Journal of minimally invasive gynecology最新文献

Objective: On September 1, 2021, abortion became illegal in Texas once embryonic cardiac activity is detected. The aim of this study was to compare women's characteristics undergoing surgical sterilization before and following the change in abortion-banning laws in Texas.

Design: A retrospective study.

Setting: Single tertiary medical center.

Patients or participants: All women that underwent bilateral salpingectomy for surgical sterilization between May 2020 to November 2022.Women who underwent surgery 15 months before the new laws (controls) were compared to women who underwent surgery 15 months after the change (study group).

Interventions: Demographic and clinical characteristics were collected from the women's medical files. Operative and postoperative data was collected from the operative reports and post-operative follow-up visits. Primary outcome was defined as the proportion of the women undergoing sterilization in each study period (15 months) calculated as percent of the total number of women included in the study (30 months).

Measurements and main results: 205 women met inclusion criteria, of them 131(64%) were in the study group and 74(36%) controls (p<0.001). The Median age was found similar between the groups [31(27-35) and 31(27-34) years for the study group and controls, respectively;(p=.98)]. The number of women with private insurance was significantly higher in the study group (p=0.04). Parity was significantly higher in the control group, as evidenced by the proportion of nulliparous women, which was more than double in the study population compared to controls [37 (28%) vs. 8 (11%); p = 0.004]. Surgery as the first contraception method was reported in 63(48%) and 41(19%) of the women in the study and control groups, respectively (p=.58). The surgical approaches did not differ between the groups (p=.63). The complication rate was found higher for the study group, but the difference did not reach significance (p=.13).

Conclusions: Surgical sterilization has significantly increased since the change in abortion banning laws in Texas. Although the mean age to undergo the surgery did not change, more nulliparous women preferred this method for contraception.

Study objective: To compare the aggregate fibroid specimen weights between abdominal and minimally invasive (MI) myomectomies to determine whether fibroid burden significantly impacts surgical approach to myomectomy.

Design: Retrospective cohort study; INTERVENTIONS: Comparison of aggregate fibroid specimen weights between abdominal and MI myomectomies SETTING: Community health care system.

Patients: 281 patients undergoing abdominal and MI myomectomies between March 2018 and December 2023.

Measurements/main results: A total of 281 patients underwent a myomectomy in our health system between 2018 and 2023. One-hundred and twenty-four (44.2%) patients had aggregate fibroid weights less than 250 grams, sixty-seven (23.8%) patients had a fibroid weight between 250 and 500 grams, and ninety (32.0%) patients had fibroid weights greater than 500 grams. Abdominal myomectomies had a higher percentage of fibroids with aggregate weight greater than 500 grams (48.5% vs 16.6%), and were associated with higher fibroid specimen weights overall (median 482 grams vs 204 grams for MI). However, after adjusting for age, BMI, race, and insurance and comparing median weights between the approaches by the following categories: less 250 grams, 250-500 grams, and greater than 500 grams, abdominal myomectomies were associated with higher fibroid weight for only the less than 250 gram weight group.

Conclusion: Abdominal myomectomies overall were associated with a higher fibroid weight compared to MI myomectomies. However, when looking at myomectomies with aggregate fibroid specimen weights of 250 grams or greater, abdominal myomectomies were not associated with greater specimen weight than with MI approaches. This study supports the growing utilization of minimally invasive approaches for myomectomies in patients with large fibroid burden.

Study objective: The association between endometriosis and congenital uterine anomalies (CUAs) has been discussed for decades, but existing evidence about this association is scarce. The aim of our study is to evaluate the prevalence of CUAs in women with endometriosis and to identify specific characteristics in women with both CUAs and endometriosis in a large cohort of patients.

Design: This is a retrospective single-center observational study conducted between January 2006 and June 2021.

Setting: Swiss tertiary hospital PATIENTS: Women with histologically confirmed endometriosis at laparoscopy.

Interventions: All women included in this study underwent a preoperative 2D ultrasound by an experienced sonographer. In cases of suspected intrauterine pathology, bleeding disorders, or infertility, an additional hysteroscopy was performed.

Measurements and main results: Out of 1566 women with histologically confirmed endometriosis, 93 were diagnosed with CUAs (5.9%). The most frequent malformations were U1c (arcuate uterus) (41/93, 44.1%), U2a (partial septate uterus) (19/93, 20.4%), U3b (complete bicorporeal uterus) (17/93, 18.3%) and U3a (partial bicorporeal uterus) (10/93, 10.8%). Women with both CUAs and endometriosis were more frequently diagnosed with endometriosis rASRM stage IV (p=0.017) and presence of dysmenorrhea (p=0.019) in comparison to women with endometriosis and a morphologically normal uterus.

Conclusions: To the best of our knowledge, this is the largest endometriosis population examined for the prevalence of CUAs. According to our findings, the prevalence of CUAs in women with endometriosis does not appear to be higher than in the general population. However, women with CUAs and endometriosis are more likely to suffer from severe endometriosis (rASRM stage IV) and dysmenorrhea compared to endometriosis patients without CUA.

Objective: To review advances of the sacrocolpopexy procedure and demonstrate the Vaginal-Assisted Laparoscopic Sacrocolpopexy approach.

Design: Participants who underwent the Vaginal-Assisted Laparoscopic Sacrocolpopexy approach and consented to intra-operative video documentation were included.

Setting: This research was conducted at a single academic institution.

Interventions: Sacrocolpopexy is an abdominal apical suspension that involves placement of mesh between the vaginal apex and anterior longitudinal ligament overlying the S1-S2 vertebrae. Vaginal Assisted Laparoscopic Sacrocolpopexy (VALS), is a modified approach to sacrocolpopexy. After the hysterectomy, the mesh is attached vaginally to the anterior and posterior vaginal walls. Vaginal dissection of the vesicovaginal and rectovaginal spaces by hand is quick and efficient and allows for palpation of needle depth, which can prevent suture tearing and inadequate mesh attachment with non-tactile placement. The surgeon then transitions back to laparoscopy to complete the remainder of the procedure. Recent literature demonstrates similar rates of mesh complications and reoperation for prolapse with concurrent total hysterectomy versus supracervical hysterectomy given the transition to type I polypropylene mesh and reduction in permanent suture use for vaginal mesh attachment. We anticipate an increase in utilization of the VALS technique given multiple benefits of total hysterectomy, including reduced risk of postoperative menses in premenopausal patients, less postoperative pain and better cosmetic outcomes without need for mini-laparotomy or port-site extension for uterine morcellation, and decreased cervical and endometrial cancer risk. Surgical benefits of the VALS technique include shorter anesthesia and operative time and reduces the need for higher level assistance intraoperatively. VALS is also more ergonomic for the surgeon, promoting use of different muscles throughout the case, thus decreasing muscle fatigue and risk of repetitive motion injury.

Conclusion: Laparoscopic sacrocolpopexy utilizing transvaginal mesh attachment is another tool in the myriad of techniques to treat advanced pelvic organ prolapse. This technique reduces operative and anesthesia time, minimizes mesh complications while maintaining successful outcomes for patients. VIDEO ABSTRACT.

Objective: The da Vinci SP Surgical System (SP) received regulatory approval for use in gynecological surgeries in Japan in 2023. Given the advantages of the precision of a robot, less pain, and the cosmesis of single-port surgery, the da Vinci SP is expected to be further used for minimally invasive surgeries. To the best of our knowledge, this is the first report of the use of SP for the treatment of rectal endometriosis with segmental bowel resection.

Setting: An urban general hospital. Stepwise demonstration of the technique with narrated video footage.

Participants: The patient was a 46-year-old woman presented with chronic pelvic pain, pain on defecation, and constipation. Magnetic resonance imaging showed uterine large fibroid, left ovarian endometrioma, and 38 mm of rectal endometriosis, with complete cul-de-sac obliteration.

Interventions: We made a 30-mm vertical incision at the umbilicus, then placed the access port, and inserted three articulating instruments and a camera. An assistant port was placed in the right lower quadrant for using the linear stapler. The surgical steps were completely identical to conventional multiport laparoscopic robotic surgery. This suggests that conventional laparoscopic or robotic skills are highly transferrable to SP. SP offer several advantages, including high-resolution three-dimensional visualization, articulating instruments, and improved dexterity and range of motion. In addition, the umbilical access port was particularly useful for proximal bowel resection, specimen retrieval, and anvil positioning during bowel resection. The total operative time was 216 minutes. The estimated blood loss was 100 ml without any complications. The uterine weight was 800 g. The postoperative course was uneventful, with no perioperative complications, including no postoperative bladder dysfunction or low anterior resection syndrome [1,2].

Conclusion: The use of SP with the access port for segmental bowel resection for rectal endometriosis is technically safe and feasible, with good cosmesis and less pain.