Journal of minimally invasive gynecology最新文献

{"title":"Duplicated Ureter: Double the Vigilance","authors":"Ahmad Hasan MD, Dilkash Kajal MD, Nigel Pereira MD","doi":"10.1016/j.jmig.2025.12.031","DOIUrl":"10.1016/j.jmig.2025.12.031","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"33 9","pages":"Pages 1215-1216"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145906091","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":"Low-Pressure Versus Standard-Pressure Pneumoperitoneum in Gynecologic Laparoscopic Surgery: A Systematic Review and Meta-Analysis","authors":"Maria Julia Lemos MD,&nbsp;Berenice Curi-Pesantes MD,&nbsp;Davi Barbosa Pereira da Silva MS,&nbsp;Laura Fonseca Queiroz MD,&nbsp;Jose Carugno MD","doi":"10.1016/j.jmig.2026.05.017","DOIUrl":"10.1016/j.jmig.2026.05.017","url":null,"abstract":"<div><h3>Objective</h3><div>To compare low-pressure pneumoperitoneum (8–10 mm Hg) with standard-pressure pneumoperitoneum (12–15 mm Hg) in women undergoing gynecologic laparoscopic surgery, focusing on postoperative pain, operative time, estimated blood loss, and length of hospital stay.</div></div><div><h3>Data Sources</h3><div>PubMed, Embase, and Cochrane Central Register were systematically searched up to February 2026 using the terms \"gynecologic laparoscopy,\" \"pneumoperitoneum,\" \"intraperitoneal pressure,\" and \"insufflation pressure.\" Reference lists of included studies and prior systematic reviews were also manually searched.</div></div><div><h3>Methods of Study Selection</h3><div>Randomized controlled trials (RCTs) enrolling adult women undergoing gynecologic laparoscopic procedures that compared low- versus standard-pressure pneumoperitoneum and reported at least one outcome of interest were included.</div></div><div><h3>Tabulation Integration and Results</h3><div>Eleven RCTs comprising 1156 patients were included. A Bayesian random-effects meta-analysis was performed. Low-pressure pneumoperitoneum was not associated with significant differences in postoperative pain at 24 hours (SMD -0.17; 95% CrI: -0.67, 0.34), postoperative pain at 3-6 hours (SMD -0.45; 95% CrI: -1.34, 0.45), shoulder-tip pain at 24 hours (MD −0.37; 95% CrI: -1.20, 0.43), operative time (MD -0.18 min; 95% CrI: -10.81, 11.14), length of hospital stay (MD -0.03 days; 95% CrI: -0.48, 0.42), or estimated blood loss (MD 31.90 mL; 95% CrI: -4.71, 67.66). Subgroup analysis revealed that low pressure was associated with reduced pain at 3–6 hours compared with 15 mm Hg specifically (MD -0.95; 95% CrI: -1.83, -0.05), and 12 mm Hg was associated with lower pain at 24 hours than 15 mm Hg (MD -0.84; 95% CrI: -1.54, -0.15). The overall certainty of evidence was rated as very low to moderate per GRADE assessment.</div></div><div><h3>Conclusion</h3><div>Low-pressure pneumoperitoneum was not associated with consistent improvements in perioperative outcomes compared with standard-pressure pneumoperitoneum in gynecologic laparoscopic surgery. However, clinical heterogeneity, a very low to moderate certainty of evidence, and limited reporting of intraoperative complications, operative conditions, and surgeon satisfaction limit the interpretation and clinical applicability of these findings. Further well-designed RCTs with standardized outcome reporting are needed to determine whether specific surgical settings or patient subgroups may benefit from lower insufflation pressures.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"33 9","pages":"Pages 1273-1282"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148015968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"International Societies","authors":"","doi":"10.1016/S1553-4650(26)00419-X","DOIUrl":"10.1016/S1553-4650(26)00419-X","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"33 9","pages":"Page A2"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148861749","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":"Initial Results in the Automatic Visual Recognition of Endometriosis Lesions by Artificial Intelligence During Laparoscopy: A Proof-of-Concept Study","authors":"Sida Chen MM,&nbsp;Jang Song BS,&nbsp;Yanmei Sun MM,&nbsp;Jing Xiao MD","doi":"10.1016/j.jmig.2025.12.047","DOIUrl":"10.1016/j.jmig.2025.12.047","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"33 9","pages":"Pages 1373-1374"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146113507","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":"Robot-Assisted Transabdominal Cervical Cerclage With the Hugo RAS System: Surgical Technique and Perioperative Outcomes in a High-Risk Obstetric Case","authors":"Stefano Ferla MD,&nbsp;Valeria De Gobbi MD,&nbsp;Renato Seracchioli MD,&nbsp;Diego Raimondo MD, PhD","doi":"10.1016/j.jmig.2026.01.050","DOIUrl":"10.1016/j.jmig.2026.01.050","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;Cervical insufficiency, the inability of uterine cervix to retain pregnancy in absence of labor, is a major cause of preterm births and stillbirths. Therapeutic options include expectant management, progesterone, pessaries, or surgical cerclage [&lt;span&gt;&lt;span&gt;1&lt;/span&gt;&lt;/span&gt;]. Minimally invasive approaches provide several advantages over laparotomy, including decreased blood loss, lower post-operative pain, shorter hospital stay and faster recovery while achieving comparable or improved obstetric outcomes [&lt;span&gt;&lt;span&gt;2&lt;/span&gt;&lt;/span&gt;, &lt;span&gt;&lt;span&gt;3&lt;/span&gt;&lt;/span&gt;]. Robotassisted transabdominal cerclage (RA-TAC) is gaining popularity due to the enhanced three-dimensional visualization, improved dexterity and precision in performing fine dissection and knot-tying [&lt;span&gt;&lt;span&gt;4&lt;/span&gt;&lt;/span&gt;].&lt;/div&gt;&lt;div&gt;This video article demonstrates our RA-TAC technique and setup in a complex patient using the Hugo™ RAS system (Medtronic, Minneapolis, MN, USA) [&lt;span&gt;&lt;span&gt;5&lt;/span&gt;&lt;/span&gt;].&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Cervical insufficiency, the inability of uterine cervix to retain pregnancy in absence of labor, is a major cause of preterm births and stillbirths. Therapeutic options include expectant management, progesterone, pessaries, or surgical cerclage [&lt;span&gt;&lt;span&gt;1&lt;/span&gt;&lt;/span&gt;]. Minimally invasive approaches provide several advantages over laparotomy, including decreased blood loss, lower post-operative pain, shorter hospital stay and faster recovery while achieving comparable or improved obstetric outcomes [&lt;span&gt;&lt;span&gt;2&lt;/span&gt;&lt;/span&gt;, &lt;span&gt;&lt;span&gt;3&lt;/span&gt;&lt;/span&gt;]. Robotassisted transabdominal cerclage (RA-TAC) is gaining popularity due to the enhanced three-dimensional visualization, improved dexterity and precision in performing fine dissection and knot-tying [&lt;span&gt;&lt;span&gt;4&lt;/span&gt;&lt;/span&gt;].&lt;/div&gt;&lt;div&gt;This video article demonstrates our RA-TAC technique and setup in a complex patient using the Hugo™ RAS system (Medtronic, Minneapolis, MN, USA) [&lt;span&gt;&lt;span&gt;5&lt;/span&gt;&lt;/span&gt;].&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;Step-by-step explanation of surgical technique of RA-TAC in a 40-year-old, BMI 36 kg/m&lt;sup&gt;2&lt;/sup&gt; patient, with unfavorable obstetric history and desire for further pregnancy.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Step-by-step explanation of surgical technique of RA-TAC in a 40-year-old, BMI 36 kg/m&lt;sup&gt;2&lt;/sup&gt; patient, with unfavorable obstetric history and desire for further pregnancy.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting&lt;/h3&gt;&lt;div&gt;Academic Hospital, IRCCS Policlinico di S. Orsola Bologna, Italy.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Academic Hospital, IRCCS Policlinico di S. Orsola Bologna, Italy.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Intervention&lt;/h3&gt;&lt;div&gt;All possible therapeutic strategies and related complications have been discussed with the patient. Considering her strong desire for pregnancy, her surgical and obstetric history- including prior preterm deliveries despite vaginal cerclage (2020–2021)- and her BMI, a preconceptional RA-TAC was planned. A “straight” port placement in a “compact” docking configuration","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"33 9","pages":"Pages 1231-1232"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146105917","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 Triple Pelvic Examination and Transvaginal Sonography: Diagnostic Predictive Value for Posterior Pelvic Deep Endometriosis","authors":"Lihua Cheng MSc,&nbsp;Chongchong Wang MSc,&nbsp;Yufang Xia PhD,&nbsp;Cui Tian MSc,&nbsp;Huikai Jiao MSc,&nbsp;Yanhui Lou PhD","doi":"10.1016/j.jmig.2026.03.014","DOIUrl":"10.1016/j.jmig.2026.03.014","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Study Objective&lt;/h3&gt;&lt;div&gt;To evaluate the predictive value of preoperative triple pelvic examination combined with transvaginal sonography (TVS) for posterior pelvic deep endometriosis (DE).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;To evaluate the predictive value of preoperative triple pelvic examination combined with transvaginal sonography (TVS) for posterior pelvic deep endometriosis (DE).&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;A prospective randomized controlled clinical study comparing preoperative and intraoperative Enzian scores.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;A prospective randomized controlled clinical study comparing preoperative and intraoperative Enzian scores.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting&lt;/h3&gt;&lt;div&gt;the Affiliated Hospital of Qingdao University.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;the Affiliated Hospital of Qingdao University.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Patients&lt;/h3&gt;&lt;div&gt;Eighty-five patients who underwent surgical treatment for endometriosis between June 2022 and December 2024.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Eighty-five patients who underwent surgical treatment for endometriosis between June 2022 and December 2024.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interventions&lt;/h3&gt;&lt;div&gt;Patients were randomized into two groups: Group A (&lt;em&gt;n&lt;/em&gt; = 42) underwent TVS and triple pelvic examination separately and independently; Group B (&lt;em&gt;n&lt;/em&gt; = 43) had TVS with prior provision of triple pelvic examination findings to sonographers. Preoperative Enzian scoring integrated clinical and TVS findings, and intraoperative Enzian scores were recorded.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Patients were randomized into two groups: Group A (&lt;em&gt;n&lt;/em&gt; = 42) underwent TVS and triple pelvic examination separately and independently; Group B (&lt;em&gt;n&lt;/em&gt; = 43) had TVS with prior provision of triple pelvic examination findings to sonographers. Preoperative Enzian scoring integrated clinical and TVS findings, and intraoperative Enzian scores were recorded.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Measurements and Main Results&lt;/h3&gt;&lt;div&gt;In both Group A and Group B, the triple pelvic examination demonstrated significantly higher sensitivity than TVS for detecting utero-sacral ligament (USL) lesions (p = .002 and p = .049, respectively). In contrast, TVS was markedly superior to the triple pelvic examination in diagnosing DE lesions in the POD (p = .001 and p = .049, respectively). The combination of the triple pelvic examination and TVS improved both the sensitivity and accuracy for detecting deep pelvic endometriotic lesions, particularly for USL involvement (p = .002 and p = .049, respectively). For USL lesions, the sensitivity of TVS performed after clinical examination in Group B was 68.18%, which was significantly higher than the 38.10% achieved by TVS alone in Group A (p = .023).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;In both Group A and Group B, the triple pelvic examination demonstrated significantly higher sensitivity than TVS for detecting utero-sacral ligament (USL) lesions (p = .002 and p = .049, respectively). In contrast, TVS was markedly superior to the triple pelvic examination in diagnosing DE lesions in the POD (p = .001 and p = .049,","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"33 9","pages":"Pages 1343-1352"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147468093","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":"Stepwise REsectoscopic DIscoid SHaping (REDISH) Followed by Ultrasound-Guided Forceps Traction for Safe and Effective One-Step Removal of Large and Deep Submucous Myomas","authors":"Ettore Cicinelli MD, PhD,&nbsp;Pierpaolo Nicolì MD,&nbsp;Bart Paul De Vree MD,&nbsp;Antonella Vimercati MD,&nbsp;Alessandro Favilli MD, PhD,&nbsp;Amerigo Vitagliano MD, PhD","doi":"10.1016/j.jmig.2026.02.037","DOIUrl":"10.1016/j.jmig.2026.02.037","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the safety and effectiveness of a novel technique for the resectoscopic removal of FIGO types 0 to 3 myomas, termed REsectoscopic DIscoid SHaping (REDISH).</div></div><div><h3>Design</h3><div>Retrospective study.</div></div><div><h3>Setting</h3><div>University Hospital.</div></div><div><h3>Participants</h3><div>Patients with a single FIGO type 0 to 3 myoma undergoing resectoscopic myomectomy.</div></div><div><h3>Interventions</h3><div>Resectoscopic myomectomies using the REDISH technique (Group A) were compared with those performed using cold loop-assisted resectoscopic myomectomy (Group B). REDISH involves bilateral and symmetrical resection of the myoma intracavitary portion under direct hysteroscopic visualization using a monopolar loop to obtain a disc-shaped remnant. Owing to its flat surfaces, the disc can be securely grasped with ring forceps and subjected to gentle traction under transabdominal ultrasound guidance. This traction facilitates detachment of the intramural portion from the pseudocapsule, promoting extrusion into the uterine cavity. The extruded tissue is then further resected hysteroscopically, and the cycle of traction followed by resection can be repeated until complete removal is achieved. In the comparator group, the intramural component was mechanically enucleated with a nonenergized loop before electrosurgical resection. Outcomes included percentages of one-step procedures, complications, surgical time, and reproductive outcomes.</div></div><div><h3>Results</h3><div>A one-step procedure was performed in 97.9% of REDISH cases versus 87.1% with the cold loop technique (<em>P</em> &lt; .001). No major complications occurred in either group. Operative time with REDISH was significantly shorter across all myoma types and sizes, with time savings increasing with myoma complexity (interaction analysis). Regression model showed that operative time increased by 3.60, 10.39, and 15.47 minutes for FIGO types 1, 2, and 3, respectively. Reproductive outcomes showed a higher ongoing pregnancy rate (63% vs 50.5%, <em>P</em> &lt; .05), while no significant differences were observed in clinical pregnancy rate, miscarriage rate, or spontaneous delivery rate.</div></div><div><h3>Conclusions</h3><div>The REDISH technique proved safe, effective, and faster than the cold loop-assisted technique, with the greatest benefits seen in myomas ≥4 cm and with &gt;50% intramural extension. Notably, it may reduce the perforation risk by avoiding deep dissection into the pericapsular plane. Reproductive outcomes were also reassuring.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"33 9","pages":"Pages 1283-1291"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147316994","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":"Chylous Ascites Manifesting as Vulvovaginal Chyle Leakage: A Rare Gynecologic Presentation","authors":"Yu-Ju Tseng MD,&nbsp;Ya-Lun Tsai MD,&nbsp;Chia-Yen Huang MD, PhD","doi":"10.1016/j.jmig.2025.12.043","DOIUrl":"10.1016/j.jmig.2025.12.043","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"33 9","pages":"Pages 1229-1230"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145933665","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":"Surgeons’ Biological Stress Responses During Fundamentals of Laparoscopic Surgery Exercises: A Descriptive Study","authors":"Aaron K. Budden BMed, MMed, FRANZCOG, PhD,&nbsp;Amanda Henry PhD, FRANZCOG,&nbsp;Claire E. Wakefield PhD,&nbsp;Jason A. Abbott PhD, FRANZCOG","doi":"10.1016/j.jmig.2026.03.011","DOIUrl":"10.1016/j.jmig.2026.03.011","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Study objective&lt;/h3&gt;&lt;div&gt;Adverse surgeon stress can contribute to poor non-technical skills and burnout, impacting surgical performance and patient outcomes. Identifying surgical stressors is key to improving surgeons’ and patients’ wellbeing. We aim to describe biological measures of surgeon stress during laparoscopic exercises.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Adverse surgeon stress can contribute to poor non-technical skills and burnout, impacting surgical performance and patient outcomes. Identifying surgical stressors is key to improving surgeons’ and patients’ wellbeing. We aim to describe biological measures of surgeon stress during laparoscopic exercises.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;Prospective Cohort&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Prospective Cohort&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting&lt;/h3&gt;&lt;div&gt;Simulated laparoscopic exercises were completed in an isolated research setting.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Simulated laparoscopic exercises were completed in an isolated research setting.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Patients&lt;/h3&gt;&lt;div&gt;26 Surgeon volunteers.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;26 Surgeon volunteers.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interventions&lt;/h3&gt;&lt;div&gt;Participants completed peg transfer, pattern cutting, and intra-corporal knot exercises from the fundamental laparoscopic skills curriculum in neutral and stressed (ergonomic, time pressure, or noise) conditions. Measures of cortisol, heart rate (HR), and heart rate variability (HRV) were recorded at baseline and during simulation, and NASA task load Index post simulation.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Participants completed peg transfer, pattern cutting, and intra-corporal knot exercises from the fundamental laparoscopic skills curriculum in neutral and stressed (ergonomic, time pressure, or noise) conditions. Measures of cortisol, heart rate (HR), and heart rate variability (HRV) were recorded at baseline and during simulation, and NASA task load Index post simulation.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Measurements and Main Results&lt;/h3&gt;&lt;div&gt;26 surgeons participated, with a wide variation in biological response to laparoscopic exercises. Surgeons’ mean scores from baseline decreased for cortisol (10.1 vs 7.2 nmol/L), increased for mean and maximum heart rate (79.2 vs 88.6 bpm; 95.8 vs 109.0 bpm), and were unchanged for HRV. Proportionally, 22% of surgeon-simulations recorded increased cortisol, 79% increased maximum HR, 42% increased HRV low-frequency to high-frequency ratio, and 70% increased HRV standard deviation of beat-to-beat. Mean HR was higher during “neutral” exercises relative to “stressed” exercises, however, a greater proportion of HRV measures were higher in “stressed” exercises. Changes in HR were not significantly correlated with physical dimensions of NASA task load index.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;26 surgeons participated, with a wide variation in biological response to laparoscopic exercises. Surgeons’ mean scores from baseline decreased for cortisol (10.1 vs 7.2 nmol/L), increased for mean and maximum heart rate (79.2 vs 88.6 bpm; 95.8 vs 109.0 bpm), and were unchanged for HRV. Proportionally, 22% of su","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"33 9","pages":"Pages 1327-1334"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147463500","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":"Risk, Prevalence and Survival Outcomes of Ovarian Cancer in Women With Endometriosis: The Endocancer Systematic Review and Meta-Analysis","authors":"Ilaria Piacenti MD,&nbsp;Veronica Tius MD,&nbsp;Benedetta Gomba MD,&nbsp;Stefano Restaino MD,&nbsp;Martina Arcieri MD,&nbsp;Silvia Zermano MD,&nbsp;Anna Biasioli MD,&nbsp;Federica Perelli MD,&nbsp;Diego Raimondo MD,&nbsp;Lucia Lazzeri MD,&nbsp;Alberto Mattei MD,&nbsp;Errico Zupi MD,&nbsp;Renato Seracchioli MD,&nbsp;Giuseppe Vizzielli PhD","doi":"10.1016/j.jmig.2026.04.021","DOIUrl":"10.1016/j.jmig.2026.04.021","url":null,"abstract":"<div><h3>Objective</h3><div>Endometriosis is linked to an increased risk of epithelial ovarian cancer (EOC), especially clear cell and endometrioid subtypes. The extent and prognostic significance of this link are still not fully understood. This systematic review and meta-analysis compiles existing evidence on ovarian cancer risk, histotype distribution, and survival outcomes in women with endometriosis.</div></div><div><h3>Data Sources</h3><div>Systematic search up to August 2025.</div></div><div><h3>Methods of Study Selection</h3><div>A systematic search of PubMed and Google Scholar was performed up to August 2025. Studies reporting ovarian cancer risk estimates or survival outcomes in endometriosis-associated ovarian cancer (EAOC) were included. Random-effects models generated pooled odds ratios (OR), hazard ratios (HR), and standardized incidence ratios (SIR). Risk analyses included &gt;500 000 women; survival analyses &gt;10 000.</div></div><div><h3>Tabulation, Integration, and Results</h3><div>Sixty-seven studies met inclusion criteria. Endometriosis increased ovarian cancer risk (OR: 1.82, HR: 3.03, SIR: 1.62). EAOC patients were younger, more often premenopausal, and more frequently diagnosed with early-stage (OR: 0.29) and low-grade tumors (OR: 1.71). Clear cell and endometrioid histotypes predominated. Overall survival was significantly better in EAOC (HR: 0.48); recurrence and mortality were lower, while platinum resistance was similar.</div></div><div><h3>Conclusion</h3><div>Endometriosis confers an increased relative but still low absolute risk of ovarian cancer. EAOC exhibits distinct clinicopathologic features and improved survival compared with non-EAOC. These findings support personalized counseling and emphasize the need for phenotype-based risk stratification and molecular markers of malignancy transformation.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"33 9","pages":"Pages 1251-1262"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856421","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}