Journal of minimally invasive gynecology最新文献

Objective: Without standardized guidelines, the management of thoracic endometriosis syndrome (TES) continues to fuel debate. Previous reviews have reported poor outcomes but lack data on complications, hospital length of stay (LOS) and chest tube drainage. Our study includes the largest number of TES patients till date and aims to evaluate post-operative outcomes.

Data sources: PubMed, Scopus, and EMBASE were searched up to March 2024 using Medical Subject Headings and free text combinations.

Methods of study selection: We included all studies on adults with diagnosed or suspected TES who received surgical treatment. Study quality was evaluated using the Newcastle-Ottawa scale.

Tabulations, integration and results: 28 studies including 1,182 patients met our eligibility criteria. Meta-analysis was performed using Open Meta-analyst to calculate the effect measures within a random effects model. Pneumothorax recurrence was 28.2%(95% CI 0.218 - 0.345, I2 = 80.07%) and reoperation rate was 14.0%(95% CI 0.062 - 0.218, I2 = 72.97%). The overall complication rate was 30.8%(95% CI 0.144 - 0.473, I2 = 92.41%) and prolonged air leak rate was 24.2%(95% CI 0.101 - 0.383, I2 = 91.5%). On average, chest drains remained in situ for 4.4 days(95% CI 2.924 - 5.899, I2 = 97.95%) and LOS was 6.1 days(95% CI 3.774 - 8.367, I2 = 97.18%).

Conclusions: Our findings reveal a clinically meaningful burden of post-surgical pneumothorax recurrence, reoperation and complications among TES patients. Additionally, prolonged hospitalisation and chest tube drainage underscore important clinical considerations. Further high-quality research on patient-reported outcomes and quality-of-life(QoL) data is needed to establish standardized protocols.

Objective: Sexual dysfunction after cancer is a common but underrecognized sequelae of breast and gynecologic cancer treatment. Many patients experience symptoms of genitourinary syndrome of menopause (GSM), including vaginal dryness, dyspareunia, and diminished sexual desire. Addressing these challenges requires a comprehensive, evidence-based approach to management.

Data sources: A comprehensive literature search was conducted using PubMed, Google Scholar, and Scopus to identify peer-reviewed studies published within the last 30 years. The search incorporated Medical Subject Headings (MeSH) and keywords related to sexual dysfunction and cancer survivorship, including terms such as "sexual dysfunction," "dyspareunia," "vaginal dryness," "vaginal hormone therapy," "breast cancer survivors," and "low desire."

Methods of study selection: Studies were included if they examined sexual dysfunction in cancer patients or survivors, were published in English, and addressed either physiological or psychological aspects of sexual health. Articles were excluded if they lacked methodological rigor. An initial screening of titles and abstracts was followed by full-text review to determine relevance and inclusion.

Tabulation: Findings were synthesized using thematic analysis, with studies grouped by cancer type, treatment modality, and impact on sexual function. Although no formal quality assessment tool was applied, emphasis was placed on high-impact studies and comprehensive reviews published in reputable journals.

Integration and results: Effective management of GSM includes non-hormonal options such as minimizing irritants, vaginal moisturizers, lubricants, the use of dilators, and pelvic floor therapies. Local hormonal therapies may offer relief for select patients depending on the hormone-sensitivity of their cancer diagnosis. For low sexual desire, psychological and pharmacological agents such as bremelanotide and flibanserin have demonstrated efficacy. Vaginal lasers and compounded hormones pose significant risks to these patient populations and should be avoided. Multidisciplinary approaches, incorporating gynecologic, psychological, and oncologic expertise, are essential for optimizing patient outcomes.

Conclusion: Sexual dysfunction following breast and gynecologic cancer requires individualized, multimodal management. A combination of non-hormonal and hormonal therapies, behavioral interventions, and emerging pharmacologic treatments offers promising avenues for improving sexual health and overall quality of life in survivors. Future research should focus on the effects of specific cancer therapies on sexual health, investigate the role of biological markers and dysfunction, and refine more personalized approaches to care.

Objective: The study aims to evaluate the necessity of intraoperative gastric decompression during gynecologic laparoscopy.

Methods: This study is a double-blind randomized control trial in which participants undergoing any benign gynecologic laparoscopy procedure with umbilical entry were block-randomized (1:1) to receive either gastric decompression or not. Individuals were screened for eligibility based on surgical scheduling for gynecologic laparoscopy undergoing umbilical entry. The intervention was performed after the patient was intubated and while the surgeon was out of the operating room to maintain blinding. At the time of laparoscopic entry, surgeons subjectively assessed the degree of stomach decompression, risk of gastric injury, and distance between the umbilicus and inferior gastric margin. A sample size calculation was determined to need 73 participants per group.

Results: From November 2023 to March 2025, 155 participants were consented to participate and 146 were enrolled and randomized. Participants in the study and control groups did not significantly vary based on age (37.8 vs 36.8), BMI (27.3 vs 27.9), or procedure type. The primary outcome, stomach well decompressed, was achieved in 97.2% of participants in the study group without an orogastric (OG) tube and 98.5% in the control group with an OG tube (difference, -1.3%, 95% confidence interval [CI], -8.8% to 6.2%; P=0.01 for noninferiority), with noninferiority margin set at -10%. There were no cases of gastric injury in both groups.

Conclusion: Routine gastric decompression during gynecologic laparoscopy with umbilical entry is not necessary for low-risk participants. Regardless of the placement of an OG tube, the stomach was adequately decompressed, not at risk of injury, and without negative postoperative participant experience.

Objective: To compare surgical outcomes, postoperative recovery, and sexual function between transvaginal natural orifice transluminal endoscopic surgery (vNOTES) and transumbilical laparoendoscopic single-site surgery (TU-LESS) for salpingectomy in patients with tubal ectopic pregnancy.

Design: Single-blind randomized controlled trial SETTING: University-affiliated tertiary care center specializing in women's and children's health.

Participants: Seventy-two patients with tubal ectopic pregnancy, eligible for laparoendoscopic salpingectomy, were enrolled between January 19 and September 30, 2024. Patients were randomly assigned in a 1:1 ratio to undergo vNOTES or TU-LESS salpingectomy.

Interventions: vNOTES or TU-LESS salpingectomy, with perioperative assessment and 3-6 months of postoperative follow-up.

Results: Except for the incisional wound assessor, outcome evaluators were blinded to group allocation. The primary outcome, intraoperative conversion rate, was 0 in both groups. Baseline demographic and clinical characteristics were comparable between groups. Compared with TU-LESS, vNOTES was associated with significantly lower pain scores at 12, 24, and 48 h (all p < 0.001), shorter operative time (44.89 ± 10.30 vs. 50.44 ± 10.31 min, p = 0.025), and reduced postoperative analgesic use (2.8% vs. 22.2%, p = 0.013). No significant differences were observed in intraoperative blood loss, complications, length of hospital stay, or incidence of incisional hernia. Female Sexual Function Index (FSFI) scores remained comparable between groups before and after surgery (p > 0.05).

Conclusion: vNOTES and TU-LESS salpingectomy showed similarly low conversion rates; although the trial was not powered for secondary outcomes, vNOTES deomonstrated better postoperative pain control and cosmetic satisfaction, with postoperative sexual function remaining comparable between approaches.

Trial registration: ChiCTR2400082909, registered on April 10, 2024 (https://www.chictr.org.cn/showprojEN.html?proj=224201).

Objective: We systematically examined the current literature on staged pre-hysterectomy uterine artery embolization (SUAE) for symptomatic uterine fibroids.

Data sources: Databases were queried from January 2010 to June 2025. A scoping review following the Arksey and O'Malley framework and PRISMA-ScR guidelines was performed. This study was prospectively registered in PROSPERO under CRD42023395014.

Methods of study selection: While 1,662 records were identified and assessed for eligibility, 914 underwent abstract screening, and only 142 records underwent full article screening. Nine articles met inclusion criteria. Two independent reviewers reviewed articles, with a third reviewer refereeing any discrepancies.

Tabulation, integrity, and results: The nine studies corresponded to 34 patients. Only case reports and a single cross-sectional observational study were identified. The average patient age was 44 years, with bleeding and bulk symptoms noted as the most common indications for hysterectomy. The median for the largest fibroid diameter was 19cm (average 20.9cm). The median uterine artery embolization to hysterectomy interval was 1 day (average 15.6 days). Regarding the route, 88.2% were total abdominal, 8.8% total laparoscopic, and 2.9% subtotal laparoscopic. The median blood loss was 352mL (average 605.3), compared to the median uterine weight of 2905g (average 4439.2). Of the 8 patients receiving blood transfusions, all had undergone total abdominal hysterectomy.

Conclusion: This review is the first to systematically examine the literature on SUAE for patients with symptomatic uterine fibroids. Because of the limited case studies and observational data available, the true outcomes are uncertain and there is insufficient evidence that SUAE should be added into clinical practice as standard of care. Overall, the findings of this exploratory scoping review best serve to generate future hypotheses while highlighting an urgent need for rigorous research.

Objective: To provide a comprehensive educational resource demonstrating cystoscopy, an essential diagnostic procedure in urogynecology and pelvic surgery. The video aims to enhance clinicians' diagnostic skills and technical expertise by showcasing normal and pathological cystoscopic findings to optimize patient outcomes.

Setting: This video was created in a high-volume tertiary care center specializing in urogynecology and pelvic reconstructive surgery, where cystoscopy is routinely performed during pelvic surgeries and clinical evaluations.

Participants: The video features real patient cases, de-identified for educational use, selected to highlight a broad range of cystoscopic findings encountered in clinical and surgical practice.

Interventions: The intervention demonstrated is cystoscopy. The video begins with an overview of normal cystoscopic findings to establish a baseline for comparison. It then presents a diverse series of clinical cases, illustrating structural variations, bladder mucosal abnormalities, foreign bodies, and urethral pathologies. Each case is paired with a discussion of appropriate management to offer practical, clinically relevant insights.

Conclusion: Cystoscopy plays a critical role in detecting bladder lesions and injuries, and mastery of this skill is vital for timely and accurate clinical intervention. By presenting a wide array of findings and their management, this video underscores the importance of proficiency in cystoscopic technique and interpretation, reinforcing its pivotal function in urogynecology and pelvic surgery.