Journal of minimally invasive gynecology最新文献

{"title":"The Association between Pathology Confirmed Versus Unconfirmed Endometriosis and Anxiety and Depression","authors":"K Lawrenson ,&nbsp;N Ngo ,&nbsp;S Taing ,&nbsp;M Liang ,&nbsp;A Manlinguez ,&nbsp;R Meyer","doi":"10.1016/j.jmig.2025.09.033","DOIUrl":"10.1016/j.jmig.2025.09.033","url":null,"abstract":"<div><h3>Study Objective</h3><div>Among patients with endometriosis, disease symptoms associate poorly with lesion burden, and severe symptoms of endometriosis can occur in patients in whom lesions cannot be detected by pathologic examination. Anxiety and depression are prevalent in patients with confirmed endometriosis. This study aimed to examine these comorbid traits in patients with endometriosis-like symptoms in the absence of a confirmed diagnosis.</div></div><div><h3>Design</h3><div>A prospective study. We collected data from patients who underwent surgery for endometriosis and controls who underwent surgery for other indications between 10/2019 and 3/2024, as part of The Biologic and Epidemiologic Markers of Endometriosis (BEME) clinic-based study.</div></div><div><h3>Setting</h3><div>Quaternary level hospital.</div></div><div><h3>Patients or Participants</h3><div>We compared patients with pathology confirmed endometriosis to patients with suspected endometriosis and negative pathology (SENP) and controls.</div></div><div><h3>Interventions</h3><div>Multivariable regressions analysis to evaluate the association between pathology confirmed endometriosis and medically treated anxiety and/or depression.</div></div><div><h3>Measurements and Primary Results</h3><div>454 women were included in the study, of which 308 (67.8%) had pathology confirmed endometriosis, 45 (9.9%) had SENP, and 101 (22.2%) were controls without endometriosis. The proportion of depression among patients with pathology confirmed endometriosis, SENP and controls 42.4%, 60.0% and 40.6%, respectively. The proportion of anxiety among the groups was 52.9%, 60.0% and 46.5%, respectively. In multivariable regression analysis, compared to patients with pathology confirmed endometriosis, depression was independently associated with patients with SENP (aOR 2.30 95%CI 1.03-5.17). Anxiety alone or the combination of anxiety and/or depression were not independently associated with any of the study groups.</div></div><div><h3>Conclusion</h3><div>Patients with pain symptoms indicative of endometriosis and negative pathology have increased risk of depression, and comparable risk of anxiety compared to patients with pathology confirmed endometriosis. Long-term follow-up of SENP patients will be valuable to determine outcomes for this group of patients, and to optimize the best strategies for clinical care.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Pages S25-S26"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334984","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":"Deep Endometriosis Affecting the Rectosigmoid and Vagina: A Surgical Strategy to Preserve Functionality","authors":"G. Rodrigues ,&nbsp;P.A. Ayroza Ribeiro ,&nbsp;C. Tomonaga ,&nbsp;F. Oliveira ,&nbsp;F. Ohara ,&nbsp;H. Salomão","doi":"10.1016/j.jmig.2025.09.076","DOIUrl":"10.1016/j.jmig.2025.09.076","url":null,"abstract":"<div><h3>Study Objective</h3><div>The aim of this video is to demonstrate a surgical technique to remove vaginal and rectum endometriosis preserving noble structures and functionality.</div></div><div><h3>Design</h3><div>Video Article</div></div><div><h3>Setting</h3><div>Patient undergoing general and spinal anesthesia, stayed in a Trendelemburg and modified lithotomy position - buttocks placed above 5-10cm above the edge of operating table, thighs slightly abducted, legs supported by stirrups maintaining knees flexion of 90 degree. The initial 11mm incision was done in the umbilical scar, and another three abdominal 5mm incisions were made to establish a triangle position of trocars.</div></div><div><h3>Patients or Participants</h3><div>Female patient, 36 years old, reporting intense dysmenorrhea since menarche, that turned to acyclic pelvic pain, dyschesia and dyspareunia for the past two years, that limits her activities and sex life. Upon vaginal examination, retrocervical nodulation and a 3cm vaginal fornix nodule were identified, along with bilateral thickening of the uterosacral ligaments. In addition, a vaginal length of 8cm was measured.</div><div>In transvaginal ultrasound for endometriosis, a retrocervical nodule extending to the uterine torus, uterosacral ligaments, left paracervical region, and vaginal fornix, measuring 1.5 cm, was identified, in addition to two lesions in the rectosigmoid at 12 and 16 cm from the anal margin.</div></div><div><h3>Interventions</h3><div>A laparoscopy for excision of endometriosis lesions, partial colpectomy and retossigmoidectomy has been done after clinical evaluation and precise diagnosis.</div></div><div><h3>Measurements and Primary Results</h3><div>Immediately after surgery, patient received a progressive diet to reestablish retossigmoid function and pain medication, with complete recovery without any complications. 60 days after surgery, patient reported complete relief of pelvic pain and dyspareunia. In examination, a vaginal length of 10cm was measured.</div></div><div><h3>Conclusion</h3><div>This case and video emphasizes the clinical relevance of endometriosis with vaginal and rectal lesions, and highlights the surgical strategy in this type of surgery, that could remove all endometriosis lesions, preserving functionality and returning quality of life to the patient.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Page S6"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335094","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":"Unusual Presentation of Rectovaginal Septum Endometriosis: Cystic Endometrioma","authors":"P. Bellelis ,&nbsp;M. Corinti Son ,&nbsp;V.S. Bruscagin ,&nbsp;D.B. Caraca","doi":"10.1016/j.jmig.2025.09.079","DOIUrl":"10.1016/j.jmig.2025.09.079","url":null,"abstract":"<div><h3>Study Objective</h3><div>To report and to illustrate with video a rare case of endometriosis of the rectovaginal septum presented as a cystic endometrioma.</div></div><div><h3>Design</h3><div>Case report.</div></div><div><h3>Setting</h3><div>Private hospital.</div></div><div><h3>Patients or Participants</h3><div>We present the case of a 39-year-old woman diagnosed with endometriosis in 2016. At the time, diagnose was due to anal pain during menstrual period, however, we do not have access to old imaging exams.</div><div>Since then, symptoms diminished using continuous dienogest, and she had been amenorrhea for 4 years.</div><div>In physical examination she had a painful bulging retrocervical nodule occupying the posterior vaginal fornix up to 4 cm to vaginal introitus.</div><div>Transvaginal sonography with bowel preparation shows normal uterus and adnexa, an endometriotic nodule in rectosigmoid measuring 4.3cm, at 10cm from anal verge affecting 20% of its circumference. Also, a cystic endometrioma in rectovaginal septum measuring 6.3 × 4.7 × 4.5 cm.</div></div><div><h3>Interventions</h3><div>In February 2021, the patient was scheduled for a laparoscopic surgery to treat deep endometriosis. We performed the exeresis of a 6 cm cystic endometrioma of rectovaginal septum, rectosigmoidectomy with end-to-end anastomosis at 2 cm from anal verge and protective loop ileostomy, colporrhaphy and exeresis of peritoneal endometriosis.</div></div><div><h3>Measurements and Primary Results</h3><div>Surgery duration time was 3h30min, estimated blood loss was about 50 ml. The patient was discharged in the second postoperative day. And the final pathological report confirmed endometriosis of all specimens.</div></div><div><h3>Conclusion</h3><div>Endometriosis of the rectovaginal septum is quite rare. Due to the distal topography, a precise imaging report is necessary. Once the anastomosis was at 2 cm from anal verge and we opened the vagina, we opted for the protective loop ileostomy to reduce the anastomotic leak rates.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Page S7"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335097","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":"Targeted Excision of Deep Nerve Endometriosis (Sciatic–Pudendal–Presacral) with Ionm-Guided Surgical Precision","authors":"T. Seckin ,&nbsp;A. Chu ,&nbsp;H. Kula ,&nbsp;J. Silverstein ,&nbsp;T. Seckin","doi":"10.1016/j.jmig.2025.09.095","DOIUrl":"10.1016/j.jmig.2025.09.095","url":null,"abstract":"<div><h3>Study Objective</h3><div>To illustrate how intraoperative neurophysiological monitoring (IONM)-guided laparoscopy improves the precision of endometriosis excision and facilitates optimal nerve preservation.</div></div><div><h3>Design</h3><div>Video Article- Case Presentation</div></div><div><h3>Setting</h3><div>Tertiary referral center specializing in advanced endometriosis surgery</div></div><div><h3>Patients or Participants</h3><div>A 36-year-old female with a history of multiple prior laparoscopic procedures presented with chronic, debilitating right-sided pelvic pain, including sciatic pain, pudendal neuralgia, dyspareunia, and functional limitation due to nerve-related symptoms.</div></div><div><h3>Interventions</h3><div>IONM-guided laparoscopic excision of deep endometriosis nodule</div></div><div><h3>Measurements and Primary Results</h3><div>IONM enabled real-time identification and functional verification of critical neural structures, including the sciatic and pudendal nerves. A fibrotic endometriotic nodule involving adjacent vascular structures was successfully excised while preserving surrounding nerves. Postoperatively, the patient experienced marked symptom improvement without the development of new neurological deficits.</div></div><div><h3>Conclusion</h3><div>This case highlights the utility of IONM-assisted laparoscopy in complex endometriosis surgery involving neural structures. IONM enables accurate identification and preservation of pelvic nerves, enhancing both surgical safety and patient outcomes in advanced cases of deep infiltrating endometriosis with nerve proximity or involvement.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Page S17"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335108","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":"Applications of Near Infrared Fluorescence Imaging in Non-Malignant Gynecologic Surgery","authors":"J Shields ,&nbsp;MC Cusimano ,&nbsp;J Kim ,&nbsp;E Gagliardi ,&nbsp;A Gargiulo ,&nbsp;C Johnson","doi":"10.1016/j.jmig.2025.09.105","DOIUrl":"10.1016/j.jmig.2025.09.105","url":null,"abstract":"<div><h3>Study Objective</h3><div>To review applications of near infrared fluorescence imaging during non-malignant gynecologic surgery.</div></div><div><h3>Design</h3><div>Educational video.</div></div><div><h3>Setting</h3><div>Operating room.</div></div><div><h3>Patients or Participants</h3><div>Series of female patients of reproductive age undergoing non-malignant gynecologic surgery complicated by: (1) endometriosis and large fibroids; (2) obliteration of the posterior cul-de-sac; (3) dense adhesions of the bladder to the lower uterine segment; and (4) a uterine isthmocele.</div></div><div><h3>Interventions</h3><div>Near infrared fluorescence imaging with indocyanine green (ICG) at a concentration of 2.5mg/mL was used for real-time delineation of the ureters/bladder and vagina. For identification of the ureters/bladder, rigid cystoscopy was performed and 5cc ICG was instilled into each ureter using 5Fr open-ended ureteral stents. For identification of the anterior and posterior vaginal fornix, 10cc ICG was instilled directly into the vagina, after sterile preparation but before placement of a uterine manipulator, and massaged into the vaginal mucosa. Near infrared imaging was also used to intensify the signal from visible light from a hysteroscope, in order to delineate the borders of a lower uterine segment isthmocele.</div></div><div><h3>Measurements and Primary Results</h3><div>Alternating between standard imaging and near infrared fluorescence imaging during minimally invasive surgery allows for continued visualization of critical structures throughout the case. The strength of fluorescent signals can vary based on the application and the nature of surrounding tissue, including the presence of significant adiposity, retroperitoneal fibrosis, and overlying adhesions.</div></div><div><h3>Conclusion</h3><div>Near infrared fluorescence imaging is an emerging clinical technology that can provide real-time guidance to surgeons by identifying tissue that needs to be resected or vital structures that need to be avoided, such as the ureters, bladder, and vagina. This technology is routinely used for sentinel lymph node mapping in gynecologic oncology, and can be safely adopted with or without fluorescent contrast agents for numerous applications in non-malignant gynecologic surgery as well.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Page S20"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335127","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":"Surgical Management of Heterotopic Cesarean Scar Ectopic with Preservation of Intrauterine Pregnancy in the First Trimester","authors":"E Gulbis ,&nbsp;K McEntee","doi":"10.1016/j.jmig.2025.09.137","DOIUrl":"10.1016/j.jmig.2025.09.137","url":null,"abstract":"<div><h3>Study Objective</h3><div>To demonstrate successful management of heterotopic cesarean scar ectopic with hysteroscopy while preserving intrauterine pregnancy.</div></div><div><h3>Design</h3><div>Single case study report demonstrating stepwise hysteroscopic technique to manage heterotopic cesarean ectopic pregnancy with narrated footage while preserving intrauterine pregnancy. Our patient was periodically followed throughout her entire pregnancy until delivery of a healthy female infant at 37 weeks.</div></div><div><h3>Setting</h3><div>Operating room in a community based hospital system</div></div><div><h3>Patients or Participants</h3><div>Single case study of one patient that was periodically followed throughout her entire pregnancy until delivery via uncomplicated repeat cesarean section at 37 weeks.</div></div><div><h3>Interventions</h3><div>Bipolar loop hysteroscopy under intraoperative ultrasound guidance to resect heterotopic pregnancy.</div></div><div><h3>Measurements and Primary Results</h3><div>Successful reduction of a heterotopic pregnancy using hysteroscopy while preserving intrauterine pregnancy. Intrauterine pregnancy resulted in delivery of a healthy female infant at 37 weeks.</div></div><div><h3>Conclusion</h3><div>This case report presents a single case of a 41-year-old G3P2001 with a history of two prior cesarean sections who had a two embryo IVF transfer that resulted in a fundal intrauterine pregnancy and ectopic cesarean scar pregnancy. Surgical management with a loop bipolar hysteroscopic system under intraoperative ultrasound guidance resulted in successful reduction of the ectopic pregnancy and preservation of the concurrent intrauterine fundal pregnancy. She was periodically followed throughout her pregnancy and had an uncomplicated repeat cesarean section at 37 weeks. Our study suggests that hysteroscopy is a viable technique to manage heterotopic pregnancy for patients who strongly desire to preserve an intrauterine pregnancy.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Page S32"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334543","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":"Single-Port Perforated IUD Removal with a Transabdominal Hysteroscope","authors":"M Marguerie,&nbsp;L Andrew,&nbsp;A Sanders","doi":"10.1016/j.jmig.2025.09.138","DOIUrl":"10.1016/j.jmig.2025.09.138","url":null,"abstract":"<div><h3>Study Objective</h3><div>To demonstrate a novel minimally invasive approach to perforated-IUD extraction</div></div><div><h3>Design</h3><div>Case presentation, educational video</div></div><div><h3>Setting</h3><div>Operating Room</div></div><div><h3>Patients or Participants</h3><div>Patients with an intra-abdominal perforated IUDs, without any evidence of other complication such as bladder/bowel perforation or abscess</div></div><div><h3>Interventions</h3><div>Use of a single port and a transabdominal hysteroscope with grasper to extract the perforated IUD</div></div><div><h3>Measurements and Primary Results</h3><div>Successful IUD extraction</div></div><div><h3>Conclusion</h3><div>Single-port surgery is the most minimally invasive method for IUD extraction and this method should be considered for most patients. Even IUDs even with moderate surrounding adhesions are reasonable to extract in this method.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Page S32"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334544","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":"Robotic-Assisted Laparoscopic Adenomyomectomy: A Uterus-Sparing Approach","authors":"CP Diniz ,&nbsp;CM Rowley ,&nbsp;J Mourad","doi":"10.1016/j.jmig.2025.09.132","DOIUrl":"10.1016/j.jmig.2025.09.132","url":null,"abstract":"<div><h3>Study Objective</h3><div>To describe the surgical technique and demonstrate the feasibility of robotic-assisted laparoscopic excision of focal adenomyomas (adenomyomectomy) in patients desiring uterine preservation.</div></div><div><h3>Design</h3><div>Case Series Report.</div></div><div><h3>Setting</h3><div>Procedures performed in an ambulatory surgery setting.</div></div><div><h3>Patients or Participants</h3><div>Two patients presented with heavy menstrual bleeding and dysmenorrhea attributed to focal adenomyosis/adenomyoma identified on preoperative imaging. Both desired uterus-sparing surgical management.</div></div><div><h3>Interventions</h3><div>Both patients underwent robotic-assisted laparoscopic adenomyomectomy. Key steps included identification of the affected area, careful excision from surrounding healthy myometrium, and multi-layer uterine reconstruction. Intraoperative techniques included vasopressin injection for hemostasis and the use of indocyanine green (ICG). The ICG, diluted significantly and instilled in a small volume (5-10cc) via the uterine manipulator at the start of the procedure, was visualized using near-infrared (Firefly) imaging to help delineate the endometrial cavity during excision. Uterine defects were reconstructed in multiple layers using delayed absorbable barbed suture.</div></div><div><h3>Measurements and Primary Results</h3><div>Operative parameters, pathological confirmation, and short-term clinical outcomes were evaluated.</div><div>• Pathology confirmed focal adenomyoma in both resected specimens.</div><div>• Estimated blood loss (EBL) was 50 and 75 mL, respectively.</div><div>• There were no intraoperative or immediate postoperative complications.</div><div>• Both patients were discharged home within 12 hours.</div></div><div><h3>Conclusion</h3><div>While hysterectomy offers definitive treatment for adenomyosis, robotic-assisted adenomyomectomy represents a feasible, safe, and effective uterus-sparing alternative, achieving favorable short-term symptom control in appropriately selected patients. This approach allows for precise excision with techniques like ICG guidance for cavity delineation, meticulous uterine reconstruction, and confirmation of tubal patency, thereby preserving uterine structure, addressing patient preference, and potentially maintaining their desired fertility.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Page S30"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334579","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":"Successful Uterine Preservation in Robert’s Uterus Masquerading As Non Communicating Rudimentary Horn","authors":"J Bharti ,&nbsp;R Vatsa ,&nbsp;GG Swetha ,&nbsp;S Manchanda ,&nbsp;N Malhotra","doi":"10.1016/j.jmig.2025.09.117","DOIUrl":"10.1016/j.jmig.2025.09.117","url":null,"abstract":"<div><h3>Study Objective</h3><div>To highlight the challenge in diagnosis and management of a rare mullerian anomaly-Robert's uterus.</div></div><div><h3>Design</h3><div>A case report of successful management of Robert's uterus which was misdiagnosed as non communicating rudimentary horn.</div></div><div><h3>Setting</h3><div>A rare case managed on a tertiary care centre. Patient underwent in low lithotomy position for hysterscopy and laparoscopy.</div></div><div><h3>Patients or Participants</h3><div>The informed written consent was taken from the patient. She was a 17 year old unmarried female who presented with progressive dysmenorrhea. She was initially misdiagnosed as bicornuate uterus and genital tuberculosis as cause of hydrosalpinx on magnetic resonance imaging(MRI).</div></div><div><h3>Interventions</h3><div>On presentation to our institute, MRI was reviewed and the diagnosis of unicornuate uterus with adjacent functional rudimentary horn was made and patient was planned for hemihysterectomy. On further evaluation and 3D ultrasound, later there was diagnostic dilemma of Robert's uterus due to no external indentation of uterine fundus. She was planned for hystero-laparoscopy and proceed.</div></div><div><h3>Measurements and Primary Results</h3><div>Hysteroscopy revealed single ostia on right side. Laparoscopy showed a single broad uterine fundus, making a diagnosis of Robert's uterus with asymmetrical septa. Hysteroscopic septal resection was done using resectoscope under ultrasound guidance.</div></div><div><h3>Conclusion</h3><div>A high index of suspicion is required for rare mullerian anomalies in all adolescent girls presenting with progressive dysmenorrhea. Broad uterine fundus with no/slight external indentation and asymmetrical cavities should clinch a diagnosis of Robert uterus. Correct diagnosis avoids inappropriate surgery of hemihysterectomy and leads to restoration of normal uterine cavity.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Page S26"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334642","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":"Surgical Techniques for Hysteroscopic Removal of an Embedded IUD Fragment","authors":"SC Spielman,&nbsp;C Crifase,&nbsp;A Dadrat,&nbsp;A Oshinowo","doi":"10.1016/j.jmig.2025.09.122","DOIUrl":"10.1016/j.jmig.2025.09.122","url":null,"abstract":"<div><h3>Study Objective</h3><div>Demonstrate various hysteroscopic techniques that can be utilized for successful removal of a deeply embedded IUD arm</div></div><div><h3>Design</h3><div>Case report</div></div><div><h3>Setting</h3><div>OR with patient in dorsal lithotomy position</div></div><div><h3>Patients or Participants</h3><div>29 year old G0 who originally presented for copper IUD removal and one IUD arm was retained.</div></div><div><h3>Interventions</h3><div>Various imaging techniques to locate the IUD arm as well as both in office and OR hysteroscopy</div></div><div><h3>Measurements and Primary Results</h3><div>IUD arm was successfully removed utilizing hysteroscopic morcellator and sharp/blunt dissection</div></div><div><h3>Conclusion</h3><div>We demonstrate how a hysteroscopic morcellator can be utilized in addition to sharp and blunt dissection to identify and remove a deeply embedded IUD arm.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Page S28"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334646","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}