Facts Views and Vision in ObGyn最新文献

{"title":"Proposals for the #Enzian addendum and update: an international expert survey for item generation.","authors":"Milena Petrovic, Jörg Keckstein, Mohamed Mabrouk, Ertan Saridogan, Mario Malzoni, Gernot Hudelist","doi":"10.52054/FVVO.2026.359","DOIUrl":"10.52054/FVVO.2026.359","url":null,"abstract":"<p><strong>Background: </strong>Accurate and standardised characterisation of endometriosis extent is essential for patient counselling regarding pain and fertility outcomes, surgical planning, multidisciplinary communication, and clinical research. The Enzian classification has been applied in Central Europe for over two decades, while the updated #Enzian classification, published in 2021, has subsequently gained broader international acceptance.</p><p><strong>Objectives: </strong>To evaluate international expert perspectives and generate potential items informing updates to selected compartments of the #Enzian classification.</p><p><strong>Methods: </strong>Twenty-six internationally recognised experts in endometriosis surgery, imaging, and reproductive medicine were invited to participate in a structured survey. The electronic questionnaire comprised 29 single-choice and open-ended items addressing five #Enzian compartments: T (tuboovarian condition), B (sacrouterine ligaments, cardinal ligaments, pelvic sidewall), C (rectum), FB (bladder), and FA (adenomyosis). Responses were collected anonymously, analysed descriptively, and thematically grouped. Consensus thresholds followed established criteria.</p><p><strong>Main outcome measures: </strong>Expert perspectives regarding the need for revision of selected #Enzian compartments and proposed modifications.</p><p><strong>Results: </strong>Twenty-three experts responded (88.5%). Strong agreement for revision was observed for compartments B, C, and FB (>80%). Moderate agreement (>60%) supported updates to compartments T and FA. Specific suggested refinements included adding the suffix d within compartment T to reflect tubal dilatation (73.9% in favour) and the suffix P within compartment B to denote pelvic sidewall/parametrial involvement (78.3% in favour). For colorectal disease (compartment C), respondents supported reporting lesion-anal verge distance and multifocality. A graded FA1-FA3 system for adenomyosis was favoured (73.9%). Opinions regarding descriptors of bladder endometriosis were heterogeneous.</p><p><strong>Conclusions: </strong>Experts identified clear priorities for refining the #Enzian classification, particularly regarding parametrial involvement, colorectal deep endometriosis and adenomyosis extent. These findings could provide a structured framework to inform subsequent Delphi consensus rounds.</p><p><strong>What is new?: </strong>The study identifies international expert-agreed priorities for refinement of selected #Enzian classification compartments.</p>","PeriodicalId":46400,"journal":{"name":"Facts Views and Vision in ObGyn","volume":" ","pages":"171-177"},"PeriodicalIF":1.5,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575350/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632282","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":"Finis coronat opus? What comes after hysteroscopic metroplasty.","authors":"Salvatore Giovanni Vitale, Pierluigi Chieppa, Rafał Watrowski, Liliana Mereu","doi":"10.52054/FVVO.2026.429","DOIUrl":"10.52054/FVVO.2026.429","url":null,"abstract":"<p><p>Hysteroscopic metroplasty is widely regarded as the endpoint of septate uterus care, yet its impact on fertility remains uncertain and the postoperative cavity is seldom reassessed. Evidence on second-look hysteroscopy is equally scarce: mostly retrospective, rarely randomised, and not designed to isolate its reproductive effect. Re-inspection should arguably be reframed as an integral, fertility-oriented step rather than optional surveillance. Routine use in all patients is unjustified and not cost-effective, yet systematic omission may also overlook clinically relevant abnormalities. A selective, risk-stratified strategy is preferable, reserving it for the highest-risk women and triaging the rest with three-dimensional sonohysterography. Prospective, second-look-controlled trials are needed.</p>","PeriodicalId":46400,"journal":{"name":"Facts Views and Vision in ObGyn","volume":"18 3","pages":"165-170"},"PeriodicalIF":1.5,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575362/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148971675","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":"Safety and efficacy of laparoscopic cornuotomy in the surgical management of complete interstitial ectopic pregnancy.","authors":"Dorothy Davies, Bethany Helm, Zoe Moatti, Natasha Eagles, Joel Naftalin, Davor Jurkovic","doi":"10.52054/FVVO.2026.350","DOIUrl":"10.52054/FVVO.2026.350","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic cornuotomy is a relatively novel surgical approach to manage interstitial ectopic pregnancy (IEP) and there is little information regarding its safety and efficacy.</p><p><strong>Objectives: </strong>To describe the success, complications and long-term outcomes of women undergoing laparoscopic cornuotomy for IEP.</p><p><strong>Methods: </strong>Retrospective observational study carried out in a tertiary early pregnancy unit from June 2009 to April 2024.</p><p><strong>Main outcome measures: </strong>The main outcome measure was a complete resolution of the IEP without the need for any additional medical or surgical treatment.</p><p><strong>Results: </strong>There were 102 cases of complete IEP, of which 71 were managed surgically. The majority of operations were performed laparoscopically (70/71), including 62/70 who underwent a laparoscopic cornuotomy, and 8/70 who underwent an Endoloop-assisted salpingectomy. The remaining patient underwent a planned open procedure. A total of 60/62 [97%, 95% confidence interval (CI), 92-100] laparoscopic cornuotomies were successful, whilst the remaining two patients required further intervention for persistent trophoblast. The median total estimated blood loss for patients undergoing laparoscopic cornuotomy was 50 mLs (interquartile range: 50-150). There were 2/62 (3%, 95% CI, 0-8) intraoperative and 3/62 (5%, 95% CI, 0-10) postoperative complications. Twenty-seven patients (27/62, 44%) subsequently conceived, resulting in a total of 52 pregnancies. There were 25 pregnancies resulting in live birth, 13 of which were vaginal with no cases of uterine rupture.</p><p><strong>Conclusions: </strong>Laparoscopic cornuotomy is an effective treatment for complete IEP with only a small proportion of patients requiring interventions for retained pregnancy tissue.</p><p><strong>What is new?: </strong>This is the largest study of laparoscopic cornuotomy so far which showed that the procedure is effective with a low-risk of future pregnancy complications.</p>","PeriodicalId":46400,"journal":{"name":"Facts Views and Vision in ObGyn","volume":"18 3","pages":"184-194"},"PeriodicalIF":1.5,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148971700","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":"Tubo-ovarian abscess in an adolescent with uterine didelphys and prior cloacal repair: case report and literature review.","authors":"Angelos Daniilidis, Stefania Saponara, Nikolaos Roussos, Ioanna Vagioni, Michail Delis, Charikleia D Demiri, Grigoris Grimbizis","doi":"10.52054/FVVO.2026.306","DOIUrl":"10.52054/FVVO.2026.306","url":null,"abstract":"<p><p>Tubo-ovarian abscess (TOA) is an uncommon complication of pelvic infection, particularly in patients with Müllerian anomalies. We report the case of a 16-year-old girl with uterine didelphys and a history of cloacal repair who presented with fever, abdominal pain, and a large multiloculated left adnexal mass. Laparoscopy revealed a TOA within a severely distorted pelvis, requiring extensive adhesiolysis, excision of the abscess cavity with adherent tubal remnants, and partial cystectomy with ovarian preservation. Histopathology confirmed a purely inflammatory process, excluding malignancy. This case highlights a non-obstructive mechanism for TOA, in which distorted pelvic anatomy and postsurgical adhesions predisposed to infection, underscoring the need for individualised evaluation and fertility-preserving management in this population.</p>","PeriodicalId":46400,"journal":{"name":"Facts Views and Vision in ObGyn","volume":"18 3","pages":"261-268"},"PeriodicalIF":1.5,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148971678","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":"A stepwise approach to the hysteroscopic management of cystic adenomyosis.","authors":"Evy Gillet, Helena Van Kerrebroeck, Panayiotis Tanos, Stavros Karampelas, Alessa Sugihara, Istvan Argay, Marion Valkenburg, Stephan Gordts, Rudi Campo","doi":"10.52054/FVVO.2026.407","DOIUrl":"10.52054/FVVO.2026.407","url":null,"abstract":"<p><strong>Background: </strong>Adenomyosis may alter the functional architecture of the inner myometrium and has been associated with impaired reproductive outcomes. Focal cystic adenomyotic lesions can persist despite hormonal suppression and may be challenging to identify and treat hysteroscopically.</p><p><strong>Objectives: </strong>To demonstrate a reproducible, stepwise, hysteroscopic technique for the identification and management of focal cystic adenomyosis of the inner myometrium.</p><p><strong>Participant: </strong>Women with infertility and recurrent implantation failure, defined as failure to achieve a clinical pregnancy after repeated embryo transfers, diagnosed with focal cystic adenomyosis of the inner myometrium based on transvaginal ultrasound and hysteroscopic assessment.</p><p><strong>Intervention: </strong>Procedures were performed in an ambulatory digital hysteroscopy setting at the Life Expert Centre (Leuven, Belgium) under conscious sedation. The approach combined hysteroscopy and transvaginal ultrasound throughout diagnosis, treatment, and follow-up. Preoperative hormonal suppression was used to identify lesions persisting despite medical therapy. Key steps were: (1) lesion mapping using ultrasound-hysteroscopic correlation, including bipolar-marker topographic correlation of lesions not directly visible during hysteroscopy; (2) meticulous dissection and resection using 5Fr mechanical instruments and / or a bipolar loop within a 15Fr mini-resectoscope; (3) application of a crosslinked hyaluronic acid anti-adhesion barrier; and (4) structured postoperative follow-up, including second-look hysteroscopy when indicated.</p><p><strong>Conclusions: </strong>Combination of hysteroscopy and transvaginal ultrasound enables minimally invasive management of focal cystic adenomyosis of the inner myometrium. This video demonstrates a reproducible approach based on precise lesion identification, targeted treatment, and structured postoperative assessment.</p><p><strong>What is new?: </strong>This video introduces a novel technique of topographic ultrasound-hysteroscopic correlation using bipolar-marker localisation, facilitating the identification and treatment of adenomyotic cysts not directly visible during hysteroscopy.</p>","PeriodicalId":46400,"journal":{"name":"Facts Views and Vision in ObGyn","volume":"18 3","pages":"269-270"},"PeriodicalIF":1.5,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575365/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148971642","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":"Beyond hysteroscopic metroplasty: time to distinguish fundal from ampliative procedures.","authors":"Ursula Catena, Attilio Di Spiezio Sardo, Grigoris Grimbizis","doi":"10.52054/FVVO.2026.507","DOIUrl":"10.52054/FVVO.2026.507","url":null,"abstract":"<p><p>Functional intrauterine surgery has recently been proposed as a conceptual framework shifting the focus from anatomical correction alone toward restoration of uterine function and reproductive competence. However, hysteroscopic treatment of congenital uterine anomalies continues to be described under the umbrella term metroplasty, despite substantial differences in uterine morphology, surgical targets, and reconstructive objectives. In this Opinion Paper, we propose distinguishing two categories of hysteroscopic reconstructive procedures: fundal metroplasty and ampliative metroplasty. Fundal metroplasty primarily addresses midline fundal anomalies, most commonly the septate uterus, through a subtractive approach aimed at restoring normal uterine architecture. Conversely, ampliative metroplasty addresses globally restricted or dysmorphic uterine cavities through an expansive approach aimed at enlarging and reshaping the cavity. The use of a single term for these distinct procedures may contribute to conceptual ambiguity in surgical terminology. Rather than proposing a new classification system, we suggest terminology based on the anatomical target and reconstructive objective of hysteroscopic surgery. Distinguishing fundal from ampliative metroplasty may facilitate more precise communication and research and provide a clearer framework for hysteroscopic reconstructive surgery within the broader concept of Functional Intrauterine Surgery.</p>","PeriodicalId":46400,"journal":{"name":"Facts Views and Vision in ObGyn","volume":"18 3","pages":"160-164"},"PeriodicalIF":1.5,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575359/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148971695","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":"Complications, recurrence, and survival rates for endometrial and cervical cancer treated by minimally invasive surgery: a systematic review and meta-analysis of randomised controlled trials.","authors":"Theodoros D Theodoridis, Christos-Georgios Kontovazainitis, Ramon Rovira Negre, Istvan Argay, Gabriele Centini, Stavros Karampelas, Marcus Wallwiener, Federica Campolo, Susana Maia, Ursula Catena, Helder Ferreira","doi":"10.52054/FVVO.2026.220","DOIUrl":"10.52054/FVVO.2026.220","url":null,"abstract":"<p><strong>Background: </strong>Consensus is lacking regarding the relative safety and oncological outcomes of minimally invasive compared to abdominal hysterectomy.</p><p><strong>Objectives: </strong>To estimate complications and survival rates of minimally invasive hysterectomy (MIH) (i.e., laparoscopic or robotic assisted) compared to total abdominal hysterectomy (TAH) for endometrial and cervical cancer.</p><p><strong>Methods: </strong>A systematic quantitative review of randomised controlled trials (RCTs) comparing MIH with TAH for the treatment of endometrial or cervical cancer. Medline-PubMed, Cochrane Library, Scopus, ongoing clinical trials and the grey literature were searched until December 1, 2024.</p><p><strong>Main outcome measures: </strong>Complications, overall survival (OS), disease-free survival (DFS), and disease-specific survival (DSS) rates.</p><p><strong>Results: </strong>Twenty-nine RCTs enrolling 6,127 patients were included. The risk of bladder injury was higher in the MIH group [risk ratio (RR): 1.84, 95% confidence interval: (CI): 1.03-3.29, I²: 0%), as was the risk of vaginal injury (RR: 12.39, 95% CI: 1.61-95.29, <i>P</i>=0.02, I²: 0%) but the risk of wound dehiscence was lower (RR: 0.32, 95% CI: 0.13-0.83, <i>P</i>=0.02, I²: 13%) compared to abdominal hysterectomy. Among cervical cancer patients, the risk for blood transfusion was significantly lower with the MIH (RR: 0.42, 95% CI: 0.21-0.84, <i>P</i>=0.01, I²: 0%). Among endometrial cancer patients, the OS, DFS, and DSS were comparable between routes of hysterectomy. In contrast, the overall the OS and DFS rates were lower for minimally invasive compared to abdominal hysterectomy (0.94, 95% CI: 0.90-0.98, <i>P</i>=0.005, I²:0 %) and (0.89, 95% CI: 0.84-0.94, <i>P</i><0.001, I²: 0%) respectively.</p><p><strong>Conclusions: </strong>Bladder and vaginal injuries are higher with minimally invasive compared to abdominal hysterectomy. Survival rates for endometrial cancer are comparable but for cervical cancer, minimally invasive hysterectomy is associated with poorer survival outcomes and this should be taken into account when counselling patients and deciding upon the route of hysterectomy.</p><p><strong>What is new?: </strong>TAH has superior survival outcomes compared to minimally invasive hysterectomy.</p>","PeriodicalId":46400,"journal":{"name":"Facts Views and Vision in ObGyn","volume":" ","pages":"195-221"},"PeriodicalIF":1.5,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867171","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":"Laparoscopic-guided TVT placement after prior colpo-suspension.","authors":"Anna Pitsillidi, Laura Vona, Günter Karl Noé","doi":"10.52054/FVVO.2026.462","DOIUrl":"10.52054/FVVO.2026.462","url":null,"abstract":"<p><strong>Background: </strong>Previous retropubic surgery, such as laparoscopic Burch colpo-suspension, can significantly alter the anatomy of the space of Retzius due to fibrosis and scarring. These changes increase the technical difficulty and risk of complications during subsequent retropubic procedures, particularly midurethral sling placement.</p><p><strong>Objectives: </strong>To demonstrate the feasibility and safety of laparoscopic-assisted tension-free vaginal tape (TVT) placement in a patient with recurrent stress urinary incontinence (SUI) following prior colpo-suspension.</p><p><strong>Participant: </strong>A 74-year-old woman with recurrent SUI following laparoscopic Burch colpo-suspension performed five years previously.</p><p><strong>Intervention: </strong>Retropubic TVT placement was performed under simultaneous laparoscopic guidance at a tertiary gynaecological centre. Intraoperative laparoscopy enabled visualisation of the retropubic space, revealing significant fibrosis and distorted anatomy. Needle passage and sling positioning were performed under direct visualisation. Because extensive retropubic dissection reduced the usual tissue support of the tape, it was temporarily secured with a rapidly absorbable suture to maintain its position without increasing suburethral tension.</p><p><strong>Conclusions: </strong>Laparoscopic-assisted TVT placement is a feasible and safe approach in patients with prior retropubic surgery. Direct visualisation allows identification of altered anatomical planes, facilitating controlled needle passage and potentially reducing the risk of complications.</p><p><strong>What is new?: </strong>This video demonstrates the importance of avoiding blind needle insertion in patients with prior colposuspension and highlights laparoscopic guidance as a valuable strategy to improve safety during retropubic sling procedures.</p>","PeriodicalId":46400,"journal":{"name":"Facts Views and Vision in ObGyn","volume":" ","pages":"271-272"},"PeriodicalIF":1.5,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575361/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867208","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":"Seeing the endometrium: time to move beyond blind sampling.","authors":"T Justin Clark","doi":"10.52054/FVVO.2026.581","DOIUrl":"10.52054/FVVO.2026.581","url":null,"abstract":"","PeriodicalId":46400,"journal":{"name":"Facts Views and Vision in ObGyn","volume":"18 3","pages":"157-159"},"PeriodicalIF":1.5,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148971633","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":"Authors' reply to: \"Research and audit are essential to improving women's experience of outpatient hysteroscopy\".","authors":"Prathiba de Silva, T Justin Clark","doi":"10.52054/FVVO.2026.574","DOIUrl":"10.52054/FVVO.2026.574","url":null,"abstract":"","PeriodicalId":46400,"journal":{"name":"Facts Views and Vision in ObGyn","volume":"18 3","pages":"275-276"},"PeriodicalIF":1.5,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575368/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148971704","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}