Journal of minimally invasive gynecology最新文献

{"title":"Long-Term Postoperative Recurrence Rates and Fertility Outcomes After Endometrioma CO2-Laser Vaporization: A Five-Year Follow-Up Experience","authors":"Stefano M. Ferrari MD,&nbsp;Carolina Dolci MD,&nbsp;Iacopo Tandoi MD,&nbsp;Matteo Schimberni MD,&nbsp;Ludovica Bartiromo MD,&nbsp;Noemi Salmeri MD,&nbsp;Sara D'Alessandro MD,&nbsp;Giulia Carnemolla MD,&nbsp;Giorgia Grisafi MD,&nbsp;Massimo Candiani MD","doi":"10.1016/j.jmig.2024.09.367","DOIUrl":"10.1016/j.jmig.2024.09.367","url":null,"abstract":"<div><h3>Study Objective</h3><div>Although cystectomy remains the gold standard for the surgical treatments of endometriomas, concerns about the negative effect on ovarian reserve are rising. Laser-CO₂ vaporization of endometriomas has shown encouraging data on ovarian reserve preservation, postoperative pregnancy rates, and recurrence. The aim of this study was to assess postoperative recurrence rate and pregnancy rate in patients with endometriomas managed by CO₂ fiber laser vaporization after at least 5 years following surgery.</div></div><div><h3>Design</h3><div>Retrospective study.</div></div><div><h3>Setting</h3><div>Italian tertiary center from October 2023 to February 2024.</div></div><div><h3>Patients</h3><div>We included women aged &gt;18 years who underwent laparoscopic CO₂ fiber laser vaporization for endometriomas. Age ≥40 years, previous ovarian surgery, previous salpingectomy or hysterectomy, negative histologic finding for endometriosis, or any findings of malignancy at histology were exclusion criteria.</div></div><div><h3>Intervention</h3><div>Ovarian endometriomas were vaporized through laparoscopic CO₂ fiber laser. After surgery, patients were included in a surveillance program with periodic clinical follow-ups.</div></div><div><h3>Measurements and Main Results</h3><div>Seventy-eight patients were included. The mean age was 33.2 ± 4.6 years, the basal anti-Müllerian hormone was 2.7 ± 1.9 ng/mL, and the median diameter of the endometriomas was 4 (3–5) cm. The median duration of follow-up was 72.5 months (67–84.5). After surgery, 65.5% (n = 36) of women with reproductive desire achieved a pregnancy, 55.6% spontaneously, and 44.4% through Assisted Reproduction Techniques, with a mean time to pregnancy of 17.7 ± 18.1 months. A Kaplan-Meier curve for the 7 patients who experienced an ipsilateral recurrence showed that the median time to recurrence was 26 months and the estimated rate of disease-free patients was 91.03% at 100 months (95% confidence interval 82.10%–95.62%).</div></div><div><h3>Conclusion</h3><div>CO₂ fiber laser vaporization is an effective and safe surgical treatment of ovarian endometriomas, combining the advantage of being an ovarian tissue-sparing technique with long-term postoperative recurrence rate comparable with that described in literature for the cystectomy.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 2","pages":"Pages 171-176"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142381080","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":"Uterine Artery Embolization Due to Intra-Abdominal Bleeding Eight Weeks After Myomectomy","authors":"Hale Goksever Celik MD, PhD ,&nbsp;Ceyda Buyuker ,&nbsp;Boran Aksakal ,&nbsp;Faruk Buyru MD","doi":"10.1016/j.jmig.2024.08.010","DOIUrl":"10.1016/j.jmig.2024.08.010","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 2","pages":"Pages 105-107"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142055824","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":"Cheek Acupuncture Reduces Postoperative Nausea and Vomiting in Patients Undergoing Laparoscopic Gynecological Surgery: A Randomized Controlled Trial.","authors":"Liangrong Wang, Xintong Zou, Linfeng Wu, Zijun Jin, Shuyu Hu, Xianfen Zhu, Xiaoyao Li","doi":"10.1016/j.jmig.2025.01.011","DOIUrl":"10.1016/j.jmig.2025.01.011","url":null,"abstract":"<p><strong>Objective: </strong>Cheek acupuncture, a recently established microneedle therapy, has been proven to effectively reduce pain, but its potential antiemetic effects remain unconfirmed. Thus, This study aimed to compare the antiemetic efficacy of cheek acupuncture with ondansetron and evaluate the cumulative effect in patients undergoing laparoscopic gynecological surgery.</p><p><strong>Design: </strong>A single-center randomized controlled trial.</p><p><strong>Setting: </strong>A university teaching hospital.</p><p><strong>Patients: </strong>A Total of 150 Adult patients who underwent laparoscopic gynecological surgery between July 2023 and December 2023.</p><p><strong>Interventions: </strong>Cheek acupuncture, IV ondansetron, or both.</p><p><strong>Measurements and main results: </strong>The incidence and severity of postoperative nausea and vomiting as well as the postoperative requirement of rescue antiemetic agent were comparable between the cheek acupuncture and ondansetron group in 48 hours postoperatively (p > .05), but all of which were significantly reduced in the combination group (p < .05). Compared with the ondansetron group, the cheek acupuncture and combination group exhibited reduced pain intensity at 3 and 48 hours postoperatively (p < .05). The use of cheek acupuncture was associated with higher satisfaction scores with anesthesia and shorter time of first flatus. Furthermore, no significant differences in other outcomes were found among the three groups (p > .05).</p><p><strong>Conclusion: </strong>Cheek acupuncture had a prominent antiemetic effect in reducing the incidence and severity of postoperative nausea and vomiting in patients undergoing gynecological laparoscopic surgery.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066161","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":"Preoperative Medication for Ovarian Endometrioma Reduces Cyst Size and Pain but Not rASRM Score.","authors":"Hye-Ji Jung, Sung Eun Kim, Hyeonmyeong Hong, Dong-Yun Lee, DooSeok Choi","doi":"10.1016/j.jmig.2025.01.010","DOIUrl":"10.1016/j.jmig.2025.01.010","url":null,"abstract":"<p><strong>Study subject: </strong>To investigate the impact of preoperative hormonal medication, including combined oral contraceptives or dienogest, on operative findings in ovarian endometrioma surgery.</p><p><strong>Design: </strong>A single-center, retrospective study.</p><p><strong>Setting: </strong>Department of Gynecology, Samsung Medical Center, Republic of Korea.</p><p><strong>Participants: </strong>Among patients who underwent ovarian endometrioma surgery for the first time at Samsung Medical Center between January 2020 and July 2023, those who started hormonal medication at another institution before their initial visit to our center, those with a waiting period of less than 3 months until the surgery date, and those with an endometrioma size of less than 4 cm at the initial visit were excluded. A total 140 remaining patients were included in the study. The patients were divided into two groups: the group that received preoperative hormonal medication (combined oral contraceptives or dienogest) and the group that did not receive medication.</p><p><strong>Interventions: </strong>To evaluate the impacts of preoperative hormonal medication on ovarian endometrioma patients, the operative findings were compared between the groups.</p><p><strong>Results: </strong>Of the 140 patients, 65 were in the no-medication group and 75 were in the medication group. Except for the median duration of follow-up and age, there were no differences in the baseline characteristics between the two groups. Operative findings were quantified using the revised American Society for Reproductive Medicine score. Although medication significantly reduced the size of the ovarian endometrioma, there were no significant differences in revised American Society for Reproductive Medicine score between the two groups. However, the medication group experienced significant preoperative pain relief.</p><p><strong>Conclusion: </strong>Preoperative hormonal medication can reduce the size of ovarian endometriomas but does not significantly affect the overall operative findings. Nevertheless, preoperative medication is helpful in reducing pain in patients before surgery.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052597","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":"Time for educational Revamp? A Nationwide Survey of Fellowships in Minimally Invasive Gynecologic Surgery Program Directors' and Fellows' Didactic Experiences.","authors":"Merima Ruhotina, Colleen Murphy, Elizabeth Rasmussen, Joan Skelly, Masoud Azodi, Shabnam Kashani","doi":"10.1016/j.jmig.2025.01.009","DOIUrl":"10.1016/j.jmig.2025.01.009","url":null,"abstract":"<p><strong>Study objective: </strong>A desire for curriculum standardization in obstetrics and gynecology residencies has been identified. No prior investigations of educational experience in fellowships in minimally invasive gynecologic surgery (FMIGS) programs have been completed. This study aimed to determine the state of the FMIGS didactic education and the perceptions of fellowship directors and fellows regarding a standardized curriculum.</p><p><strong>Design: </strong>National survey.</p><p><strong>Setting: </strong>Web-based survey platform.</p><p><strong>Participants: </strong>AAGL FMIGS program directors and fellows.</p><p><strong>Interventions: </strong>N/A.</p><p><strong>Measurements and main results: </strong>Eighty-seven of the 151 fellowship directors responded to the survey, resulting in a response rate of 57.6%. Fifty-eight the 97 fellows responded to the survey, for a response rate of 59.8%. When participants were asked whether their programs had structured didactic education curricula, 98.9% of fellowship directors replied yes, whereas only 77.6% of fellows responded yes (p <.001). Approximately 97% of fellowship directors reported that structured didactic time was protected from clinical duties. However, only 67.2% of the participants reported that didactic time was protected (p <.001). Participants (71.3% of the fellowship directors and 84.5% of the fellows) strongly agreed that their didactic education could be improved. A large majority of the participants agreed that all MIGS fellows should learn the same content in their didactic curricula, that fellows should have access to the same educational resources, and that participating in a standardized didactic curriculum would allow for a better transition into independent practice.</p><p><strong>Conclusion: </strong>Fellowship directors and fellows are aligned with their desire to improve their current didactic education programs and the need for a centrally located, structured, and standardized fellowship education curriculum.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052664","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":"Presidential Address Presented at the 53rd AAGL Global Congress in New Orleans on the 17th of November 2024: Look Forward!","authors":"Michel Canis","doi":"10.1016/j.jmig.2025.01.007","DOIUrl":"10.1016/j.jmig.2025.01.007","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029079","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":"Vaginal-Assisted NOTES Hysterectomy for Large Uterus Using the da Vinci SP.","authors":"Kiyoshi Kanno, Naofumi Higuchi, Ryo Taniguchi, Masaaki Andou","doi":"10.1016/j.jmig.2025.01.008","DOIUrl":"10.1016/j.jmig.2025.01.008","url":null,"abstract":"<p><strong>Objective: </strong>Recent advancements of minimally invasive gynecologic surgery have led to the development of transvaginal natural orifice translumenal endoscopic surgery (vNOTES) [1,2]. Robot-assisted vNOTES has also been explored as a method providing accurate and fine surgical procedures with improved ergonomics, visualization, wristed instruments, elimination of the hand tremor [3,4]. The objective of this video is to demonstrate the technical and anatomical highlights of a vaginal-assisted NOTES hysterectomy (VANH) using the da Vinci SP (SP).</p><p><strong>Setting: </strong>An urban general hospital. Stepwise demonstration of the technique with narrated video footage.</p><p><strong>Participants: </strong>A 51-year-old woman, para 2 with no previous history of abdominal surgery, who presented with dysmenorrhea and urinary frequency. Magnetic resonance imaging revealed a large uterus with multiple fibroids.</p><p><strong>Interventions: </strong>The surgical steps are completely identical to conventional laparoscopic or robotic VANH [2,3]. This suggests that conventional laparoscopic skills are highly transferrable to SP. SP offer several advantages, including high-resolution three-dimensional visualization, articulating instruments, and improved dexterity and range of motion. In addition, conventional multi-arm robotic platforms have difficulty docking and adjusting the arm angle for vNOTES, but SP allows easy docking due to its single-arm design [5]. A Gelpoint V-Path is used as the vNOTES platform to hold the SP metal cannula. This cannula contains four channels, allowing the use of three instruments and a camera. The double bipolar method is used since this facilitates precise dissection with minimal thermal spread. The total operative time was 102 minutes. The estimated blood loss was 50ml without any complications. The uterus weighed 970 g. The postoperative course was uneventful.</p><p><strong>Conclusion: </strong>VANH using SP is technically safe and feasible for benign uterine diseases in selected patients. Maneuverability of articulating instruments used in SP may allow broad expansion of the indication for vNOTES to more challenging cases. VIDEO ABSTRACT.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023861","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: beware of the tip of the iceberg.","authors":"Alessia Limena, Maria Sakellariou, Claire Figuier, Michel Canis","doi":"10.1016/j.jmig.2025.01.006","DOIUrl":"https://doi.org/10.1016/j.jmig.2025.01.006","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006894","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 Intracervical Terlipressin on Intravasation and Venous Embolization During Transcervical Myomectomy and Endometrium Resection: A Randomized Controlled Study.","authors":"Lucilla E Overdijk, Lillian Hesselink, Paul J M van Kesteren, Peter de Haan, Luuk Karskens, Robert Riezebos, Eric J F Franssen, Bart M P Rademaker","doi":"10.1016/j.jmig.2024.12.023","DOIUrl":"10.1016/j.jmig.2024.12.023","url":null,"abstract":"<p><strong>Study objective: </strong>To investigate whether intracervical injection of terlipressin during hysteroscopic surgery could reduce the amount of intravasation, the incidence and severity of gas embolism, and the COHb levels in the blood.</p><p><strong>Design: </strong>Randomized double-blind controlled trial.</p><p><strong>Setting: </strong>Gynecologic surgical unit in a general hospital.</p><p><strong>Patients: </strong>Patients who were scheduled for transcervical resection of type 1 or type 2 myomas (TCR-M), or for extensive transcervical endometrium resection (TCR-E).</p><p><strong>Interventions: </strong>Patients were randomized to receive either terlipressin 0.85 mg or placebo injections intracervical at the beginning of the procedure.</p><p><strong>Measurements: </strong>The amount of intravasation and level of COHb was measured at the end of the procedure. The incidence and severity of gas embolisms was determined during the procedure by transesophageal echocardiography (TEE). Study groups were compared using an Independent Samples T-Test or a Mann-Whitney U test as indicated.</p><p><strong>Main results: </strong>Forty-four patients were included in this study. No significant differences were found in intravasation volume, venous emboli and post-surgery COHb between study groups. There was a trend towards more severe embolisms (grade IV embolisms: 12 versus 6, p = .08), paradoxical embolisms (4 versus 2, p = .55) and a shorter operation time (mean of 43 versus 36 minutes, p = .09) in patients who received placebo compared to terlipressin.</p><p><strong>Conclusion: </strong>This study could not demonstrate a clear beneficial effect of intracervical terlipressin administration. However, further research is needed to investigate if terlipressin can reduce operation time, severe embolisms and the need for redo procedures.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006929","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 Intravenous Tranexamic Acid Reduce Blood Loss at the Time of Total Colpocleisis? A Randomized Double-Blind Placebo-Controlled Trial.","authors":"Colleen D McDermott, Danny Lovatsis, Stella Wang, Ella Huszti, Kristin Wadsworth","doi":"10.1016/j.jmig.2025.01.005","DOIUrl":"10.1016/j.jmig.2025.01.005","url":null,"abstract":"<p><strong>Study objective: </strong>To determine the efficacy of intravenous (IV) tranexamic acid (TXA) in reducing blood loss and blood transfusion among women undergoing total colpocleisis.</p><p><strong>Design: </strong>Double-blind, randomized, placebo-controlled trial.</p><p><strong>Setting: </strong>Tertiary academic urogynecology practice.</p><p><strong>Participants: </strong>Consenting women undergoing total colpocleisis (±midurethral sling) for treatment of posthysterectomy pelvic organ prolapse.</p><p><strong>Interventions: </strong>Participants were randomly assigned to a single dose of 1gram TXA or placebo after anesthesia induction. Primary outcome measures were the differences in preoperative hemoglobin (hgb) and hematocrit (hct) compared to those measured 24 hours after surgery. Secondary outcomes included the difference in intraoperative blood loss and the need for blood transfusion during hospital stay. Safety outcomes were assessed 6 weeks postoperatively.</p><p><strong>Main results: </strong>Thirty participants completed the study (TXA: 14; placebo: 16). Preoperative variables were similar between groups. Intraoperative outcomes were also comparable, and all surgeries were completed under general anesthesia. No significant differences were observed in any blood loss outcomes between groups (TXA versus placebo differences: hgb 3.2g/dL versus 2.6g/dL, p = .41; hct 0.09 versus 0.08, p = .25; intraoperative blood loss 340mL versus 405mL, p = .58). One patient in the TXA group received a blood transfusion 1 day after surgery due to medically significant anemia. There were no significant adverse events related to the study intervention in the TXA group.</p><p><strong>Conclusion: </strong>This study showed no statistically significant differences in blood loss outcomes with the use of IV TXA at the time of total colpocleisis (±midurethral sling). While TXA administration showed no advantage regarding blood loss, it demonstrated no significant adverse effects. This study reinforces judicious use of TXA at the time of colpocleisis rather than using it prophylactically.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006910","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}