Journal of minimally invasive gynecology最新文献

Study objective: a To identify the type of endometriosis education and surgical training colorectal surgery residents are exposed to during training b To determine the current surgical management of endometriosis among recently graduated colorectal surgeons and their level of comfort.

Design: A qualitative cross-sectional study was performed. An anonymous questionnaire was emailed to colorectal surgery residents of 2023 and recent graduates for completion. Data was then extracted and analyzed from REDCap. A chi-square test was performed on the primary outcome variables.

Setting: A REDCap electronic survey was administered through email to each participant.

Patients: All colorectal surgery residents in 2023 and recent graduates from Colon and Rectal Surgery subspecialty from 2012 to 2022.

Interventions: A 17-item anonymous questionnaire was sent via email through REDCap MEASUREMENTS AND MAIN RESULTS: The survey was completed by 70 participants. Most respondents (58.5%) did not receive formal education on bowel endometriosis. Forty percent of participants (28/70) did not feel they received adequate training for surgical management of bowel endometriosis. In terms of surgical exposure, 3.8% (2) responded they had been involved in > 15 bowel endometriosis cases and 18 (25.7%) had been exposed to 1-5 cases during colorectal training. Factors that predicted feeling adequately trained in managing endometriosis included formal endometriosis education (OR 4.70, 95% CI 1.37-16.12, p-value .027) and surgical exposure during training (OR 4.38, 95% CI 1.18 - 16.26, p-value .014). Additionally, the number of cases exposed during training is highly correlated with feeling adequately trained.

Conclusion: More than half of colorectal surgeons did not receive formal education on bowel endometriosis and the majority had only been exposed to 1-5 cases during their colorectal training. An overwhelming majority were interested in further education. This study highlights opportunities for improvement in the exposure to education and surgical management of endometriosis among colorectal surgery trainees.

Objective: The objective of this study is to compare intraoperative and postoperative outcomes in women undergoing removal of adnexal structures by either posterior culdotomy or abdominal extraction.

Design: This is a retrospective cohort study conducted via medical record review. Demographic, clinical, and operative variables were abstracted from the medical records. Statistical analysis consisted of descriptive statistics, Fisher's exact tests, Wilcoxon rank sum tests, and multivariable logistic regression models.

Setting: Single academic tertiary care center between 2010 and 2022.

Participants: A total of 718 patients were identified and included in our analysis who underwent minimally invasive ovarian cystectomy or oophorectomy. Patients were excluded if they underwent concomitant hysterectomy.

Interventions: Patients underwent minimally invasive oophorectomy or ovarian cystectomy, and specimens were extracted by either abdominal extraction or culdotomy extraction.

Results: Of the 718 patients who met inclusion criteria, 127 (17.7%) underwent culdotomy extraction and 591 (82.3%) underwent abdominal extraction. The culdotomy extraction group had longer operative times (113 minutes vs 96 minutes, p<0.001) and higher estimated blood loss (25 milliliters vs 10 milliliters, p<0.001) compared to the abdominal extraction group. There were more malignancies in the culdotomy extraction than the abdominal extraction group (15.7% vs 8.1%, respectively, p<0.001). After adjusting for potential confounders, those who underwent culdotomy extraction were more likely to have two or more clinic visits (OR 2.89; 95% CI, 1.66-5.03; p<0.001) and call or message the clinic (OR 2.08; 95% CI, 1.35-3.20; p<0.001). There were no incidences of cuff dehiscence, cuff cellulitis, or pelvic abscess in either group.

Conclusion: Removal of adnexal specimens via abdominal port site or posterior culdotomy incision is a feasible option for specimen extraction and can be individualized based on patient and surgeon preference and patient factors. Those undergoing culdotomy extraction may require more preoperative counseling due to higher rate of postoperative messages seen in our cohort.

Study objective: Although mean/static compliance of bladder filling can be readily assayed via cystometry, a protocol measuring compliance dynamics at a specific stage of bladder filling has not been established in human patients. For patients with pelvic organ prolapse (POP), the objective benefits of robotic-assisted sacrocolpopexy (RSCP) surgical intervention for restoring bladder functions, primarily urine storage, have yet to be established. Also, bladder compliance is a viscoelastic parameter crucially defines the storage function. Therefore, we aimed to investigate the impact of RSCP on bladder compliance of POP patients using a pressure-volume analysis (PVA), which graphically illustrate bladder compliance.

Design: A retrospective pre- and post-operative study.

Setting: Multiple hospitals in Taiwan.

Patients: 27 female POP patients (stage ≥ II).

Intervention: RSCP for POP repair.

Measurements and main results: We retrospectively reviewed the pre- and post-operative PVAs for women with POP, who underwent RSCP. The mean compliance of the entire (Cm), the early half (C1/2), and the late half (C2/2) of bladder filling were analyzed as primary outcomes. Changes in intra-vesical volume (ΔVive) and detrusor pressure (ΔPdet) of bladder filling, ΔPdet in the early (ΔPdet1/2) and late (ΔPdet2/2) filling, and post-voiding residual volume (Vres) were analyzed as secondary outcomes. Compared with the pre-operative control, RSCP increased Cm (p=0.010, N=27) and C2/2 (p<0.001, N=27) but negligibly affected C1/2 (p=0.457, N=27). Mechanistically, RSCP decreased ΔPdet (p=0.001, N=27) without significantly affecting ΔVive (p=0.863, N=27). Furthermore, RSCP decreased the ΔPdet2/2 (p<0.001, N=27) but not ΔPdet1/2 (p=0.295, N=27).

Conclusions: This is the first report of applying PVA in assaying dynamics of bladder compliance in patients with POP. Our results suggest that RSCP improved bladder storage in women with POP since it increased bladder compliance, particularly in the late filling possibly by restoring the anatomical location and geometric conformation for bladder expansion.

Clinical trial registration: This study was registered in ClinicalTrials.gov (https://clinicaltrials.gov/study/NCT05682989); registration number: NCT05682989 submitted on 12/28, 2022.