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Measuring the Impact of an Exoscopic Camera System on Learner Mental Workload in Vaginal Surgery. 测量外窥镜系统对阴道手术学习者心理负荷的影响。
IF 3.3 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2026-02-05 DOI: 10.1016/j.jmig.2026.02.002
Katherine L Woodburn, Megan S Orlando, N Brandon Barba, Pamela Garcia-Filion, Darlene Vargas Maldonado, John Gebhart, Rosanne M Kho

Study objective: To measure the workload effect of an exoscopic camera system during vaginal hysterectomy on workload and learning experience of Obstetrics and Gynecology trainees.

Design: Prospective cohort study SETTING: Two tertiary academic medical centers in the United States PATIENTS/PARTICIPANTS: Obstetrics and Gynecology residents and fellows INTERVENTIONS: Vaginal hysterectomy performed with and without an exoscopic camera system MEASUREMENTS AND MAIN RESULTS: The primary outcome was workload measured using the NASA Task Load Index (NASA-TLX) across six dimensions: mental demand, physical demand, temporal demand, effort, performance, and frustration. The secondary outcomes were trainee perceptions of the surgical experience using Likert scale questions. From June 2021 to January 2024, 39 surveys were completed (21 with camera, 18 without); 10 trainees had paired data. The mean overall NASA-TLX scores did not differ between groups (40.4 [SD 14.9] with camera vs. 47.5 [SD 21.5] without; p=0.14). Physical demand scores were lower with the camera (39.9 [SD 41.3] with vs. 53.1 [SD 19.2] without; p=0.05). Among paired data, median overall NASA-TLX scores were similar (47.4 vs. 49.3; p=0.28), with 7 of 10 trainees reporting lower scores with the camera system. Effect sizes for trainee perceptions showed small positive effects on visualization (Cliff's δ =0.26) and skill building (Cliff's δ =0.29), moderate effect on procedural flow (Cliff's δ =0.46), and large effect on engagement (Cliff's δ =0.50) with the use of the exoscopic camera. No effects were seen for anatomical knowledge application (Cliff's δ =0.04), confidence in anticipation (Cliff's δ =0.06), or intrusion (Cliff's δ =-0.01).

Conclusion: Use of an exoscopic camera system during vaginal hysterectomy was associated with improved trainee engagement and procedural flow, and reduced physical demand, without increasing overall mental workload. These findings support its utility as an educational adjunct in vaginal surgery training.

Summation: In a prospective cohort study, use of an exoscopic camera system during vaginal hysterectomy was associated with improved trainee engagement and reduced physical demand without increasing overall mental workload.

研究目的:探讨阴道子宫切除术中外窥镜摄像系统对妇产科实习生工作量和学习经验的影响。设计:前瞻性队列研究设置:美国的两个三级学术医疗中心患者/参与者:妇产科住院医师和研究员干预措施:阴道子宫切除术有和没有外窥镜相机系统测量和主要结果:主要结果是使用NASA任务负荷指数(NASA- tlx)测量工作负荷,包括六个维度:精神需求、身体需求、时间需求、努力、表现和挫折。次要结果是使用李克特量表问题的受训者对手术经验的感知。2021年6月至2024年1月,共完成39次调查(带相机21次,不带相机18次);10名受训者有配对数据。NASA-TLX平均总分在两组间无差异(有相机组40.4 [SD 14.9]比无相机组47.5 [SD 21.5]; p=0.14)。有相机的身体需求得分较低(39.9 [SD 41.3]比无相机的53.1 [SD 19.2]; p=0.05)。在配对数据中,NASA-TLX总分的中位数相似(47.4比49.3;p=0.28), 10名受训者中有7名报告使用相机系统得分较低。外窥镜对受训者感知的效应大小显示,使用外窥镜对可视化(Cliff’s δ =0.26)和技能培养(Cliff’s δ =0.29)有较小的正向影响,对程序流程(Cliff’s δ =0.46)有中等影响,对敬业度(Cliff’s δ =0.50)有较大影响。解剖知识应用(Cliff’s δ =0.04)、预期信心(Cliff’s δ =0.06)和入侵(Cliff’s δ =-0.01)均未见影响。结论:阴道子宫切除术中使用外窥镜相机系统可以改善受训者的参与度和手术流程,减少体力需求,而不会增加总体精神工作量。这些发现支持了它在阴道外科培训中作为教育辅助的效用。总结:在一项前瞻性队列研究中,在阴道子宫切除术中使用外窥镜相机系统可以提高受训者的参与度,减少身体需求,而不会增加总体精神工作量。
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引用次数: 0
LAPAROSCOPIC EXCISION OF AN ACCESSORY CAVITATED UTERINE MALFORMATION IN AN ADOLESCENT PATIENT. 腹腔镜下切除青少年副空化子宫畸形一例。
IF 3.3 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2026-02-04 DOI: 10.1016/j.jmig.2026.01.062
Ismail Biyik, Montserrat Cubo-Abert, Safak Hatirnaz

Objective: To demonstrate the laparoscopic, uterus-sparing excision of an accessory cavitated uterine malformation (ACUM) in an adolescent patient and to emphasize the importance of accurate preoperative imaging for intraoperative localization.

Setting: Tertiary referral center for minimally invasive gynecologic surgery.

Participants: An 18-year-old adolescent patient presenting with severe dysmenorrhea and chronic pelvic pain refractory to medical treatment.

Interventions: Laparoscopic excision of a noncommunicating accessory cavitated uterine lesion with preservation of the main uterine cavity.

Conclusion: Preoperative transabdominal ultrasonography and magnetic resonance imaging demonstrated a 35 × 43 mm cystic lesion located in the left anterior uterine wall, clearly separated from the endometrial cavity and consistent with ACUM. During laparoscopy, no obvious uterine bulging was observed, making intraoperative localization challenging. A targeted myometrial incision allowed identification and complete excision of the lesion, which contained chocolate-colored fluid and was lined with endometrium-like tissue. The main uterine cavity was preserved, and layered myometrial reconstruction was performed. Histopathological examination confirmed the diagnosis of ACUM. Laparoscopic uterus-sparing excision is a safe and effective treatment option for adolescent patients with ACUM when guided by accurate preoperative imaging.

目的:探讨腹腔镜下保留子宫切除青少年副空化子宫畸形(ACUM)的方法,并强调术前准确影像学对术中定位的重要性。单位:三级妇科微创外科转诊中心。参与者:一名18岁的青少年患者,表现为严重痛经和慢性盆腔疼痛,药物治疗难治性。干预措施:腹腔镜切除非交通附属空化子宫病变,保留主子宫腔。结论:术前经腹超声及磁共振示35 × 43 mm囊性病变位于子宫左前壁,与子宫内膜腔明显分离,符合ACUM。腹腔镜检查未见明显子宫膨出,使术中定位困难。有针对性的子宫肌膜切口可以识别并完全切除病变,病变含有巧克力色的液体,内衬子宫内膜样组织。保留子宫主腔,分层重建子宫肌膜。组织病理学检查证实ACUM的诊断。在准确的术前影像指导下,腹腔镜子宫保留切除术是青少年ACUM患者安全有效的治疗选择。
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引用次数: 0
Surgical complications of salpingo-oophorectomy in women undergoing risk-reducing surgery for hereditary breast and ovarian cancer - A retrospective cohort study. 一项回顾性队列研究:遗传性乳腺癌和卵巢癌妇女行输卵管卵巢切除术的手术并发症。
IF 3.3 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2026-02-03 DOI: 10.1016/j.jmig.2026.01.052
Anna Katrine Holst Lund, Klara Vinsand Naver, Kresten Rubeck Petersen, Pernille Ravn, Karin Anna Wallentin Wadt, Julie Isabelle Plougmann Gislinge

Objective: Risk-reducing bilateral salpingooophorectomy (RRSO) lowers the risk of ovarian cancer (OC) by 80-90% in women with a hereditary predisposition to breast and/or ovarian cancer (HBOC/HOC). As genetic testing expands, more women may be candidates for RRSO, which underscores the need to assess the safety of the procedure. We aimed to evaluate the frequency of surgical complications following RRSO to support informed decision-making for women advised to undergo the procedure.

Design: Retrospective cohort study SETTING: Copenhagen University Hospital Herlev, Denmark January 2017-December 2022 PARTICIPANTS: 246 women with HBOC/HOC who underwent risk reducing surgery were included. Patients, who had declined to participate in quality assurance studies were excluded.

Interventions: Risk reducing bilateral/unilateral salpingoophorectomy ± hysterectomy RESULTS: 246 women underwent surgery, and 15 (6.09%) experienced complications. 9 (60%) were Clavien Dindo grade I and 6 (40%) grade II. No grade III, IV, or V complications occurred. Grade I included minor pain or superficial infection not requiring antibiotic treatment, and grade II were all due to infections requiring treatment with antibiotics. No significant differences were found between women with and without complications with respect to age, BMI, previous abdominal surgery or smoking CONCLUSION: The incidence and severity of complications after risk reducing surgery were low. This evidence is valuable in counseling women with HBOC and offers reassurance about the safety of RRSO.

目的:降低风险的双侧输卵管卵巢切除术(RRSO)可使具有乳腺癌和/或卵巢癌遗传易感性(HBOC/HOC)的女性患卵巢癌(OC)的风险降低80-90%。随着基因检测的扩展,更多的女性可能成为RRSO的候选人,这强调了评估该程序安全性的必要性。我们的目的是评估RRSO术后手术并发症的频率,以支持建议接受该手术的妇女做出明智的决策。设计:回顾性队列研究设置:丹麦哥本哈根大学赫列夫医院2017年1月- 2022年12月参与者:纳入246名接受降低风险手术的HBOC/HOC女性。拒绝参加质量保证研究的患者被排除在外。干预措施:降低双侧/单侧输卵管卵巢切除术±子宫切除术的风险结果:246名妇女接受了手术,15名(6.09%)出现并发症。Clavien Dindo I级9例(60%),II级6例(40%)。无III级、IV级或V级并发症发生。I级包括轻微疼痛或不需要抗生素治疗的浅表感染,II级均为需要抗生素治疗的感染。有无并发症的女性在年龄、BMI、既往腹部手术及是否吸烟等方面无显著差异。结论:降低风险手术后并发症的发生率和严重程度均较低。这一证据对HBOC妇女的咨询有价值,并为RRSO的安全性提供了保证。
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引用次数: 0
Multicenter Prospective Study on Transvaginal Radiofrequency Ablation of Uterine Fibroids: Efficacy, Safety, and Reproducibility. 经阴道射频消融子宫肌瘤的多中心前瞻性研究:有效性、安全性和可重复性。
IF 3.3 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2026-02-02 DOI: 10.1016/j.jmig.2026.01.054
Angel Santalla-Hernandez, Iván Gomez- Gutierrez-Solana, María DelaTorre-Bulnes, María Eugenia Marín-Martínez, Domingo Molina-González, María Esperanza Gadea-Niñoles, Antonia María Lopez-Lopez, Irene Pelayo-Delgado, Cristina Torrijo-Rodrigo, Rosario Lara-Peñaranda, María José Palomo-Viciana, Mariña Naveiro-Fuentes
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引用次数: 0
Letter to the Editor: Regarding Multicenter Prospective Study on Transvaginal Radiofrequency Ablation of Uterine Fibroids: Efficacy, Safety, and Reproducibility. 致编辑:关于经阴道射频消融子宫肌瘤的多中心前瞻性研究:有效性、安全性和可重复性。
IF 3.3 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2026-02-02 DOI: 10.1016/j.jmig.2026.01.057
David Toub
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引用次数: 0
Author's Reply. 作者的回答。
IF 3.3 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2026-02-02 DOI: 10.1016/j.jmig.2026.01.058
Antoine Netter, Adrien Bartoli, Nicolas Bourdel
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引用次数: 0
Regarding "Initial Results in the Automatic Visual Recognition of Endometriosis Lesions by Artificial Intelligence During Laparoscopy:A Proof-of-Concept Study". 关于“腹腔镜期间人工智能对子宫内膜异位症病变的自动视觉识别的初步结果:概念验证研究”。
IF 3.3 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2026-02-01 DOI: 10.1016/j.jmig.2025.12.047
Sida Chen, Yang Song, Yanmei Sun, Jing Xiao
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引用次数: 0
Ovarian tissue transplantation using autologous platelet-rich plasma: a pilot clinical trial. 自体富血小板血浆卵巢组织移植:一项试点临床试验。
IF 3.3 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2026-02-01 DOI: 10.1016/j.jmig.2026.01.061
Rossella Vicenti, Marisol Doglioli, Antonio Raffone, Stefano Ferla, Irene Esposito, Elio Fabbri, Annarita Cenacchi, Luigi Cobellis, Maria Giovanna Vastarella, Claudia Vicenzi, Renato Seracchioli, Diego Raimondo

Objective: To study the feasibility and safety of using autologous platelet-rich plasma (PRP) during laparoscopic orthotopic reimplantation of cryopreserved ovarian tissue.

Design: Single-center, interventional, pilot, prospective, cohort study.

Setting: Tertiary university hospital (IRCCS-Azienda Ospedaliero-Universitaria di Bologna-Policlinico Sant'Orsola).

Participants: Five eligible consecutive patients, who previously cryopreserved ovarian tissue before chemo(radio) therapy for oncologic diseases and were scheduled for orthotopic reimplantation with the use of autologous PRP to treat iatrogenic premature ovarian failure, were compared with a historical cohort of 19 similar patients who underwent orthotopic reimplantation without the use of autologous PRP.

Interventions: Before surgery, autologous PRP (10 mL) was transformed into gel using calcium gluconate. Autotransplantation was performed by standard four-port laparoscopy, creating pockets in the ovarian cortex and/or peritoneal cavity to insert frozen-thawed ovarian tissue fragments covered by gelled PRP. Pre-, intra- and postoperative data were collected (characteristics of the study population, adverse reactions, operative time, surgical complications, menstrual resumption).

Results: Study outcomes included: rate of adverse reactions, rate of intra- and postoperative surgical complication, total intraoperative time, rate of restored endocrine function and median (absolute range) time to first menses (expressed in months) during follow-up. The mean (range) age at ovarian tissue retrieval and at transplantation were 30 (27-31) and 38 (36-41) years for the PRP group, and 33 (24-34) and 41 (34-42) years for the non-PRP group. During the study period, no intra- and postoperative complication nor adverse reaction to PRP use was observed. All patients treated with PRP experienced resumption of regular ovarian function after a median (range) period of 3 (1-6) months, with a significant shorter time in the PRP group. One patient in the experimental group conceived three months after surgery and had one live birth at the time of this report.

Conclusion: Autologous PRP appears to be a feasible and safe adjunct in orthotopic ovarian tissue transplantation, potentially enhancing the restoration of ovarian function.

目的:探讨自体富血小板血浆(PRP)在腹腔镜卵巢冷冻组织原位再植术中的可行性和安全性。设计:单中心、干预性、先导性、前瞻性、队列研究。环境:第三大学医院(ircc - azienda Ospedaliero-Universitaria di Bologna-Policlinico san 'Orsola)。参与者:5名符合条件的连续患者,在肿瘤疾病化疗(放疗)前冷冻保存卵巢组织并计划使用自体PRP进行原位再植治疗医源性卵巢早衰,与19名接受原位再植但未使用自体PRP的类似患者进行历史队列比较。干预措施:术前,自体PRP (10 mL)用葡萄糖酸钙转化成凝胶。自体移植在标准的四孔腹腔镜下进行,在卵巢皮层和/或腹膜腔中形成口袋,插入由凝胶PRP覆盖的冷冻解冻卵巢组织碎片。收集术前、术中和术后数据(研究人群特征、不良反应、手术时间、手术并发症、月经恢复)。结果:研究结果包括:不良反应发生率、术中及术后手术并发症发生率、术中总时间、内分泌功能恢复率、随访期间至第一次月经的中位(绝对范围)时间(以月表示)。卵巢组织摘除和移植时,PRP组的平均(范围)年龄分别为30(27-31)和38(36-41)岁,非PRP组的平均(范围)年龄分别为33(24-34)和41(34-42)岁。在研究期间,没有观察到PRP使用的内、术后并发症和不良反应。所有接受PRP治疗的患者在中位(范围)3(1-6)个月后恢复正常卵巢功能,PRP组的恢复时间明显更短。实验组中有一名患者在手术后三个月怀孕,并在本报告发表时产下一名活产婴儿。结论:自体PRP在卵巢原位组织移植中是一种安全可行的辅助手段,具有促进卵巢功能恢复的潜力。
{"title":"Ovarian tissue transplantation using autologous platelet-rich plasma: a pilot clinical trial.","authors":"Rossella Vicenti, Marisol Doglioli, Antonio Raffone, Stefano Ferla, Irene Esposito, Elio Fabbri, Annarita Cenacchi, Luigi Cobellis, Maria Giovanna Vastarella, Claudia Vicenzi, Renato Seracchioli, Diego Raimondo","doi":"10.1016/j.jmig.2026.01.061","DOIUrl":"https://doi.org/10.1016/j.jmig.2026.01.061","url":null,"abstract":"<p><strong>Objective: </strong>To study the feasibility and safety of using autologous platelet-rich plasma (PRP) during laparoscopic orthotopic reimplantation of cryopreserved ovarian tissue.</p><p><strong>Design: </strong>Single-center, interventional, pilot, prospective, cohort study.</p><p><strong>Setting: </strong>Tertiary university hospital (IRCCS-Azienda Ospedaliero-Universitaria di Bologna-Policlinico Sant'Orsola).</p><p><strong>Participants: </strong>Five eligible consecutive patients, who previously cryopreserved ovarian tissue before chemo(radio) therapy for oncologic diseases and were scheduled for orthotopic reimplantation with the use of autologous PRP to treat iatrogenic premature ovarian failure, were compared with a historical cohort of 19 similar patients who underwent orthotopic reimplantation without the use of autologous PRP.</p><p><strong>Interventions: </strong>Before surgery, autologous PRP (10 mL) was transformed into gel using calcium gluconate. Autotransplantation was performed by standard four-port laparoscopy, creating pockets in the ovarian cortex and/or peritoneal cavity to insert frozen-thawed ovarian tissue fragments covered by gelled PRP. Pre-, intra- and postoperative data were collected (characteristics of the study population, adverse reactions, operative time, surgical complications, menstrual resumption).</p><p><strong>Results: </strong>Study outcomes included: rate of adverse reactions, rate of intra- and postoperative surgical complication, total intraoperative time, rate of restored endocrine function and median (absolute range) time to first menses (expressed in months) during follow-up. The mean (range) age at ovarian tissue retrieval and at transplantation were 30 (27-31) and 38 (36-41) years for the PRP group, and 33 (24-34) and 41 (34-42) years for the non-PRP group. During the study period, no intra- and postoperative complication nor adverse reaction to PRP use was observed. All patients treated with PRP experienced resumption of regular ovarian function after a median (range) period of 3 (1-6) months, with a significant shorter time in the PRP group. One patient in the experimental group conceived three months after surgery and had one live birth at the time of this report.</p><p><strong>Conclusion: </strong>Autologous PRP appears to be a feasible and safe adjunct in orthotopic ovarian tissue transplantation, potentially enhancing the restoration of ovarian function.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146113462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Assisted Reproductive Technology in Women with Endometriosis and a History of Catamenial Pneumothorax: Reproductive Outcomes and Safety Considerations. 辅助生殖技术在子宫内膜异位症和双肠气胸病史的妇女:生殖结果和安全考虑。
IF 3.3 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2026-02-01 DOI: 10.1016/j.jmig.2026.01.059
Gianfranco Fornelli, Mathilde Bourdon, Chloé Maignien, Léa Melka, Lorenzo Gherzi, Lorraine Maitrot Mantelet, Catherine Patrat, Edgardo Somigliana, Marco Alifano, Pietro Santulli

Study objective: To describe reproductive outcomes and clinical safety considerations associated with assisted reproductive technology (ART) in women with a history of surgically treated catamenial pneumothorax (thoracic endometriosis syndrome).

Design: Retrospective case series conducted from January 2014 to December 2023.

Setting: Single tertiary academic center integrating reproductive medicine and thoracic surgery.

Participants: Women aged 18-43 years with surgically treated catamenial pneumothorax were included.

Interventions: Exposure was ART in women with catamenial pneumothorax ultimately managed surgically, performed either before and/or after the thoracic operation; the timing of ART relative to surgery was recorded.

Measurements and main results: Primary outcomes were reproductive outcomes (including live birth rate per patient and per transfer) and safety outcomes (pneumothorax occurrence/recurrence and ART-related complications). Ten of the eleven patients (91 %) had right-sided catamenial pneumothorax. Five women (45 %) had undergone pelvic endometriosis surgery before thoracic management. Nineteen ovarian stimulation cycles were performed. Among infertile patients, seven of ten (70 %) achieved at least one live birth: five after in vitro fertilization with autologous oocytes, one after oocyte donation, and one after intrauterine insemination with donor sperm. Four women (36 %) experienced their first pneumothorax episode within four months of assisted reproductive technology. No thoracic recurrences were observed after surgery, despite subsequent ovarian stimulations.

Conclusion: ART was associated with positive reproductive outcomes and a low rate of reported adverse events in women with a history of surgically treated catamenial pneumothorax, with no observed thoracic recurrences following treatment. Prospective studies are needed to further characterize outcomes and risks.

研究目的:描述有手术治疗过胸膜气胸(胸段子宫内膜异位症综合征)病史的女性使用辅助生殖技术(ART)的生殖结果和临床安全考虑。设计:2014年1月至2023年12月进行回顾性病例系列研究。环境:生殖医学和胸外科相结合的单一三级学术中心。参与者:包括年龄在18-43岁的手术治疗的双膜气胸女性。干预措施:在胸手术之前和(或)之后,接受抗逆转录病毒治疗的双侧气胸女性患者最终接受手术治疗;记录ART相对于手术的时间。测量和主要结果:主要结果是生殖结果(包括每位患者和每次转移的活产率)和安全性结果(气胸发生/复发和art相关并发症)。11例患者中有10例(91 %)为右侧双肠膜气胸。5名妇女(45% %)在胸腔镜治疗前接受过盆腔子宫内膜异位症手术。共进行了19个卵巢刺激周期。在不孕症患者中,十分之七(70 %)至少有一个活产:五个通过自体卵母细胞体外受精,一个通过卵母细胞捐赠,一个通过供体精子宫内人工授精。四名妇女(36% %)在辅助生殖技术的四个月内经历了第一次气胸发作。手术后没有胸部复发,尽管随后卵巢刺激。结论:抗逆转录病毒治疗与积极的生殖结果有关,并且在有手术治疗过的双侧气胸病史的妇女中报告的不良事件发生率低,治疗后没有观察到胸部复发。需要前瞻性研究来进一步确定结果和风险。
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引用次数: 0
Robot-assisted transabdominal cervical cerclage with the Hugo RAS system: surgical technique and perioperative outcomes in a high-risk obstetric case. 机器人辅助经腹宫颈环切术与Hugo RAS系统:手术技术和围手术期结果在高危产科病例。
IF 3.3 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2026-01-31 DOI: 10.1016/j.jmig.2026.01.050
Ferla Stefano, DE Gobbi Valeria, Seracchioli Renato, Raimondo Diego

Objective: Cervical insufficiency, the inability of uterine cervix to retain pregnancy in absence of labor, is a major cause of preterm births and stillbirths. Therapeutic options include expectant management, progesterone, pessaries, or surgical cerclage [1]. Minimally invasive approaches provide several advantages over laparotomy, including decreased blood loss, lower post-operative pain, shorter hospital stay and faster recovery while achieving comparable or improved obstetric outcomes [2,3]. Robot-assisted transabdominal cerclage (RA-TAC) is gaining popularity due to the enhanced three-dimensional visualization, improved dexterity and precision in performing fine dissection and knot-tying [4]. This video article demonstrates our RA-TAC technique and setup in a complex patient using the Hugo™ RAS system (Medtronic, Minneapolis, MN, USA) [5].

Setting: Academic Hospital, IRCCS Policlinico di S. Orsola Bologna, Italy PARTICIPANTS: A 40-year-old woman, BMI 36 kg/m^2, with an unfavorable obstetric history and a strong desire for further pregnancy.

Intervention: All possible therapeutic strategies and related complications have been discussed with the patient. Considering her strong desire for pregnancy, her surgical and obstetric history- including prior preterm deliveries despite vaginal cerclage (2020-2021)- and her BMI, a preconceptional RA-TAC was planned. A "straight" port placement in a "compact" docking configuration was installed. Surgery was performed under general anesthesia in 49 minutes. There were no intraoperative or postoperative complications. After 15 months, the patient successfully delivered a healthy 2896 g male infant via elective cesarean section at 36+6 weeks, with no need for perinatal care; the cerclage was removed and bilateral salpingectomy was performed.

Conclusions: Robotic-assisted surgery represents a feasible option for transabdominal cerclage, particularly in patients with obesity or intra-abdominal adhesions. Surgeon ergonomics, three-dimensional visualization, unrestricted range of motion, improved tremor control are key-advantages in procedures demanding maximal precision. While current literature lacks strong evidence demonstrating superiority of robotic-assisted over laparoscopic cerclage, this video illustrates technique, feasibility and potential benefits of RA-TAC.

目的:宫颈功能不全是指在没有分娩的情况下,宫颈不能保留妊娠,是早产和死产的主要原因。治疗选择包括期待治疗、黄体酮、子宫托或手术环扎术。微创入路与剖腹手术相比有几个优势,包括减少出血量、术后疼痛更小、住院时间更短、恢复更快,同时达到类似或改善的产科结果[2,3]。机器人辅助的经腹环扎术(RA-TAC)越来越受欢迎,因为它增强了三维可视化,提高了灵巧性和精确性,可以进行精细的解剖和打结。这篇视频文章演示了我们的RA-TAC技术,并在一个复杂的患者中使用Hugo™RAS系统(Medtronic, Minneapolis, MN, USA)[5]。地点:学术医院,IRCCS Policlinico di S. Orsola Bologna,意大利参与者:40岁女性,BMI 36 kg/m^2,有不良的产科史,强烈的妊娠愿望。干预:与患者讨论所有可能的治疗策略及相关并发症。考虑到她强烈的怀孕愿望,她的手术和产科病史——包括阴道结扎术后早产(2020-2021年)——以及她的身体质量指数,我们计划进行孕前RA-TAC。在“紧凑”对接配置中安装了一个“直”端口。全麻下手术49分钟完成。无术中、术后并发症。15个月后,患者在36+6周时通过选择性剖宫产成功产下一名健康的2896 g男婴,无需围产期护理;切除环扣并行双侧输卵管切除术。结论:机器人辅助手术是经腹环扎术的可行选择,特别是对于肥胖或腹内粘连的患者。外科医生人体工程学、三维可视化、不受限制的运动范围、改进的震颤控制是要求最高精度的手术的关键优势。虽然目前的文献缺乏强有力的证据证明机器人辅助环切术优于腹腔镜环切术,但本视频展示了RA-TAC的技术、可行性和潜在益处。
{"title":"Robot-assisted transabdominal cervical cerclage with the Hugo RAS system: surgical technique and perioperative outcomes in a high-risk obstetric case.","authors":"Ferla Stefano, DE Gobbi Valeria, Seracchioli Renato, Raimondo Diego","doi":"10.1016/j.jmig.2026.01.050","DOIUrl":"https://doi.org/10.1016/j.jmig.2026.01.050","url":null,"abstract":"<p><strong>Objective: </strong>Cervical insufficiency, the inability of uterine cervix to retain pregnancy in absence of labor, is a major cause of preterm births and stillbirths. Therapeutic options include expectant management, progesterone, pessaries, or surgical cerclage [1]. Minimally invasive approaches provide several advantages over laparotomy, including decreased blood loss, lower post-operative pain, shorter hospital stay and faster recovery while achieving comparable or improved obstetric outcomes [2,3]. Robot-assisted transabdominal cerclage (RA-TAC) is gaining popularity due to the enhanced three-dimensional visualization, improved dexterity and precision in performing fine dissection and knot-tying [4]. This video article demonstrates our RA-TAC technique and setup in a complex patient using the Hugo™ RAS system (Medtronic, Minneapolis, MN, USA) [5].</p><p><strong>Setting: </strong>Academic Hospital, IRCCS Policlinico di S. Orsola Bologna, Italy PARTICIPANTS: A 40-year-old woman, BMI 36 kg/m^2, with an unfavorable obstetric history and a strong desire for further pregnancy.</p><p><strong>Intervention: </strong>All possible therapeutic strategies and related complications have been discussed with the patient. Considering her strong desire for pregnancy, her surgical and obstetric history- including prior preterm deliveries despite vaginal cerclage (2020-2021)- and her BMI, a preconceptional RA-TAC was planned. A \"straight\" port placement in a \"compact\" docking configuration was installed. Surgery was performed under general anesthesia in 49 minutes. There were no intraoperative or postoperative complications. After 15 months, the patient successfully delivered a healthy 2896 g male infant via elective cesarean section at 36+6 weeks, with no need for perinatal care; the cerclage was removed and bilateral salpingectomy was performed.</p><p><strong>Conclusions: </strong>Robotic-assisted surgery represents a feasible option for transabdominal cerclage, particularly in patients with obesity or intra-abdominal adhesions. Surgeon ergonomics, three-dimensional visualization, unrestricted range of motion, improved tremor control are key-advantages in procedures demanding maximal precision. While current literature lacks strong evidence demonstrating superiority of robotic-assisted over laparoscopic cerclage, this video illustrates technique, feasibility and potential benefits of RA-TAC.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146105917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Journal of minimally invasive gynecology
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