JOURNAL OF GYNECOLOGIC SURGERY最新文献

{"title":"Update on Conservative Surgery for Fibroids: Laparoscopic Radiofrequency and Transcervical Fibroid Ablation","authors":"Ghadear Shukr","doi":"10.1089/gyn.2023.0064","DOIUrl":"https://doi.org/10.1089/gyn.2023.0064","url":null,"abstract":"Growing interest in minimally invasive uterine-sparing conservative surgery for managing uterine fibroids has made radiofrequency ablation (RFA) a popular procedure. The two most common approaches are a laparoscopic RFA (LAP-RFA) technique—the Acessa ProVu® System (Acessa Health Inc., Austin, TX, USA)—and transcervical fibroid ablation (TFA)—the Sonata® System (Gynesonics, Redwood City, CA, USA). Positive impacts on decreasing uterine size, improving patients' quality of life, and inducing uncomplicated pregnancy outcomes, support RFA as an option to manage fibroids in the right patients. However, although these procedures are promising, they are not yet approved by the U.S. Food and Drug Administration for patients seeking treatment for infertility. This article briefly addresses updates in the current literature on these 2 procedures . (J GYNECOL SURG 20XX:000)","PeriodicalId":44791,"journal":{"name":"JOURNAL OF GYNECOLOGIC SURGERY","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136264163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative Ultrasound Scanning Reduces Surgery Duration and Improves Myomectomy Outcomes in Cape Coast, Ghana, West Africa","authors":"Abdoul Azize Diallo, Albright Nana Afua Amesua Brookman, Sebastian Ken-Amoah, Evans Ekanem","doi":"10.1089/gyn.2023.0018","DOIUrl":"https://doi.org/10.1089/gyn.2023.0018","url":null,"abstract":"Objectives: Uterine leiomyomas are the commonest benign tumors in women. Myomectomy is preferred for symptomatic uterine leiomyomas when a patient wants to stay fertile. Abdominal myomectomy can be complex and lead to complications. This study examined the usefulness of preoperative ultrasound (US) scans prior to myomectomy to enhance outcomes. Materials and Methods: This retrospective, hospital-based case-control review evaluated surgical outcomes after myomectomies when surgeons themselves performed preoperative US scans in a cases group. The study was at the University of Cape Coast Hospital, Cape Coast, Ghana, from January1, 2018, to December 31, 2020. Data were extracted from the hospital records and analyzed with a Statistical Package for Social Sciences (SPSS version 21.0). Results: The mean ages were 34.5 years and 33.2 years for cases and controls, respectively. abnormal uterine bleeding and infertility associated with uterine fibroids were the commonest indications for myomectomy (88.5% and 70.8%, respectively). The mean duration of surgery was 98.63 minutes for the cases, which was statistically lower than for the controls (115.41 minutes). The number of incisions on the uterus and the frequency of blood transfusion was higher in the controls. There were no significant differences in postoperative complications and durations of hospital stays between the cases and controls. Conclusions: Preoperative US helps reduce surgery duration, incisions on uteri, blood transfusions (which can be correlated to blood loss); yet, there are no proven reduced hospital stays and postoperative complications. Surgeons should perform US scans before surgery.","PeriodicalId":44791,"journal":{"name":"JOURNAL OF GYNECOLOGIC SURGERY","volume":"434 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135112590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship Between Retropubic Vessels and Pelvic Bony Anatomy: Retropubic Midurethral-Sling Placement Considerations","authors":"Nawsin Baset, Sirai Ramirez, Nafis Deen, Larry Segars, Tony Olinger, Melanie Meister","doi":"10.1089/gyn.2023.0090","DOIUrl":"https://doi.org/10.1089/gyn.2023.0090","url":null,"abstract":"Objective: Retropubic midurethral sling placement (MUS) is a surgical procedure for treating stress urinary incontinence (SUI) in females that uses mesh to support the urethra to prevent leakage during episodes of increased abdominal pressure. Hematoma is a documented risk of MUS placement. The location of relevant pelvic vasculature was compared to pelvic bony dimensions with the aim of measuring these anatomic relationships in order to prevent hematomas during MUS placement. Materials and Methods: The superficial epigastric, inferior epigastric, external iliac, and obturator arteries were dissected bilaterally from 13 formalin-embalmed cadavers. Distance was measured to a retropubic trocar placed in the typical fashion. Anteroposterior pelvic (AP) diameter and ischial interspinous distance were recorded. SPSS was used for statistical analyses. Results: All arteries were identified lateral to the trocar site. Obturator arteries were the closest (30.60 ± 5.19 mm) and external iliac arteries were the furthest (48.08 ± 9.64 mm). There was a significant correlation between artery–trocar distance and AP diameter, but not interspinous distance. Conclusions: Major vascular structures lie in close proximity to the path of the trocar used in MUS placement for treating SUI. The female AP diameter is correlated with the distance between these vessels and the trocar—and may be a clinically useful measure to determine which patients are at increased risk for hematomas during MUS. (J GYNECOL SURG 20XX:000)","PeriodicalId":44791,"journal":{"name":"JOURNAL OF GYNECOLOGIC SURGERY","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135112591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preexisting Gynecologic Conditions Associated with Chronic Pelvic Pain in Veterans Undergoing Hysterectomy for Benign Indications: Impact on Minimally Invasive Hysterectomy","authors":"Alexander S. Wang, Andrew S. Bossick, Georgine M. Lamvu, Lisa Callegari, Jodie G. Katon","doi":"10.1089/gyn.2023.0089","DOIUrl":"https://doi.org/10.1089/gyn.2023.0089","url":null,"abstract":"Objectives: This article describes the prevalence of preexisting gynecologic conditions associated with chronic pelvic pain (CPP) in veterans having hysterectomy for benign indications and explores whether preexisting CPP affects receipt of minimally invasive hysterectomy (MIH). Materials and Methods: This cross-sectional study used Veterans Health Administration (VHA) data to identify hysterectomies provided or paid for by the VHA between 2007 and 2014. Veterans were included if they had any type of hysterectomy—abdominal or MIH (vaginal, laparoscopic, or robotic). Veterans were categorized as having preexisting gynecologic conditions associated with CPP if they had an International Classification of Diseases, 9th Revision, Clinical Modification diagnosis of endometriosis/adenomyosis, dysmenorrhea, dyspareunia, or pelvic-congestion syndrome within 1 year prior to hysterectomy. Generalized linear models with a Poisson distribution were used to estimate the relative risks (RRs) and 95% confidence intervals (CIs) for preexisting CPP conditions and MIH. Results: The final sample had 6830 veterans who had hysterectomies. Of these, 66.5% (n = 4540) had preexisting CPP conditions. MIH was performed in 41.8% (n = 1897) of veterans who had preexisting CPP conditions. After adjustment, there was no association between preexisting CPP and MIH (unadjusted RR: 1.05; 95% CI: 0.97, 1.15; adjusted RR: 0.99; 95% CI: 0.90, 1.08). Conclusions: Veterans undergoing hysterectomy have a high prevalence of preexisting conditions associated with CPP. More hysterectomies were performed in veterans with preexisting CPP, compared to those without. However, the presence of preexisting CPP did not affect the likelihood of receiving MIH. (J GYNECOL SURG 20XX:000)","PeriodicalId":44791,"journal":{"name":"JOURNAL OF GYNECOLOGIC SURGERY","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135729776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obstetric Outcomes of Singleton Birth After Hysteroscopic Septoplasty of Complete Uterine Septum","authors":"Omar Abuzeid, Cassandra Heiselman, Anna Fuchs, Jenny LaChance, Kimberly Herrera, David Garry, Mostafa Abuzeid","doi":"10.1089/gyn.2023.0031","DOIUrl":"https://doi.org/10.1089/gyn.2023.0031","url":null,"abstract":"Objective: The aim of this research was to determine the obstetric outcomes in patients who had singleton live birth after hysteroscopic septoplasty of complete uterine septum (CUS) that reached the internal or the external cervical os. Materials and Methods: This retrospective study included 112 patients, each with a history of reproductive failure between 2002 and 2019. Of these patients, 29 each had a singleton live birth after hysteroscopic septoplasty for CUS (group 1) and 83 each had a singleton live birth after hysteroscopy revealed a normal uterine cavity (group 2). In group 1 the septum reached the internal or the external cervical os in 16 and 13 patients, respectively. Subgroup analysis was performed of 24 patients: 8, in whom the septum reached the external cervical os (group 1a); and 16, in whom the septum reached the internal cervical os (group 1b). Results: There was no significant difference in incidence of premature birth (12.5% versus 12.2%) or other pregnancy complications, gestational age, or newborn birth weight between group 1 and group 2, respectively. Obstetric outcomes between the 2 subgroups were also similar. Conclusions: The study data suggest favorable obstetric outcomes for singleton gestation after hysteroscopic septoplasty of CUS reaching the internal or external cervical os. Division of cervical septum was not associated with cervical insufficiency. (J GYNECOL SURG 20XX:000)","PeriodicalId":44791,"journal":{"name":"JOURNAL OF GYNECOLOGIC SURGERY","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135825414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhanced Recovery Protocols in Gynecological Surgery","authors":"Ryan Tang, Katie Letchworth, Aaron Muncey","doi":"10.1089/gyn.2023.0079","DOIUrl":"https://doi.org/10.1089/gyn.2023.0079","url":null,"abstract":"Enhanced Recovery After Surgery (ERAS) protocols represent a new era in surgical care in many different surgical disciplines, including gynecologic surgery. ERAS focuses on optimizing patient health prior to surgery and decreasing the stress response during and after surgery. This leads to benefits such as shortened length of stay, decreased postsurgical complications, and decreased readmission rates for patients. This narrative article summarizes current ERAS protocols developed for gynecologic surgery from leading institutions—including the ERAS Society, in Stockholm, Sweden, the American Society of Enhanced Recovery and Perioperative Medicine, (ASER), in Glenview, IL, USA, Duke, the University of Virginia, and Beaumont Hospital–Troy—and compares them to the current authors' protocal at the H. Lee Moffitt Cancer Center and Research Institute, in Tampa, Florida, USA. The article also discusses patient benefits of ERAS in gynecologic surgery through a review of studied outcomes, such as medical outcomes for patients, postoperative pain control, patient satisfaction, and cost savings to hospital systems. (J GYNECOL SURG 20XX:000)","PeriodicalId":44791,"journal":{"name":"JOURNAL OF GYNECOLOGIC SURGERY","volume":"84 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135146790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ventrofixed Uterus: Unfreezing the Uterus in 6 Standardized Steps.","authors":"Tanushree Rao,&nbsp;Sandesh Kade","doi":"10.1089/gyn.2023.0041","DOIUrl":"10.1089/gyn.2023.0041","url":null,"abstract":"<p><strong>Objective: </strong>This article presents a 6-step laparoscopic technique for dissecting a central uterine band in a ventrofixed uterus, in order to minimize injury to adjacent structures during such procedures as repeat cesarean sections and hysterectomy.</p><p><strong>Methods: </strong>The description of this laparoscopic surgical technique shows how the anatomically consistent avascular space beneath the uterine band was accessed via lateral dissection. An online video demonstrating the anatomy, anatomical free space, and secure dissection techniques is included.</p><p><strong>Results: </strong>The proposed technique enables safe dissection of the uterine band and reduces the risk of bladder injury during uterine-preserving procedures. Accessing the anatomical free space via lateral dissection results in a safer operative field, decreased blood loss, and preserved myometrium during uterine-preserving procedures.</p><p><strong>Conclusions: </strong>The anatomically consistent avascular space beneath the uterine band is accessible via lateral dissection, enabling secure dissection of the uterine band. This technique can be used in both laparoscopic and open procedures, such as repeat cesarean sections. Familiarity with the anatomy of the central uterine-adhesion band can ensure a safe operation and reduce the risk of bladder injury. (J GYNECOL SURG 39:220).</p>","PeriodicalId":44791,"journal":{"name":"JOURNAL OF GYNECOLOGIC SURGERY","volume":"39 5","pages":"220-221"},"PeriodicalIF":0.3,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10561766/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41215509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Learning and Teaching Surgery","authors":"Mitchel S. Hoffman","doi":"10.1089/gyn.2023.0087","DOIUrl":"https://doi.org/10.1089/gyn.2023.0087","url":null,"abstract":"Journal of Gynecologic SurgeryVol. 39, No. 5 EditorialFree AccessLearning and Teaching SurgeryMitchel S. HoffmanMitchel S. Hoffman—Mitchel S. Hoffman, MD, Editor-in-Chief Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA.MCC GYN Program, Moffitt Cancer Center, Tampa, Florida, USA.Search for more papers by this authorPublished Online:3 Oct 2023https://doi.org/10.1089/gyn.2023.0087AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail A surgeon must select from among 3 routes for performing a hysterectomy: vaginal; open abdominal; or laparoscopic. In addition, there are variations of these approaches that include robotic and vNOTES [vaginal natural orifice transluminal endoscopic surgery].The first article of this issue has Drs. Kristin N. Taylor and Kenneth H. Kim (MD, MHPE) from the Samuel Oschin Cancer Center at Cedars–Sinai Medical Center (Los Angeles, CA) providing a historical perspective on the use of robotics in gynecologic surgery. Dr. Kim, an internationally renowned expert on the subject, adds thoughts on future directions that this evolving technology might take.As an introduction to this article, I would like to comment on surgical training in robotic surgery. During an open abdominal operation, the attending surgeon can readily demonstrate, observe, control, and correct surgical steps with a trainee. The same is true, although to a lesser extent, for vaginal and laparoscopic surgery. Robotic surgery is unique in this respect. The individual operating at the surgeon console has complete control, at least momentarily, of the operation. The attending surgeon can point, draw a line, control an assisting robotic instrument (dual console), and resume complete control very rapidly.The complete transfer of control of robotic surgery to a trainee highlights 2 important issues. First: Even with only momentary control, a catastrophic complication may occur (such as moving scissors that are out of the field of view and puncturing a major vessel). Second: How do we effectively teach complex gynecologic surgery without being able to continuously demonstrate or redirect the trainee should the need to do so arise during the case? There are no clear answers to these questions, although the development of the teaching console and the ability of the educator to control 1 of 3 instruments have been major advances with respect to teaching robotic surgery. Currently, the major focus of the Taylor and Kim article provides the best answer to balancing surgical safety and education in robotic surgery with the use of a priori simulation-based training.This article presents a very relevant point of view regarding how sophisticated data developed from the robotic simulator will push education beyond practice and basic feedback to practice, leading to very sophisticated feedback","PeriodicalId":44791,"journal":{"name":"JOURNAL OF GYNECOLOGIC SURGERY","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134931112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis of Endometriosis: The Surgeon's Eye Compared to Histopathology","authors":"Dana C. McKee, Marlene E. Girardo, Megan N. Wasson","doi":"10.1089/gyn.2023.0032","DOIUrl":"https://doi.org/10.1089/gyn.2023.0032","url":null,"abstract":"Objective: The aim of this research was to evaluate intraoperative visual detection of endometriosis compared to final histopathologic diagnosis based on lesion type. Materials and Methods: This prospective clinical study at a tertiary-care, academic medical center involved 77 patients who had surgery by high-volume endometriosis surgeons for suspected endometriosis. Pelvic peritonectomy was performed with documentation of visual presence or absence of endometriosis and lesion type. Powder burn lesions were defined as typical lesions. White scarring, clear vesicles, red flame, and peritoneal pockets were defined as atypical lesions. Results: Of 1069 peritoneal specimens, there was visual detection of endometriosis in 352 (32.93%). Endometriosis was confirmed on histopathologic evaluation of: powder-burn, 65.8%; white scarring, 51.6%; clear vesicles, 45.7%; red-flame, 39.1%; and peritoneal pockets, 28.9% (p = 0.003). Additionally, 11.3% of specimens with no visible endometriosis demonstrated a positive histopathologic diagnosis. Overall sensitivity was 68.36%; specificity was 78.15%; positive predictive value (PPV) was 49.72%; and negative predictive value was 88.66%. All lesions had high specificity (powder-burn, 96.20%; white scarring, 91.34%; clear vesicles; 92.54%; red-flame, 97.84%; and peritoneal pockets; 95.91%). PPV depended on lesion type (powder-burn, 65.75%; white scarring, 51.61 %; clear vesicles, 45.74%; red-flame, 39.13% peritoneal pockets, 28.95%). Conclusions: Visual detection of endometriosis during surgical evaluation is not reliable. The potential for atypical-lesion appearance and disease not macroscopically visible suggests a role for complete pelvic peritonectomy. (J GYNECOL SURG 39:235)","PeriodicalId":44791,"journal":{"name":"JOURNAL OF GYNECOLOGIC SURGERY","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136307254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Chronic Female Pelvic Pain","authors":"Jessica Ibañez, Robert S. Ackerman","doi":"10.1089/gyn.2023.0066","DOIUrl":"https://doi.org/10.1089/gyn.2023.0066","url":null,"abstract":"Chronic pelvic pain in the female patient is often debilitating and can arise from a variety of sources, often with multiple etiologies. Difficulties managing these disorders parallel the difficulties in establishing a specific diagnosis for them. A focused and detailed history and a physical examination are often most helpful, categorizing pain signs and symptoms and suggesting an organ system that is not in homeostasis. Diagnostic laboratory testing and imaging are often of limited value. Initial treatment focuses on identification of the specific causes or sources of this pelvic pain. Oral analgesics, physical and psychologic treatments, interventional procedures, and injections have the potential to be both diagnostic and therapeutic for patients. Surgical management is often maintained as a last-line treatment option and may not necessarily enhance diagnostic evaluation or add pain relief. (J GYNECOL SURG 20XX:000)","PeriodicalId":44791,"journal":{"name":"JOURNAL OF GYNECOLOGIC SURGERY","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134885395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}