Journal of minimally invasive gynecology最新文献

{"title":"Surgical Enhancement With the Placement of Temporary Bilateral Ureteral Stents With Indocyanine Green Injection for All Stages of Endometriosis in vNOTES: Retrospective Cross-Sectional Study","authors":"Daniel Y. Lovell MD ,&nbsp;Emily Sendukas MD ,&nbsp;Qiannan Yang MD, PhD ,&nbsp;Xiaoming Guan MD, PhD","doi":"10.1016/j.jmig.2024.09.365","DOIUrl":"10.1016/j.jmig.2024.09.365","url":null,"abstract":"<div><h3>Study Objective</h3><div>To demonstrate the time to place temporary bilateral stents with indocyanine green (ICG) injection, time to intra-operative identification of bilateral ureters - with and without the use of ICG, and number of times for ICG activation in endometriosis excision surgery.</div></div><div><h3>Design</h3><div>Retrospective cross-sectional study.</div></div><div><h3>Setting</h3><div>Single Tertiary Academic Hospital.</div></div><div><h3>Patients</h3><div>Fifty serial patients with functioning pelvic ureters, who underwent vaginal natural orifice transluminal endoscopic surgery (vNOTES) for all stages of endometriosis excision between September 2023 and May 2024.</div></div><div><h3>Interventions</h3><div>Placement of temporary bilateral ureteral stents with indocyanine green injection before the start of vNOTES, noting the time needed to identify intra-peritoneal ureters with and without ICG activation, and average number of times ICG was activated for endometriosis excision.</div></div><div><h3>Measurements and Main Results</h3><div>The median time to place bilateral ureteral stents with ICG injection was 229 seconds. The median time for intra-operative ureteral identification with ICG was 1s (L) and 1s (R). The median time for intra-operative ureteral identification without ICG was 17s (L) and 17s (R). The median time ICG was activated for ureteral identification to perform endometriosis excision was 12 times (L), 11 times (R). From the observations previously described, we share the potential of improved efficiency and efficacy in using ICG in ureteral identification for endometriosis surgery.</div></div><div><h3>Conclusion</h3><div>Placement of temporary bilateral ureteral stents with ICG has the potential for more efficient ureteral identification even after including time for ureteral stent placement and ICG injection. The upfront time needed to place stents may prove to lead to a safer, more efficient procedure.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 2","pages":"Pages 166-170"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372094","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":"Evidence-Based Practice for Minimization of Blood Loss During Laparoscopic Myomectomy: An AAGL Practice Guideline","authors":"","doi":"10.1016/j.jmig.2024.09.021","DOIUrl":"10.1016/j.jmig.2024.09.021","url":null,"abstract":"<div><h3>Study Objective</h3><div>To provide evidence-based recommendations regarding the use of pre-operative medical adjuncts and intra-operative interventions for reducing blood loss during laparoscopic (conventional or robotic-assisted) myomectomy.</div></div><div><h3>Design</h3><div>A systematic review and meta-analyses of the relevant literature were performed to develop evidence-based guideline recommendations.</div></div><div><h3>Setting</h3><div>Published literature.</div></div><div><h3>Patients</h3><div>Patients undergoing laparoscopic myomectomy.</div></div><div><h3>Interventions</h3><div>Pre-operative medical adjuncts and intra-operative interventions for reducing blood loss.</div></div><div><h3>Measurements and Main Results</h3><div>The primary outcome was surgical blood loss. Secondary outcomes were change in hematocrit or hemoglobin and blood transfusion. Additional outcomes included length of procedure, intra- and post-operative complications, conversion to laparotomy, reoperation, readmission, and length of stay. A total of 75 studies fulfilled the eligibility criteria and formed the basis for this practice guideline. Evidence-based recommendations were developed regarding the use of pre-operative medical adjuncts including gonadotropin-releasing hormone agonist and progesterone), as well as intra-operative vasoconstrictors, uterine artery occlusion, electrosurgical devices and barbed suture.</div></div><div><h3>Conclusions</h3><div>Systematic review and multiple meta-analyses identified moderate evidence supporting the use of 3-month administration of leuprolide acetate prior to myomectomy and intra-operative use of misoprostol, epinephrine, vasopressin, oxytocin, and uterine artery occlusion for reducing blood loss during laparoscopic myomectomy.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 2","pages":"Pages 113-132"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143347044","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":"Perforated Intrauterine Device in the Abdomen: Leave or Retrieve?","authors":"Erin Seto MSc ,&nbsp;Emily N. Liu ,&nbsp;Nigel Pereira MD","doi":"10.1016/j.jmig.2024.07.025","DOIUrl":"10.1016/j.jmig.2024.07.025","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 2","pages":"Pages 103-104"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142055822","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":"International Societies","authors":"","doi":"10.1016/S1553-4650(25)00004-4","DOIUrl":"10.1016/S1553-4650(25)00004-4","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 2","pages":"Page A2"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143343531","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":"3D Imaging Reconstruction and Laparoscopic Robotic Surgery Approach to Disseminated Peritoneal Leiomyomatosis","authors":"Giuseppe D'Angelo MD ,&nbsp;Gaby N. Moawad MD ,&nbsp;Attilio Di Spiezio Sardo PhD ,&nbsp;Mario Ascione MD ,&nbsp;Roberta Danzi MD ,&nbsp;Pierluigi Giampaolino PhD ,&nbsp;Giuseppe Bifulco PhD","doi":"10.1016/j.jmig.2024.10.003","DOIUrl":"10.1016/j.jmig.2024.10.003","url":null,"abstract":"<div><h3>Study Objective</h3><div>This video article explores the synergistic approach of 3-dimensional (3D) imaging reconstruction and laparoscopic robotic surgery for the management of a complex case of disseminated peritoneal leiomyomatosis [<span><span>1</span></span>]. The primary focus lies in the capability of the reconstruction model to provide diagnostic support to identify myomas during surgical procedures, potentially enhancing surgical precision, reducing operating times, minimizing uterine incisions, and limiting blood loss. 3D imaging reconstruction techniques were used to facilitate the identification of multiple parasitic and nonserosal myomas, which is particularly challenging when operating with a robotic surgical platform that lacks haptic feedback.</div></div><div><h3>Design</h3><div>A case report design was used, focusing on a 43-year-old nulliparous infertile woman with multiple symptomatic uterine myomas. Our institution has made a further diagnosis of disseminated peritoneal leiomyomatosis [<span><span>2</span></span>,<span><span>3</span></span>].</div></div><div><h3>Setting</h3><div>Tertiary referral center.</div></div><div><h3>Interventions</h3><div>Owing to the widespread nature of peritoneal leiomyomatosis and numerous uterine myomas, robotic surgery was considered a preferable option based on our experience to operate within confined anatomic spaces. 3D imaging reconstruction technology was used for preoperative and intraoperative planning, enabling precise determination of the myomas’ location, size, and volume obtained through magnetic resonance imaging. Real-time 3D imaging guided rapid myoma localization and surgical strategy adjustment [<span><span>4</span></span>,<span><span>5</span></span>]. The procedure resulted in the removal of 15 myomas, with minimal blood loss (250 mL) and a total operative time of 120 minutes. Multilayer running hysterorrhaphy was performed using a barbed monofilament suture to ensure effective hemostasis, incorporating serosal introflection to reduce the risk of postoperative adhesion development.</div></div><div><h3>Conclusion</h3><div>The combined approach of 3D imaging reconstruction and laparoscopic robotic surgery holds significant potential for the management of disseminated peritoneal leiomyomatosis. This approach can overcome some robotic surgery limitations, particularly the absence of haptic feedback, providing accurate preoperative planning and real-time intraoperative guidance, facilitating efficient myoma localization, minimizing uterine incisions, and reducing blood loss. Further research is needed to fully evaluate the clinical impact of this promising technology.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 2","pages":"Pages 111-112"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467858","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":"Perioperative Antibiotic Choice and Postoperative Infectious Complications in Pelvic Organ Prolapse Surgery","authors":"Margot Le Neveu MD ,&nbsp;Erica Qiao MD ,&nbsp;Stephen Rhodes PhD ,&nbsp;Anne Sammarco MD, MPH ,&nbsp;Adonis Hijaz MD ,&nbsp;David Sheyn MD","doi":"10.1016/j.jmig.2024.10.004","DOIUrl":"10.1016/j.jmig.2024.10.004","url":null,"abstract":"<div><h3>Objective</h3><div>The objective of this study was to determine how rates of postoperative infectious complications after pelvic organ prolapse surgery differ based on perioperative antibiotic administered. In particular, we sought to determine whether anaerobic coverage is associated with reduced rates of infectious complications.</div></div><div><h3>Design</h3><div>This was a retrospective cohort study.</div></div><div><h3>Setting</h3><div>Premier Healthcare U.S. national database, a comprehensive all-payer dataset capturing patients from urban and rural nonprofit, community, and teaching hospitals.</div></div><div><h3>Participants</h3><div>Adult patients who underwent vaginal, laparoscopic, and/or abdominal prolapse surgery with or without hysterectomy from January 2000 to March 2020. Procedures with and without mesh were included.</div></div><div><h3>Interventions</h3><div>Rates of infectious complications were compared among patients who received guideline-concordant antibiotic regimens, including those with anaerobic coverage. The primary outcome was any surgical site infection within 30 days of surgery without mesh or 90 days of surgery involving mesh.</div></div><div><h3>Results</h3><div>Among 130,198 prolapse surgeries, the most common antibiotic regimens were cefazolin (n = 97,058, 74.5%), second-generation cephalosporin (n = 16,442, 12.6%), clindamycin + aminoglycoside (n = 8,397, 6.4%) and cefazolin + metronidazole (n = 4,328, 3.3%). On multivariable logistic regression, only clindamycin + aminoglycoside was associated with a higher rate of surgical site infections (OR = 1.37; 95% CI 1.09–1.72) and other infectious morbidity (OR = 1.26; 95% CI 1.12–1.42) when compared to cefazolin alone. The addition of metronidazole to cefazolin was not associated with reduced rates of surgical site infections (OR = 1.09; 95% CI 0.82–1.45). Obesity (OR = 1.22; 95% CI 1.03–1.43), diabetes without complication (OR = 1.30; 95% CI 1.08–1.57), Charlson comorbidity score &gt;0 (OR = 1.24; 95% CI 1.06–1.45), and tobacco use (OR = 1.22, 95% CI 1.05–1.40) were also associated with increased composite surgical site infection.</div></div><div><h3>Conclusion</h3><div>Compared with cefazolin alone, the use of alternative perioperative antibiotics, including those with anaerobic coverage, was not associated with reduced infectious complications after pelvic organ prolapse surgery in this U.S. national sample.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 2","pages":"Pages 185-193.e6"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467862","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":"Work Related Pain in Gynecologic Surgeons - A National Survey.","authors":"Riley J Young, Alexis Allen, Donald McIntire, Erica F Robinson, Olga Bougie, Kimberly A Kho","doi":"10.1016/j.jmig.2025.01.014","DOIUrl":"10.1016/j.jmig.2025.01.014","url":null,"abstract":"<p><strong>Study objective: </strong>This study aimed to: (1) ascertain the prevalence of work-related pain among gynecologic surgeons, (2) describe the risk factors and sequelae of pain, and (3) assess the need for an ergonomic curriculum.</p><p><strong>Design: </strong>Survey study.</p><p><strong>Setting: </strong>The survey was electronically administered.</p><p><strong>Participants: </strong>Gynecologic surgery subspecialists and fellows in training, and Obstetrics and Gynecology specialists who performed gynecologic surgery were included.</p><p><strong>Measurements and main results: </strong>A 38-question anonymous survey was developed from the available ergonomic literature and had 3 main sections: (1) demographic information, (2) pain history, and (3) ergonomic education. A total of 305 gynecologic surgeons participated in the study. Of these, 76.7% were female. Most respondents were Minimally Invasive Gynecologic Surgeons (64.6%) with conventional laparoscopy as the primary surgical modality (65.6%). Of the respondents, 95.7% reported experiencing pain during or after surgery. Female surgeons (p = .018), shorter surgeons (OR = 2.4, 95% confidence interval [1.1, 5.4]), and those with a smaller gloves (p = .025) were more likely to report severe pain. Surgeons who reported worse pain were more likely to seek treatment (p = .007) and to take time off from operating (p <.001). Among the respondents, 79.4% reported engaging in various interventions to treat surgery-related pain. Due to pain, 23.9% reported changing the surgical modality, and 62.5% were concerned about their ability to operate in the future. Of the surgeons, 61.3% did not feel confident in their ability to set up their operating room ergonomically. 98.0% recommend formal ergonomic training for residents.</p><p><strong>Conclusions: </strong>Surgeons are at risk of work-related pain. Gynecologic surgeons have been understudied and face specific ergonomic challenges. In this national survey of high-volume gynecologic surgeons of various subspecialties, we report a high rate of surgery-related pain and significant clinical and nonclinical sequelae of pain, and demonstrate the need to implement and improve ergonomic training for Obstetrics and Gynecology trainees.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122955","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":"Vaginoscopic Resection of an Obstructed Right Hemivagina in Obstructed Hemivagina and Ipsilateral Renal Agenesis Syndrome","authors":"Kharmen A. Bharucha MD ,&nbsp;Camille Ladanyi MD ,&nbsp;Olga Fajardo MD","doi":"10.1016/j.jmig.2024.07.022","DOIUrl":"10.1016/j.jmig.2024.07.022","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 2","pages":"Pages 100-102"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141859998","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":"Authors' Reply","authors":"Huihui Chen MD,&nbsp;Min Yao MD,&nbsp;Yizhi Wang MD,&nbsp;Xipeng Wang MD, PhD","doi":"10.1016/j.jmig.2024.10.009","DOIUrl":"10.1016/j.jmig.2024.10.009","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 2","pages":"Pages 198-200"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502273","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 Minimally Invasive Gynecologic Surgery Subspecialty Training on Outcomes of Benign Laparoscopic Hysterectomy: A Retrospective Cohort Study","authors":"Raanan Meyer MD ,&nbsp;Rebecca J. Schneyer MD ,&nbsp;Kacey M. Hamilton MD ,&nbsp;Gabriel Levin MD ,&nbsp;Mireille D. Truong MD ,&nbsp;Matthew T. Siedhoff MD, MSCR ,&nbsp;Kelly N. Wright MD","doi":"10.1016/j.jmig.2024.09.012","DOIUrl":"10.1016/j.jmig.2024.09.012","url":null,"abstract":"<div><h3>Study Objective</h3><div>To compare surgical outcomes among patients undergoing minimally invasive hysterectomy (MIH), laparoscopic or robotic, with minimally invasive gynecologic surgery (MIGS) subspecialists, gynecologic oncologists (GOs), or general obstetrician/gynecologists (OB/GYNs).</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting</h3><div>Quaternary care academic hospital.</div></div><div><h3>Patients</h3><div>Patients undergoing MIH for benign indications from March 2015 to March 2020 were included.</div></div><div><h3>Interventions</h3><div>MIH.</div></div><div><h3>Measurements and Main Results</h3><div>The primary outcome was the odds of a composite of any intra- or postoperative complications within 30 days of surgery by surgeons’ group. A total of 728 MIHs were performed during the study period and constituted the cohort, of which 368 (50.5%) were performed by MIGSs, 144 (19.8%) by GOs, and 216 (29.7%) by OB/GYNs. Intra- and postoperative complications occurred in 11.7% of the MIGS group, 22.9% of the GO group (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.36–3.71), and 25.9% of the OB/GYN group (OR, 2.65; 95% CI, 1.70–4.12). Major intra- or postoperative complications were associated with surgeons’ groups (OR, 7.02; 95% CI, 2.67–18.47, and OR, 6.84; 95% CI, 2.73–17.16 for GO and OB/GYN compared with MIGS, respectively). Intraoperative complication rates were significantly lower for MIGS surgeons (1.4%) than for GOs (9.0%; OR, 7.21; 95% CI, 2.52–20.60) and OB/GYNs (9.7%; OR, 7.82; 95% CI, 2.90–21.06). There was a higher odd of postoperative complications for OB/GYNs than MIGS (18.5% vs 10.9%; OR, 1.86; 95% CI, 1.16–3.00). Rates of conversion to laparotomy were lowest among MIGS surgeons (0.3%) compared with GOs (7.6%) and OB/GYNs (7.9%). Estimated blood loss 90th percentile or higher and surgery time 90th percentile or higher were more common for OB/GYNs than MIGS surgeons (OR, 2.12; 95% CI, 1.07–4.22; OR, 2.48; 95% CI, 1.49–4.12, respectively).</div></div><div><h3>Conclusion</h3><div>Fellowship-trained MIGS subspecialists had improved surgical outcomes for benign MIH compared with GOs and OB/GYNs, with lower rates of perioperative complications and fewer conversions to laparotomy.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 2","pages":"Pages 143-150"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289339","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}