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Journal of minimally invasive gynecology最新文献

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International Societies 国际社会
IF 3.3 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2026-01-24 DOI: 10.1016/S1553-4650(26)00005-1
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引用次数: 0
Why Are We Still Talking About Endometriosis? A Call for Structural Change in Complex Benign Gynecologic Care 为什么我们还在谈论子宫内膜异位症?对复杂良性妇科护理结构改变的呼吁
IF 3.3 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2026-01-24 DOI: 10.1016/j.jmig.2026.01.001
Mireille Truong MD
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引用次数: 0
Optimal Laparoscopic Surgical Technique for Preserving Fertility and Ovarian Reserve in Patients with Endometrioma: A Systematic Review and Bayesian Network Meta-Analysis of Randomized Controlled Trials. 子宫内膜瘤患者保留生育能力和卵巢储备的最佳腹腔镜手术技术:随机对照试验的系统评价和贝叶斯网络荟萃分析。
IF 3.3 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2026-01-24 DOI: 10.1016/j.jmig.2026.01.039
Katherine Ann Reimão Miller, Ana Clara Pimenta Servidoni, Priscila Luiza Dos Santos, Hanna Surmann, Davi Barbosa Pereira da Silva, Marina Paula Andres, Luiza Gama Coelho Riccio, Mauricio Simoes Abrao

Objective: This systematic review and Bayesian network meta-analysis aimed to evaluate the comparative efficacy and safety of various laparoscopic techniques for endometrioma management, focusing on their impact on fertility outcomes and ovarian reserve preservation.

Data sources: A systematic search was conducted in PubMed/MEDLINE, Embase, Cochrane Library, and Scopus, following PRISMA 2020 guidelines.

Methods of study selection: This systematic review and bayesian network meta-analysis included only randomized controlled trials (RCTs), encompassing women between 18 and 45 years, undergoing primary laparoscopic surgery for unilateral or bilateral endometriomas. Eligible interventions included cystectomy with bipolar coagulation, cystectomy alone, cystectomy with suturing, fenestration with bipolar coagulation, drainage with CO₂ laser vaporization, cystectomy with hemostatic sealant, cystectomy with ultrasonic scalpel, and vasopressin-assisted cystectomy with bipolar coagulation. Eleven RCTs were included (956 participants).

Tabulation, integration, and results: Statistical analyses integrated Bayesian random-effects to compute pooled risk ratios (RR), and mean differences (MD), with 95% credible intervals (Crls). SUCRA rankings were used to rank interventions. For cumulative pregnancy rate within 12 months (Δ AMH at 3, 6 and 12 months), no statistically significant differences were observed across treatment comparisons. However, probabilistic ranking consistently indicated cystectomy with ultrasonic scalpel as the most favorable technique at 6 (SUCRA=0.711) and 12 months (SUCRA=0.693), while cystectomy with suturing ranked the least favorable. Regarding reproductive outcomes, drainage with CO₂ laser vaporization showed the most favorable ranking profile for cumulative clinical pregnancy within 12 months. Importantly, the overall ranking probabilities for fertility and ovarian reserve were not supported by statistically significant differences among techniques.

Conclusion: This meta-analysis evaluated different laparoscopic techniques for endometrioma management. While no technique demonstrated statistically significant superiority across all outcomes, the probabilistic rankings identified cystectomy with ultrasonic scalpel as a more favorable approach for ovarian reserve preservation and drainage with CO₂ laser vaporization for pregnancy achievement. These findings highlight the need for careful, individualized patient counseling enabling tailored surgical decisions aligned with individual reproductive goals. Future direct head-to-head trials with standardized long-term follow-up are warranted to definitively guide clinical practice.

目的:本系统综述和贝叶斯网络荟萃分析旨在评估各种腹腔镜技术治疗子宫内膜异位瘤的比较疗效和安全性,重点关注它们对生育结局和卵巢储备保存的影响。数据来源:系统检索PubMed/MEDLINE、Embase、Cochrane Library和Scopus,遵循PRISMA 2020指南。研究方法选择:本系统综述和贝叶斯网络荟萃分析仅纳入随机对照试验(rct),纳入18至45岁的女性,接受单侧或双侧子宫内膜瘤的腹腔镜手术。符合条件的干预措施包括膀胱切除术合并双极凝固、单独膀胱切除术、缝合膀胱切除术、开窗双极凝固、co2激光汽化引流、止血密封膀胱切除术、超声手术刀膀胱切除术、加压素辅助双极凝固膀胱切除术。纳入11项随机对照试验(956名受试者)。制表、整合和结果:统计分析整合了贝叶斯随机效应,以95%可信区间(Crls)计算汇总风险比(RR)和平均差异(MD)。采用SUCRA排名对干预措施进行排名。对于12个月内的累积妊娠率(Δ AMH在3,6和12个月),各治疗比较无统计学差异。然而,概率排序一致显示超声刀膀胱切除术在6个月(SUCRA=0.711)和12个月(SUCRA=0.693)是最有利的技术,而缝合膀胱切除术是最不利的技术。在生殖结局方面,在12个月的累积临床妊娠中,CO₂激光汽化引流最有利。重要的是,生育能力和卵巢储备的总体排名概率在技术之间没有统计学上的显著差异。结论:本荟萃分析评估了不同腹腔镜治疗子宫内膜异位瘤的技术。虽然没有一种技术在所有结果中表现出统计学上的显著优势,但概率排名表明超声刀膀胱切除术是更有利的卵巢储备保存和引流方法,CO₂激光汽化可以实现妊娠。这些发现强调了对患者进行仔细、个性化的咨询的必要性,从而使手术决定与个人生殖目标保持一致。未来有必要进行标准化长期随访的直接头对头试验,以明确指导临床实践。
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引用次数: 0
Extreme intrauterine surgery: multiple-step hysteroscopic approach to treat a 4 cm fibroid in a complete uterine septum with cervical septum. 极端宫内手术:多步骤宫腔镜入路治疗完整子宫间隔伴宫颈间隔的4cm肌瘤。
IF 3.3 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2026-01-24 DOI: 10.1016/j.jmig.2026.01.047
Ursula Catena, Alice Poli, Eleonora La Fera, Francesco Fanfani

Objective: To describe a multiple-steps hysteroscopic approach to restore normal uterine anatomy in a patient presenting with single cervix, partial cervical septum, complete uterine septum, and 4 cm intraseptal fibroid. Uterine septum is the most common congenital anomaly of the female genital tract1. Its association with septate cervix is rare2. In exceptional cases, a fibroid may be found within the uterine septum. Published video demonstrations of intraseptal fibroid management are limited.

Setting: The procedures were performed at the Digital Hysteroscopic Clinic CLASS-Hysteroscopy of Fondazione Policlinico Gemelli-IRCCS in Rome, Italy.

Participants: A 37-year-old infertile woman with cervical septum and complete uterine septum complicated by G2 intraseptal fibroid3 protruding into the left uterine hemi-cavity. A diagnostic approach, combining 2D/3D transvaginal ultrasound (TVUS) and office hysteroscopy, followed by magnetic resonance imaging prior to surgery were performed4. IRB approval was obtained.

Interventions: A three-steps hysteroscopic approach under anesthesia with laryngeal mask was performed, according to an ambulatory model of care5. The first step involved the incision of the cervical septum and partial incision of the uterine septum until the fibroid plane, using the Collins loop of a 15-Fr bipolar mini-resectoscope, followed by the first step of myomectomy with a 90°-angled-loop of a 26-Fr bipolar resectoscope. The second step was performed one month later to complete the myomectomy. The third procedure was carried out one month after the second step, to remove the uterine septum using a 15-Fr bipolar mini-resectoscope. No complications occurred. The patient was discharged three hours after each procedure. Post-operative hysteroscopic control revealed a normal cervix and a normally shaped uterine cavity, with no intrauterine adhesions or residual fibroid tissue.

Conclusion: The integration of 2D/3D TVUS and hysteroscopy, in the hands of experienced and skilled surgeons, is essential for managing rare and complex cases, minimizing complications and ensuring optimal surgical outcomes.

目的:介绍单子宫颈、部分子隔、完全子隔和4厘米室间隔肌瘤患者的多步骤宫腔镜下恢复正常子宫解剖的方法。子宫间隔是女性生殖道最常见的先天性异常。它与分隔宫颈的关联是罕见的2。在特殊情况下,子宫隔内可能会发现肌瘤。已发表的关于腹膜内肌瘤处理的视频演示有限。背景:手术在意大利罗马的gerelli - irccs基金会数字宫腔镜诊所-宫腔镜进行。对象:37岁不孕女性,宫颈间隔和完全子宫间隔合并G2室间隔内肌瘤3突出至左侧子宫半腔。诊断方法,结合二维/三维经阴道超声(TVUS)和办公室宫腔镜检查,然后在手术前进行磁共振成像。获得IRB批准。干预措施:根据护理的动态模型,在麻醉下使用喉罩进行三步宫腔镜检查。第一步使用Collins环的15-Fr双极微型切除镜切开宫颈间隔和部分子宫间隔直至肌瘤平面,随后第一步使用26-Fr双极90°角环切除子宫肌瘤。一个月后进行第二步,完成子宫肌瘤切除术。第三次手术在第二步后一个月进行,使用15-Fr双极微型切除镜切除子宫隔。无并发症发生。病人在每次手术后三小时出院。术后宫腔镜检查显示宫颈正常,宫腔形态正常,未见宫腔粘连及子宫肌瘤组织残留。结论:在经验丰富的熟练外科医生的指导下,将2D/3D电视超声与宫腔镜相结合,对于治疗罕见和复杂的病例,减少并发症和确保最佳手术效果至关重要。
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引用次数: 0
Board Of Directors-Ed Calendar 董事会编辑日历
IF 3.3 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2026-01-24 DOI: 10.1016/S1553-4650(26)00004-X
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引用次数: 0
TOC TOC
IF 3.3 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2026-01-24 DOI: 10.1016/S1553-4650(26)00007-5
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引用次数: 0
Laparoscopic Excision of Obturator Nerve Endometriosis: A Stepwise Approach. 腹腔镜下闭孔神经子宫内膜异位症切除术:渐进式方法。
IF 3.3 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2026-01-23 DOI: 10.1016/j.jmig.2026.01.041
Sanah Alani, Dong Bach Nguyen, Jessica Papillon Smith, Andrew Zakhari

Study objective: To demonstrate a reproducible approach to the laparoscopic excision of endometriosis involving the obturator nerve.

Design: Narrated surgical video.

Setting: Academic tertiary care hospital.

Participants: Case of a 30-year-old woman found on MRI to have a 1.6 cm endometriosis nodule involving the left obturator nerve, along with adenomyosis, rectovaginal and ureteric endometriosis. Due to symptoms refractory to medical management, a laparoscopy is performed to excise the obturator nerve lesion, in addition to a disc rectal excision and ureteral reimplantation.

Interventions: Laparoscopic excision of obturator nerve endometriosis.

Measurements and primary results: The surgical steps can be summarized in six steps: (1) abdominal survey; (2) sigmoid mobilization; (3) iliolumbar space(lateral) dissection; (4) pararectal space (medial) dissection; (5) obturator space (caudal) dissection; (6) nodule release and excision.

Conclusion: Excision of obturator nerve endometriosis by laparoscopy can be safely performed with a thorough knowledge of anatomy and a systematic dissection of pelvic spaces. MRI is essential for preoperative planning in these rare forms of deep infiltrating endometriosis.

研究目的:展示一种可重复的方法腹腔镜切除子宫内膜异位症累及闭孔神经。设计:有旁白的手术录像。单位:三级专科医院。参与者:30岁女性病例,MRI发现1.6 cm子宫内膜异位症结节累及左闭孔神经,同时伴有子宫腺肌症、直肠阴道和输尿管子宫内膜异位症。由于症状难以治疗,除了行直肠椎间盘切除和输尿管再植外,还行腹腔镜切除闭孔神经病变。干预措施:腹腔镜切除闭孔神经子宫内膜异位症。测量和初步结果:手术步骤可归纳为六个步骤:(1)腹部检查;(2)乙状结肠活动;(3)髂腰间隙(外侧)剥离;(4)直肠旁间隙(内侧)夹层;(5)闭孔间隙(尾侧)剥离;(6)结节释放和切除。结论:在充分了解解剖知识和系统解剖盆腔间隙的情况下,腹腔镜下切除闭孔神经子宫内膜异位症是安全的。MRI对这些罕见的深浸润性子宫内膜异位症的术前规划至关重要。
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引用次数: 0
Laparoscopic Removal of Migrated Intrauterine Device in the Presacral Space. 腹腔镜下去除骶前腔移位宫内节育器。
IF 3.3 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2026-01-23 DOI: 10.1016/j.jmig.2025.12.038
Nadin Alghanaim, Mark Magdy, Dean Conrad
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引用次数: 0
A Dual-Model Strategy for Pediatric Adnexal Torsion: Nomograms for Diagnosis and Necrosis Using Emerging Immune-Inflammatory Biomarkers. 儿童附件扭转的双模型策略:使用新出现的免疫炎症生物标志物诊断和坏死的形态图。
IF 3.3 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2026-01-23 DOI: 10.1016/j.jmig.2026.01.043
Yanran Zhang, Liang Ge, Xin Zhao, Jiaying Liu, Yuhan Jiang, Shuxuan Li, Shujian Zhang, Hui Zhang, Yuan Yang, Xiaoying Xie, Li Zhao, Yuerong Wang, Wen Yu, Jianghua Zhan

Objective: To develop and validate preoperative nomograms for predicting pediatric adnexal torsion (AT) and post-torsion adnexal necrosis using clinical, laboratory, and ultrasonographic parameters.

Design: Retrospective cohort study.

Setting: Single-center medical institution (Tianjin Children's Hospital).

Participants: A total of 186 girls (≤18 years) with suspected AT who underwent surgical exploration between March 2019 and January 2025.

Interventions: Patients were randomly divided into training (n=130) and test (n=56) cohorts. Candidate variables including demographic characteristics, symptoms, laboratory indices, and ultrasound findings were screened using least absolute shrinkage and selection operator (LASSO) regression. Multivariable logistic regression models were constructed to predict AT and, among confirmed AT cases, adnexal necrosis. Model performance was evaluated by area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis.

Results: Adnexal torsion was confirmed in 67 patients (36.0%), of whom 21 (31.3%) had pathological adnexal necrosis. For AT prediction, age, abdominal tenderness, systemic immune-inflammation index (SII), and the ultrasonographic whirlpool sign were identified as independent predictors and incorporated into a nomogram. This model demonstrated good discrimination (AUC 0.933 in the training cohort and 0.891 in the test cohort) with satisfactory calibration. Among patients with confirmed AT, pan-immune-inflammation value (PIV) and thrombin time (TT) independently predicted adnexal necrosis and were used to construct a separate necrosis nomogram, achieving an AUC of 0.811. Both models provided favorable net clinical benefit across clinically relevant threshold probabilities.

Conclusion: These nomograms provide a clinically accessible framework for preoperative risk stratification of pediatric AT and adnexal necrosis, leveraging routine clinical, laboratory, ultrasonographic, and emerging inflammatory indices.

目的:利用临床、实验室和超声参数,建立和验证术前形态图预测小儿附件扭转(AT)和扭转后附件坏死的方法。设计:回顾性队列研究。单位:单中心医疗机构(天津市儿童医院)。参与者:在2019年3月至2025年1月期间接受手术探查的186名疑似AT的女孩(≤18岁)。干预措施:患者随机分为训练组(n=130)和测试组(n=56)。候选变量包括人口统计学特征、症状、实验室指标和超声检查结果,使用最小绝对收缩和选择算子(LASSO)回归进行筛选。建立了多变量logistic回归模型来预测AT,并在确诊的AT病例中预测附件坏死。通过受试者工作特征曲线(AUC)下面积、校准曲线和决策曲线分析来评价模型的性能。结果:确诊附件扭转67例(36.0%),其中病理性附件坏死21例(31.3%)。对于AT的预测,年龄、腹部压痛、全身免疫炎症指数(SII)和超声漩涡征象被确定为独立的预测因素,并纳入nomogram。该模型具有良好的判别性(训练队列的AUC为0.933,测试队列的AUC为0.891),校正结果令人满意。在确诊的AT患者中,泛免疫炎症值(PIV)和凝血酶时间(TT)独立预测附件坏死,并用于构建单独的坏死nomogram, AUC为0.811。两种模型均在临床相关阈值概率上提供了良好的净临床效益。结论:利用常规的临床、实验室、超声检查和新出现的炎症指标,这些图为儿科AT和附件坏死的术前风险分层提供了一个临床可访问的框架。
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引用次数: 0
Investigation of Hand Pain With Laparoscopy Among Gynecologic Surgeons. 妇科外科医生腹腔镜下手部疼痛的调查。
IF 3.3 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2026-01-22 DOI: 10.1016/j.jmig.2026.01.040
Emily Wolverton, Bharti Garg, Erin T Carey, Jacqueline Mk Wong

Study objective: To investigate the areas of greatest hand pain among laparoscopic gynecologic surgeons and to analyze surgeon variables associated with discomfort.

Design: Secondary analysis of observational cohort survey data.

Setting: United States nationwide survey PATIENTS: Gynecologic surgeons were surveyed via email through the Society of Gynecologic Surgeons and a convenience sample of U.S. academic institutions.

Interventions: Surgeons reported demographic characteristics, presence of hand pain in specific locations, and use of laparoscopic advanced energy devices.

Measurements & main results: Of 190 participants, a majority (68.9%) reported discomfort attributed to laparoscopy; over half (56.8%) reported hand pain. Prevalence of pain in the thumb, forefinger, and wrist was greater among surgeons of female sex, glove size <7, and trainee status. After adjustment for glove size, residents had increased odds of pain in the thumb (aOR 4.18, CI 1.82-10.81), forefinger (aOR 4.16, CI 1.24-13.92) and wrist (aOR 4.47, CI 1.60-12.53) compared to attendings with >10 years of experience. Surgeons of glove size <7 had increased odds of pain in the thumb (aOR 2.23, CI 1.10-4.52), forefinger (aOR 3.03, CI 1.16-7.96), and wrist (aOR 2.53, CI 1.15-5.58) after adjustment for level of experience. Among LigaSure users, residents more often endorsed pain at each hand site and reported the LigaSure device as too large (71.4%) compared to fellows and attendings (p=0.012).

Conclusion: Hand pain is highly prevalent among gynecologic laparoscopists. Surgeons of smaller glove size had over two times and residents had over four times the odds of hand pain with laparoscopy. Prioritization of surgical ergonomics education among trainees and the development of ergonomic laparoscopic tools remains critical, as does research on surgeon real-time experiences to eliminate the self-selection bias inherent in survey-based research.

研究目的:调查腹腔镜妇科外科医生手痛最严重的部位,并分析与不适相关的外科变量。设计:对观察性队列调查数据进行二次分析。患者:通过妇科外科医生协会和美国学术机构的方便样本,通过电子邮件对妇科外科医生进行调查。干预措施:外科医生报告了人口统计学特征,特定部位手部疼痛的存在,以及腹腔镜先进能量装置的使用。测量和主要结果:在190名参与者中,大多数(68.9%)报告腹腔镜检查引起的不适;超过一半(56.8%)报告手痛。拇指、食指和手腕疼痛的患病率在女性外科医生中更高,手套尺寸为10年。结论:手痛在妇科腹腔镜医师中非常普遍。手套尺寸较小的外科医生在腹腔镜手术中手部疼痛的几率是普通居民的两倍多,而普通居民的手部疼痛几率是普通居民的四倍多。在受训者中优先进行手术人机工程学教育和开发人机工程学腹腔镜工具仍然至关重要,对外科医生实时经验的研究也至关重要,以消除基于调查的研究中固有的自我选择偏见。
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引用次数: 0
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Journal of minimally invasive gynecology
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