.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"31 11","pages":"Page S28"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658074","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(24)00780-5","DOIUrl":"10.1016/S1553-4650(24)00780-5","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"31 11","pages":"Page A2"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142586736","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":"Bladder Endometriosis Fluorescence-Guided Surgery - A Case Report","authors":"Teixeira BA Castelo Branco,&nbsp;K Mori,&nbsp;A Nicola,&nbsp;F Ohara,&nbsp;P Ayroza,&nbsp;H Salomão","doi":"10.1016/j.jmig.2024.09.136","DOIUrl":"10.1016/j.jmig.2024.09.136","url":null,"abstract":"<div><h3>Study Objective</h3><div>Describe a complex case of a patient with a large bladder endometriosis nodule with surgical excision guided by indocyanine green (ICG).</div></div><div><h3>Design</h3><div>Narrated surgical video discussing the surgical technique to excise a large bladder endometriosis nodule using indocyanine green to guide the dissection. This video highlights indocyanine green as a useful tool in a complex case of endometriosis as well as, identification of important anatomical landmarks for this type of procedure</div></div><div><h3>Setting</h3><div>Tertiary academic center. The patient was positioned in semi-gynecological position for the procedure. A 10 mm port was placed on the umbilicus, and 3 auxiliary ports were placed following the triangulation technique.</div></div><div><h3>Patients or Participants</h3><div>32-years-old woman with dismenorrhea for 5 years, and occasional dysuria, with no improvemnt with LNG-IUD. On physical examination, she had a 2-cm palpable nodule on the retrocervical area. Her transvaginal ultrassound showed, bladder nodule with infiltration into the submucosa, as well as her RMI showed a perivesical peritoneal lesion with infiltration of the detrusor muscle, and anterior myometrium. The urodynamic study demonstrated reduced bladder complacency.</div></div><div><h3>Interventions</h3><div>The patient underwent cystoscopy with ureteral catheterization with indocynine green injection. A laparoscopy was performed for the excision of the endometriosis with removal of the bladder nodule after vesico-uterine space dissection, guided by ICG. Adjacent myometrium was removed to decrease the risks of recurrence. The bladder was then sutured.</div></div><div><h3>Measurements and Main Results</h3><div>The procedure was completed without any complications. Endometriosis were confirmed through the pathology report. The patient reported a complete improvement of her symptoms after 6-month of follow up.</div></div><div><h3>Conclusion</h3><div>The technique performed in the video demonstrates the benefit of using ICG, identifying anatomical landmarks and limits, ensuring complete resection of bladder endometriosis, as well as reducing postoperative complications.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"31 11","pages":"Pages S34-S35"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658149","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":"Treatment of Severe and Moderate Intrauterine Adhesions: Results of PREG2 International RCT on the Effectiveness of Womed Leaf Barrier Film","authors":"H Fernandez ,&nbsp;L Miquel ,&nbsp;J Sroussi ,&nbsp;S Weyers ,&nbsp;M Munmany ,&nbsp;X Luo ,&nbsp;P Kovar ,&nbsp;Y Wang ,&nbsp;A Sardo Di Spiezio ,&nbsp;A Surbonne ,&nbsp;V Delporte ,&nbsp;E Moratalla ,&nbsp;M Sauvan ,&nbsp;G Perrini ,&nbsp;L Sui ,&nbsp;M Mara","doi":"10.1016/j.jmig.2024.09.095","DOIUrl":"10.1016/j.jmig.2024.09.095","url":null,"abstract":"<div><h3>Study Objective</h3><div>Recurrence rate after hysteroscopic adhesiolysis can be as high as 60%. This RCT aimed to assess the effectiveness of a new intrauterine mechanical barrier film in the management of IUA.</div></div><div><h3>Design</h3><div>PREG2 is a double-blind randomized, controlled, stratified study.</div></div><div><h3>Setting</h3><div>16 sites in Europe and China.</div></div><div><h3>Patients or Participants</h3><div>Patients scheduled for hysteroscopic adhesiolysis because of symptomatic severe or moderate adhesions (AFS score ≥ 5).</div></div><div><h3>Interventions</h3><div>Following adhesiolysis, patients were randomized to either have a Womed Leaf film inserted or not. Womed Leaf (Womed SAS, France) is a degradable polymer film that expands to fill the entire cavity and acts as a mechanical barrier between the uterine walls. After about a week, it degrades and is discharged naturally. Hormonal treatment was authorized in both groups. Patients were scheduled for second-look hysteroscopy (SLH) after 4 to 8 weeks.</div></div><div><h3>Measurements and Main Results</h3><div>The effectiveness endpoints were: Change in AFS score between baseline and SLH, responder rate (i.e. patients who improved of at least two clinical categories, e.g. from severe to mild or from moderate to no IUA) and absence of IUA at SLH. The patient and the SLH evaluator were blind. 160 women were randomized. The reduction in AFS score at SLH was significantly higher in the intervention compared to the control group (5.2 ± 2.8 vs. 4.2 ± 3.2; p=0.0153). The responder rate was significantly higher in the intervention group (51% vs 29% OR 2.7 [1.4–5.5]; p=0.0052). The absence of adhesions at SLH was significantly higher in the intervention group (41% vs 24% OR 2.44 [CI 1.161 - 5.116]; p=0.0189). None of the reported adverse events were serious or considered related to the device.</div></div><div><h3>Conclusion</h3><div>This large RCT of patients with severe or moderate IUA demonstrated the effectiveness of Womed Leaf. It is the first adhesion barrier to show any clinically meaningful improvement in this challenging indication.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"31 11","pages":"Pages S21-S22"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658442","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":"Optimizing Retraction in Laparoscopic Surgery","authors":"HT Ryles ,&nbsp;RH Cockrum ,&nbsp;F Tu ,&nbsp;M Brockman ,&nbsp;S Senapati","doi":"10.1016/j.jmig.2024.09.114","DOIUrl":"10.1016/j.jmig.2024.09.114","url":null,"abstract":"<div><h3>Study Objective</h3><div>The objectives of this video are to reinforce important principles of retraction for laparoscopy and demonstrate their application.</div></div><div><h3>Design</h3><div>This is a video compilation of several surgeries.</div></div><div><h3>Setting</h3><div>These surgeries were performed at a single academic center</div></div><div><h3>Patients or Participants</h3><div>Participants were patients undergoing surgery at our hospital</div></div><div><h3>Interventions</h3><div>N/A.</div></div><div><h3>Measurements and Main Results</h3><div>N/A.</div></div><div><h3>Conclusion</h3><div>Three fundamental principles of teaching surgical retraction are clear communication, maintaining tissue tension, and maximizing exposure. Standardized directional language should be used while performing and teaching surgery. Here we reinforce the above concepts and introduce standardized retraction language in order to optimize retraction in laparoscopic surgery.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"31 11","pages":"Page S27"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658449","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":"Resection of Ischiorectal Endometriosis and Martius Flap Reconstruction","authors":"S Mathur ,&nbsp;A Kobylianskii ,&nbsp;N Lemos","doi":"10.1016/j.jmig.2024.09.081","DOIUrl":"10.1016/j.jmig.2024.09.081","url":null,"abstract":"<div><h3>Study Objective</h3><div>To describe the surgical management of ischiorectal endometriosis with a primary excision and secondary Martius flap reconstruction.</div></div><div><h3>Design</h3><div>A stepwise demonstration of surgical technique and key anatomic landmarks with the use of an educational video.</div></div><div><h3>Setting</h3><div>Ischiorectal endometriosis is rare and can be associated with vaginal deliveries and birth trauma. The intervention was carried out at tertiary care academic institution.</div></div><div><h3>Patients or Participants</h3><div>We present the case of a 34-year-old patient who presents with a 10-year history of progressively worsening perineal pain after childbirth. An MRI confirmed an endometriosis nodule in the ischiorectal fossa involving the superficial and deep perineal muscles, and the external anal sphincter.</div></div><div><h3>Interventions</h3><div>In this video, we have described an approach to resection using a trans-ischiorectal fossa approach and subsequent reconstruction with a Martius flap. Rotational grafts such as the Martius flap have been used for fistula repair and are less invasive when compared to gluteal or gracilis flaps. The patient did well post-operatively from the graft reconstruction and remains pain free.</div></div><div><h3>Measurements and Main Results</h3><div>We describe a two-step approach as a feasible strategy to avoid an invasive rotational flap. This video aims to provide a step-by-step approach to both resection and reconstruction while providing an overview of perineal anatomy.</div></div><div><h3>Conclusion</h3><div>Ischioanal endometriosis is a rare presentation, typically associated with perineal birth trauma. We describe a trans-ischiorectal approach to the resection of this lesion along with a secondary Martius flap reconstruction.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"31 11","pages":"Pages S17-S18"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658007","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}