Journal of minimally invasive gynecology最新文献

{"title":"Robotic-assisted vNOTES for Emergency Detorsion in a Patient with Morbid Obesity: Case Presentation.","authors":"Emily Sendukas, Xiaoming Guan","doi":"10.1016/j.jmig.2025.05.004","DOIUrl":"10.1016/j.jmig.2025.05.004","url":null,"abstract":"<p><strong>Objective: </strong>To provide a case presentation of surgical management of adnexal torsion through robotic-assisted vaginal natural orifice transluminal endoscopic surgery (vNOTES) in a patient with morbid obesity.</p><p><strong>Setting: </strong>Single academic center.</p><p><strong>Participant: </strong>A 20-year-old woman, who is a G0 and has class III obesity (body mass index 49) presented to the emergency room with right pelvic pain and vomiting. Imaging revealed a 15 cm cystic lesion in the right adnexa, with concern for right adnexal torsion on exam. She was posted for emergency surgery.</p><p><strong>Interventions: </strong>An educational video with a narrated step-by-step approach of robotic-assisted vNOTES adnexal detorsion and paratubal cystectomy. This surgery was performed with the DaVinci Xi Robot docked vaginally through a gelpoint device. After the cystectomy, anatomy was restored, and a salpingectomy was performed because of significant edema and damage of the right fallopian tube [1-3].</p><p><strong>Conclusion: </strong>This video shows a surgical approach to adnexal detorsion through robotic vNOTES. It provides instruction on the setup and the surgical steps in a vNOTES surgery through a posterior colpotomy [4,5]. It shares tips to successfully complete the procedure, including how to use the surgical assistant when only using 2 robotic arms because of limited space of the pelvis, such as during the cystectomy, providing traction and countertraction. By presenting this case, this video hopes to make the vNOTES procedure more accessible and an option for patients in an emergency surgery setting. At our institution, there is a dedicated gynecologic robot room, and the case was not delayed using the robot. If this is not the case in other institutions, the surgery can be completed in a laparoscopic manner with similar techniques used in this video. The vNOTES method provides a safe option for patients, including those with obesity or extensive surgical histories, and avoids an abdominal incision, which can decrease intraoperative and postoperative complications.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144618597","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 Vaginal Cuff Closure: A Systematic Review and Meta-Analysis of Barbed Versus Conventional Sutures in Total Laparoscopic and Robot-Assisted Hysterectomies","authors":"Laura Vilar Planella MD ,&nbsp;Ignacio Rodríguez García MSc ,&nbsp;Silvia Franco Camps MD ,&nbsp;Pere N. Barri-Soldevila MD ,&nbsp;Silvia Cabrera Díaz MD, PhD","doi":"10.1016/j.jmig.2025.06.023","DOIUrl":"10.1016/j.jmig.2025.06.023","url":null,"abstract":"<div><h3>Objective</h3><div>This meta-analysis aimed to compare barbed sutures (BS) and conventional sutures (CS) for vaginal cuff closure in total laparoscopic and robot-assisted hysterectomies, evaluating their impact on operative time, suture time, blood loss, postoperative complications, surgical site infections, and granulation tissue formation.</div></div><div><h3>Data Sources</h3><div>A comprehensive search of the electronic databases PubMed/MEDLINE and Embase was conducted, covering literature published from 2004 to June 2024.</div></div><div><h3>Methods of Study Selection</h3><div>A systematic review and meta-analysis were conducted, including 24 studies comprising 4.593 women (2212 in the BS group and 2.381 in the CS group). Data were analyzed separately for laparoscopic and robot-assisted procedures.</div></div><div><h3>Tabulation, Integration, and Results</h3><div>No significant differences were found in vaginal cuff dehiscence rates between BS and CS in both surgical approaches. In laparoscopic hysterectomies, BS significantly reduced operative time by 8.58 minutes (95% confidence interval [CI], −14.05 to −3.10), suture time by 4.9 minutes (95% CI, −7.16 to −2.65), and estimated blood loss by 5.42 mL (95% CI, −10.71 to −0.12). In robot-assisted hysterectomies, BS significantly reduced operative time (−37.82 minutes; 95% CI, −54.88 to −20.76) and granulation tissue formation (2.61% vs 11.29%, favoring BS; 95% CI, 0.18–1.23). No significant differences were observed in postoperative complications or surgical site infections for either approach.</div></div><div><h3>Conclusion</h3><div>BS are a safe and effective option for vaginal cuff closure in minimally invasive hysterectomies. They offer significant advantages in laparoscopic procedures by reducing operative time, suture time, and blood loss, whereas in robot-assisted surgeries, they shorten operative time and decrease granulation tissue formation. These findings support the use of BS as a reliable choice for optimizing surgical outcomes.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 10","pages":"Pages 862-876"},"PeriodicalIF":3.3,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608611","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":"INTESTINAL RESECTION AND REDO ANASTOMOSIS FOLLOWING ANASTOMOTIC DEHISCENCE POST SEGMENTAL BOWEL ENDOMETRIOSIS SURGERY: A CASE REPORT.","authors":"Francisco Fuentes, Vinicius Maestri, Nayara Gressele, William Kondo","doi":"10.1016/j.jmig.2025.06.009","DOIUrl":"https://doi.org/10.1016/j.jmig.2025.06.009","url":null,"abstract":"<p><strong>Objective: </strong>To present a case of surgical management of anastomotic dehiscence after laparoscopic bowel deep endometriosis resection.</p><p><strong>Setting: </strong>Anastomosis leakage (AL) is defined as a defect of the integrity in a surgical junction between two hollow viscera with communication between the intraluminal and extraluminal compartments [1,2]. Currently, no consensus exists on the management of AL following bowel surgery for endometriosis. Treatment recommendations are often extrapolated from guidelines for colorectal cancer surgery [2-4]. Management strategies depend on various factors, including the patient's clinical condition, bowel viability, surgeon expertise, time since initial surgery, anastomosis height, patient risk factors, and the underlying indication for bowel surgery [4,5].</p><p><strong>Participants: </strong>A 36-year-old woman with suspected AL post segmental bowel endometriosis surgery.</p><p><strong>Intervention: </strong>A 36-year-old with a history of infertility and chronic pelvic pain underwent a laparoscopic segmental resection because of bowel deep endometriosis. On postoperative Day 5, she experienced pelvic pain in addition to small pelvic collections in a computed tomography scan. Given the suspicion of an anastomotic leakage, exploratory laparoscopy was performed. During the laparoscopy, AL was identified, occurring within six days postoperatively and located more than 8 cm from the anal verge. The patient remained hemodynamically stable without signs of sepsis. Consequently, resection and redo anastomosis were performed. Based on the surgical team's experience, a protective stoma was deemed unnecessary.</p><p><strong>Conclusion: </strong>Early anastomotic leakage can be managed by resecting the anastomotic zone and performing a redo anastomosis. The decision to create a protective stoma should be individualized and tailored to each patient's clinical condition.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144600729","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":"Safety of in-bag Morcellation During Laparoscopic Myomectomy and Hysterectomy: A Systematic Review and Meta-analysis.","authors":"Gautier Chene, Laura Miquel, Aubert Agostini, Sofiane Bendifallah, Céline Solignac, Bernadette Darne, Solène Languille, Krystel Nyangoh Timoh, Marie Carbonnel","doi":"10.1016/j.jmig.2025.07.002","DOIUrl":"10.1016/j.jmig.2025.07.002","url":null,"abstract":"<p><strong>Objective: </strong>To systematically evaluate the outcomes of in-bag versus no-bag morcellation during laparoscopic myomectomy and hysterectomy, focusing on safety.</p><p><strong>Data sources: </strong>Searches were conducted in Cochrane Library, Embase, and PubMed, covering studies from inception up to January 31, 2024.</p><p><strong>Methods of study selection: </strong>Inclusion of studies on females undergoing laparoscopic myomectomy and/or hysterectomy with in-bag morcellation, excluding series with fewer than 10 patients.</p><p><strong>Tabulation, integration and results: </strong>Data were synthesized using meta-analysis techniques, with sensitivity analyses for rare events, focusing on intraoperative complications (i.e., a composite outcome including conversion to laparotomy, bowel injury, or accidental injury to any viscus injury or vessel). The secondary outcomes include presence of parasitic fibroma, fragment of myometrium/uterus, blood transfusion, bleeding > 500 mL, total operative time, postoperative length of stay, postoperative pain, conversion to laparotomy, postoperative complications, and cost. From 1970 published studies, we included 20 trials, enrolling 5505 women in the in-bag group and 37 283 women in the no-bag group. We included 9 trials in each subgroup, myomectomy and hysterectomy, enrolling 767 and 4678 women in the in-bag group and 830 and 36 380 women in the no-bag groups, respectively. We observed increased intraoperative complications compared to no-bag morcellation (Odds ratio [OR] 1.45, 95% confidence interval [CI] 1.11;1.89) with a null heterogeneity (I² = 0%). The hysterectomy subgroup analysis showed a significant association between bag and intraoperative complications (OR 1.47, 95% CI 1.12;1.93) but not myomectomy (OR 1.00, 95% CI 0.29;3.43). We did not have enough information to conclude about the presence of parasitic fibroma, a fragment of myometrium, and costs. No statistical differences were observed concerning the other secondary outcomes.</p><p><strong>Conclusion: </strong>The use of containment bags in morcellation may increase the risk of intraoperative complications, particularly in the case of hysterectomy. However, these events may not directly link to bag use and could potentially represent confounding factors. Further studies are needed to investigate in-bag morcellation.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584172","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":"Endometriosis, a Familiar Companion of Isthmocele: A Systematic Review and Meta-analysis.","authors":"Marietta Gulz, Angela Vidal, Dimitrios Rafail Kalaitzopoulos, Tanya Karrer, Michael D Mueller","doi":"10.1016/j.jmig.2025.06.012","DOIUrl":"10.1016/j.jmig.2025.06.012","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the prevalence of endometriosis in patients with isthmocele and the outcome of isthmocele repair using a systematic literature review and meta-analysis of existing retro- and prospective studies.</p><p><strong>Data sources: </strong>A systematic search was conducted to identify trials published through May 2024 using Embase, MEDLINE, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews.</p><p><strong>Methods of study selection: </strong>A systematic literature review and meta-analysis was performed. Studies that investigated the coexistence of isthmocele and endometriosis or adenomyosis and the outcomes of surgical isthmocele repair were included. Data were extracted from 15 studies comprising 1149 women, and a meta-analysis was conducted using a random-effects model.</p><p><strong>Tabulation, integration, and results: </strong>Key outcomes were the prevalence of endometriosis and adenomyosis in women with isthmocele and pre- and postoperative outcomes, including abnormal uterine bleeding, dysmenorrhea, chronic pelvic pain, and infertility. Fifteen studies, of which 13 were suitable for quantitative synthesis, were included in this systematic review and meta-analysis. One was of good, one of fair, and the other 13 of poor quality. The prevalence of endometriosis in women with isthmocele was 33.6% (95% confidence interval, 23.7-45.1). Uterine scar endometriosis was found in 20.1% (95% confidence interval, 12.8-30.3). Surgery significantly improved abnormal uterine bleeding (76.7% before surgery, 22.8% after surgery), dysmenorrhea (31.4% to 7.4%), chronic pelvic pain (74.6%-18.3%), and infertility (75.1%-29.8%). Clinical pregnancy rates after combined laparoscopic and hysteroscopic repair were high (71%).</p><p><strong>Conclusion: </strong>Endometriosis is a frequent finding in women with isthmocele. Surgical repair of isthmocele significantly reduces symptoms and improves fertility outcomes. Nevertheless, the poor quality of most of the included studies must be taken into account. To establish causal relationships and refine surgical approaches, further research is needed.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584171","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":"Meta-Analysis of Laparoscopic Versus Vaginal Uterosacral Ligament Suspension","authors":"Ali Azadi MD, FACOG ,&nbsp;Hollie Ulibarri BS ,&nbsp;Amanda Arroyo BS ,&nbsp;Daniela Gonzalez Herrera BS ,&nbsp;Brooke Hamilton BS ,&nbsp;Kate Ruffley BS ,&nbsp;McKenna Robinson BS ,&nbsp;Greg J. Marchand MD, FACS, FICS, FACOG","doi":"10.1016/j.jmig.2025.07.001","DOIUrl":"10.1016/j.jmig.2025.07.001","url":null,"abstract":"<div><h3>Objective</h3><div><strong>:</strong> We set out to systematically evaluate and compare the safety and efficacy outcomes of laparoscopic and vaginal approaches in uterosacral suspension.</div></div><div><h3>Data Sources</h3><div><strong>:</strong> We searched major databases using appropriate terms to find studies comparing laparoscopic (or robotic-assisted laparoscopic) versus vaginal techniques for the repair of pelvic organ prolapse (POP). We searched from each database’s inception until January 01, 2024.</div></div><div><h3>Methods of Study Selection</h3><div><strong>:</strong> We included studies of patients undergoing POP surgery via either vaginal or laparoscopic routes, with or without concomitant hysterectomy. Ultimately, 9 studies met our criteria.</div></div><div><h3>Tabulation, Integration, and Results</h3><div><strong>:</strong> We conducted this meta-analysis utilizing Review Manager Software and OpenMeta [Analyst]. The laparoscopic group had a longer operative time (mean difference [MD] = 5.77 minutes, p = .02, <em>I</em>² = 47%) and lower estimated blood loss (MD = –49.71 mL, p = .05, <em>I</em>² = 81%). The length of hospital stay was similar between groups (MD = –0.26 days, p = .28, <em>I</em>² = 97%). The recurrence rate of any POP was lower in the laparoscopic group (risk ratio [RR] = 0.53, p = .03, <em>I</em>² = 0%). There were no significant differences in anatomical success rate (RR = 1.06, p = .16, <em>I</em>² = 35%), dyspareunia (RR = 0.79 p = .5, <em>I</em>² = 0%), or postoperative POP quantification stages I (RR = 1.11, p = .31, <em>I</em>² = 60%), II (RR = 0.93, p = .77, <em>I</em>² = 0%), and III (RR = 0.54, p = .52, <em>I</em>² = 0%). Following subgroup analysis with only cases that did not include hysterectomy, the differences in operative time ([–3.26,9.77] [p = .11]; <em>I</em>² = 55%<strong>)</strong>, and estimated blood loss ([–55.75,7.66]) [p =.14]; <em>I</em>² = 54%) were no longer statistically significant.</div></div><div><h3>Conclusion</h3><div>Both techniques proved effective. Laparoscopic uterosacral ligament suspension (L-USLS) involved longer operative times and less blood loss than vaginal-USLS. Adjusting for concomitant hysterectomy eliminated differences in operative time, blood loss, and hospital stay. Both methods showed similar hospital stay lengths, urinary tract infection rates, transfusion needs, reoperation rates, readmission rates, dyspareunia, and postoperative POP quantification stages. L-USLS displayed lower POP recurrence and urinary retention rates. While L-USLS may have advantages with hysterectomy, particularly in reduced blood loss, vaginal-USLS is also viable without hysterectomy. Due to study heterogeneity and lack of large randomized controlled trial data, more rigorous studies are essential to better define these surgical options.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 10","pages":"Pages 877-888"},"PeriodicalIF":3.3,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567486","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":"Repair of Vesicovaginal Fistula in 12 Steps Using the da Vinci Surgical System.","authors":"Adi Dayan-Schwartz, Noga Shachor, Meirav Braverman, Liron Kogan","doi":"10.1016/j.jmig.2025.06.015","DOIUrl":"10.1016/j.jmig.2025.06.015","url":null,"abstract":"<p><strong>Objective: </strong>To demonstrate the feasibility and effectiveness of a stepwise robotic-assisted vesicovaginal fistula (VVF) repair following oncologic surgery and adjuvant therapy.</p><p><strong>Setting: </strong>University teaching hospital.</p><p><strong>Participant: </strong>A 60-year-old woman with stage IIIC1, grade 2 endometrial carcinoma developed VVF following total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, sentinel lymph node sampling, and six cycles of carboplatin, paclitaxel, and Dostarlimab.</p><p><strong>Intervention: </strong>After failed conservative management with Foley catheter and bilateral nephrostomies, the patient underwent robotic-assisted VVF repair. Conservative management was prolonged beyond the typical 6-week trial to allow completion of adjuvant treatment, with continuous bladder drainage and nephrostomies maintained. This approach is supported by literature indicating early postoperative fistulas may close spontaneously with adequate diversion, particularly when small, uninfected, and not radiation-related [1]. However, persistent leakage, failed closure, and impaired quality of life necessitated surgery. Repair was conducted approximately 6 weeks after primary surgery and adjuvant chemotherapy, during a treatment-free interval. This timing was selected to: (1) allow tissue recovery, (2) confirm absence of active disease, and (3) address significant symptoms and quality-of-life burden. This aimed to optimize tissue condition and vascularity for successful closure while minimizing undue delay in cancer treatment. The VVF repair performed in 12 systematic steps, as detailed in the video.</p><p><strong>Results: </strong>The surgery was completed robotically, with removal of the nephrostomy tubes and placement of a Foley catheter, left in place for 14 days. The patient was discharged on postoperative day 1. Follow-up imaging confirmed fistula closure and restored continence. At submission, the patient has 6 months of follow-up with no fistula recurrence, voiding dysfunction, or need for additional urinary diversion.</p><p><strong>Conclusion: </strong>This case illustrates the efficacy of a stepwise robotic VVF repair, offering precise dissection, enhanced visualization, and successful anatomical and functional restoration.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567487","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":"Board Of Directors-Ed Calendar","authors":"","doi":"10.1016/S1553-4650(25)00178-5","DOIUrl":"10.1016/S1553-4650(25)00178-5","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 7","pages":"Page A1"},"PeriodicalIF":3.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144571419","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":"TOC","authors":"","doi":"10.1016/S1553-4650(25)00181-5","DOIUrl":"10.1016/S1553-4650(25)00181-5","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 7","pages":"Pages A4-A5"},"PeriodicalIF":3.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144571422","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":"Conservative Treatment of Uterine Myomas: A Network Meta-Analysis of Randomized Controlled Studies","authors":"Mattia Dominoni MD, PhD,&nbsp;Barbara Gardella MD,&nbsp;Andrea Gritti MD,&nbsp;Marianna Francesca Pasquali MD,&nbsp;Arsenio Spinillo MD","doi":"10.1016/j.jmig.2024.12.012","DOIUrl":"10.1016/j.jmig.2024.12.012","url":null,"abstract":"<div><h3>Objective</h3><div>To comparatively evaluate the effectiveness of uterine artery embolization (UAE), high-intensity focused ultrasound (HIFU), radiofrequency ablation treatment (RFT), and laparoscopic/laparotomic surgery in the conservative treatment of uterine fibroids.</div></div><div><h3>Data Sources</h3><div>The research was performed via electronic databases PubMed, Embase, and Cochrane Library, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards.</div></div><div><h3>Methods of Study Selection</h3><div>The network included 10 randomized trials between 2000 and 2024 and 1002 randomized subjects.</div></div><div><h3>Tabulation, Integrations, and Results</h3><div>The network meta-analysis was conducted with subroutine netmeta on R. The risk of bias was assessed using the Revised Cochrane risk-of-bias tool for randomized trials. The surface under the cumulative ranking curve (SUCRA) was computed by Bayesian network meta-analysis. Incidences of reintervention per 100 person/year of follow-up were 4.13 (range, 0–19.4), 16.1 (6.2–32.8), 14.3 (0–15.1), and 6 (4.3–6.7) for myomectomy, UAE, HIFU, and RFT, respectively. The incidence rate ratios compared with myomectomy were 2.45 (95% confidence interval [CI], 1.38–4.37), 5.23 (95% CI, 1.59–17.3), and 4.59 (95% CI, 0.77–27.3; p = .09) for UAE, HIFU, and RFT, respectively. RTF had the highest (SUCRA, 1.25% and 3%) whereas myomectomy had the lowest risk of reintervention (SUCRA, 98% and 95%) or hysterectomy during follow-up (median, 12 months; range, 3–24). The risk of major complications was significantly lower after UAE (odds ratio, 0.38; 95% CI, 0.17–0.85) than myomectomy. The procedure with the lowest likelihood of major complications was HIFU (SUCRA, 81.5%). Finally, in the evaluation of QoL at follow-up visits, there were no differences between the treatments studied, although the model was highly heterogeneous and inconsistent.</div></div><div><h3>Conclusion</h3><div>In the analysis of randomized trials, surgical myomectomy carried the least risk of reintervention and subsequent hysterectomy during a relatively short follow-up period. HIFU was the method with the lowest risk of major complications.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 7","pages":"Pages 583-591.e1"},"PeriodicalIF":3.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903291","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}