Journal of minimally invasive gynecology最新文献

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Race, Ethnicity, and Sex Representation Trends Among Minimally Invasive Gynecologic Surgery Fellowship Trainees and Graduates 微创妇科手术培训生和毕业生的种族、民族和性别代表性趋势。

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Journal of minimally invasive gynecology

Pub Date : 2024-09-01 DOI: 10.1016/j.jmig.2024.05.015

Study Objective

To study the race, ethnicity, and sex representation and annual trends of AAGL FMIGS fellows and graduates.

Design

A retrospective cross-sectional study.

Setting

AAMC databases were queried for demographic information between 2011 and 2023.

Patients/subjects

AAGL FMIGS fellows and graduates.

Interventions

N/A

Measurements and Main Results

Descriptive statistical analysis and the actual-to-expected (AE) ratio of each race, ethnicity, and sex were performed. AE ratio was calculated by dividing the 13-year average actual percentage of FMIGS trainees and graduates by the expected percentage based demographics of OBGYN residents and the US general population.

477 fellows graduated or were in training between 2011 and 2023; race and ethnicity information was obtained for 347 (72.7%) individuals, and sex information was available for 409 (85.7%). Representation of females ranged from 66.7% in 2017 to 93.3% in 2022. There was a significantly increasing slope for the representation of females (+1.3% per year; 95% CI 0.00–0.03; p = .027). Compared to their distribution among US OBGYN residents, White fellows’ representation was lower [AE ratio, 95% CI 0.60 (0.44–0.81)] and of Asian fellows was higher [AE ratio, 95% CI 2.17 (1.47–3.21)]. Female fellows’ representation was lower than expected [AE ratio, 95% CI 0.68 (0.48–0.96)] compared to their distribution among US OBGYN residents.

Compared to the general US population, White fellows [AE ratio, 95% CI 0.65 (0.48–0.87)] and Hispanic fellows [AE ratio, 95% CI 0.53 (0.34–0.83)] representation was lower. Asian fellows’ representation was higher compared to the general US population [AE ratio, 95% CI 5.87 (3.48–9.88)].

Conclusion

White and Hispanic fellows’ representation was lower than expected, while Asian fellows’ representation was higher in AAGL-accredited FMIGS programs. Female representation increased throughout the years, but overall, female fellows’ representation was lower than expected compared to their distribution among OBGYN residents. These findings may help develop equitable recruitment strategies for FMIGS programs and reduce health disparities within complex gynecology.

研究目的：研究 AAGL FMIGS 研究员和毕业生的种族、民族和性别代表性及年度趋势：设计：回顾性横断面研究：患者/受试者：AAGL FMIGS 研究员和毕业生：患者/受试者：AAGL FMIGS 研究员和毕业生：不适用测量和主要结果：进行了描述性统计分析，并得出了每个种族、民族和性别的实际与预期（AE）比率。AE 比率的计算方法是：根据妇产科住院医师和美国总人口的人口统计数据，用 13 年 FMIGS 受训人员和毕业生的平均实际百分比除以预期百分比。477 名研究员在 2011 年至 2023 年期间毕业或接受培训；其中 347 人（72.7%）获得了种族和民族信息，409 人（85.7%）获得了性别信息。女性比例从 2017 年的 66.7% 到 2022 年的 93.3%。女性代表的斜率明显增加（每年+1.3%；95% CI 0.00-0.03；P=0.027）。与他们在美国妇产科住院医师中的分布相比，白人研究员的比例较低[AE 比值，95% CI 0.60 (0.44-0.81)]，而亚裔研究员的比例较高[AE 比值，95% CI 2.17 (1.47-3.21)]。女性研究员的比例低于预期[AE 比值，95% CI 0.68 (0.48-0.96)]，低于她们在美国妇产科住院医生中的分布。与美国总人口相比，白人研究员[AE 比值，95% CI 0.65 (0.48-0.87)]和西班牙裔研究员[AE 比值，95% CI 0.53 (0.34-0.83)]的代表性较低。与美国总人口相比，亚裔研究员的比例更高[AE 比值，95% CI 5.87 (3.48-9.88)]：结论：在AAGL认证的FMIGS项目中，白人和西班牙裔研究员的比例低于预期，而亚裔研究员的比例较高。女性研究员的比例逐年增加，但总体而言，与妇产科住院医师的分布相比，女性研究员的比例低于预期。这些发现可能有助于为妇产科全科医生培训项目制定公平的招聘策略，并减少复杂妇科中的健康差异。

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引用次数: 0

Assessing Feasibility and Outcomes of Robotic Single Port Transvaginal NOTES(RSP-vNOTES) Hysterectomy: A Case Series. 评估机器人单孔经阴道NOTES（RSP-vNOTES）子宫切除术的可行性和结果：病例系列。

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Journal of minimally invasive gynecology

Pub Date : 2024-08-31 DOI: 10.1016/j.jmig.2024.08.018

Xiaoming Guan, Qiannan Yang, Daniel Y Lovell

Objective: To demonstrate the feasibility and short-term outcomes of Robot-Assisted Single Port vaginal NOTES (RSP-vNOTES) for total hysterectomy, with or without endometriosis resection for all stages.

Design: Retrospective case series.

Setting: Single academic tertiary care hospital in Houston, Texas, USA.

Participants: 28 adult women with chronic pelvic pain who underwent RSP-vNOTES hysterectomy, with or without endometriosis resection.

Interventions: Hysterectomy with or without excision of endometriosis via single-port robot-assisted vNOTES platform (Intuitive Da Vinci SP Platform).

Main results: 28 patients with a mean age of 40.1 years (range 24.0-54.0 years), mean BMI 28.5 kg/m² (range 19.5-48.4 kg/m²), underwent RSP-vNOTES from November 11, 2023 to May 7, 2024. Five (17.9%) patients underwent solely a hysterectomy, while 23 (82.1%) patients underwent additional endometriosis resection; 28.6% with stage I, 25.0% stage II, 7.1% stage III, and 21.4% with stage IV. Mean total operative time was 188.7 minutes (range 135.0-427.0 minutes), with robot dock time of 2.9 minutes (range 1.0-10.0 minutes), robot console time of 97.3 minutes (range 51.0-221.0 minutes), and hysterectomy time of 55.3 minutes (range 24.0-170.0 minutes). Estimated blood loss averaged 32.1 mL (range 25.0-50.0mL). One case required a mini-laparotomy as the irregularly-shaped 1668g fibroid uterus was unable to be removed vaginally. Complications included one case of vaginal cuff cellulitis and one case of urinary tract infection.

Conclusion: Our findings indicate that RSP-vNOTES, a novel single-port surgical approach, presents a promising alternative surgical platform in vaginal surgeries.

目的证明机器人辅助单孔阴道NOTES（RSP-vNOTES）用于全子宫切除术的可行性和短期疗效，无论是否进行各期子宫内膜异位症切除术：设计：回顾性病例系列：参与者：28 名患有慢性盆腔疼痛的成年女性，她们接受了 RSP-vNOTES 子宫切除术，无论是否进行了子宫内膜异位症切除术：主要结果：28名患者，平均年龄40.1岁（范围24.0-54.0岁），平均体重指数28.5 kg/m2（范围19.5-48.4 kg/m2），于2023年11月11日至2024年5月7日接受了RSP-vNOTES。5例（17.9%）患者仅接受了子宫切除术，23例（82.1%）患者接受了额外的子宫内膜异位症切除术；其中28.6%为I期，25.0%为II期，7.1%为III期，21.4%为IV期。平均手术总时间为188.7分钟（范围135.0-427.0分钟），其中机器人停靠时间为2.9分钟（范围1.0-10.0分钟），机器人控制台时间为97.3分钟（范围51.0-221.0分钟），子宫切除时间为55.3分钟（范围24.0-170.0分钟）。估计平均失血量为 32.1 毫升（范围为 25.0-50.0 毫升）。有一个病例由于形状不规则的1668克肌瘤子宫无法经阴道切除，因此需要进行小型开腹手术。并发症包括一例阴道袖口蜂窝织炎和一例尿路感染：我们的研究结果表明，RSP-vNOTES 是一种新型的单孔手术方法，为阴道手术提供了一个前景广阔的替代手术平台。

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引用次数: 0

A National Database Study on Racial Disparities in Route of Hysterectomy with a Surrogate Control for Uterine Size: A Proposed Quality Metric for Benign Indications. 以子宫大小为替代对照的子宫切除术路径种族差异国家数据库研究：良性适应症的质量指标建议。

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Journal of minimally invasive gynecology

Pub Date : 2024-08-30 DOI: 10.1016/j.jmig.2024.07.006

Leslie K Palacios-Helgeson, Ashish Premkumar, Jacqueline M K Wong, Claire H Gould, Megan A Cahn, Blake C Osmundsen

Study objective: To investigate the association between race and route of hysterectomy among patients undergoing hysterectomy for abnormal uterine bleeding (AUB) in the absence of uterine myoma disease and excluding malignancy.

Design: A cross-sectional cohort study utilizing the Healthcare Cost and Utilization Project Nationwide Inpatient Sample and National Ambulatory Surgical databases to compare abdominal to minimally invasive routes of hysterectomy.

Setting: Hospitals and hospital-affiliated ambulatory surgical centers participating in the Healthcare Cost and Utilization Project in 2019.

Patients: A total of 75 838 patients who had undergone hysterectomy for AUB, excluding uterine myoma and malignancy.

Interventions: n/a MEASUREMENTS AND MAIN RESULTS: Of the 75 838 hysterectomies performed for AUB in the absence of uterine myomas and malignancy, 10.1% were performed abdominally and 89.9% minimally invasively. After adjusting for confounders, Black patients were 38% more likely to undergo abdominal hysterectomy compared to White patients (OR 1.38, CI 1.12-1.70 p = .002). Black race, thus, is independently associated with open surgery.

Conclusion: Despite excluding uterine myomas as a risk factor for an abdominal route of hysterectomy, Black race remained an independent predictor for abdominal versus minimally invasive hysterectomy, and Black patients were found to undergo a disproportionately higher rate of abdominal hysterectomy compared to White patients.

研究目的调查在没有子宫肌瘤疾病且排除恶性肿瘤的情况下，因异常子宫出血而接受子宫切除术的患者中，种族与子宫切除术路径之间的关联：设计：一项横断面队列研究，利用医疗成本与利用项目全国住院病人样本和全国非住院手术数据库，比较腹部子宫切除术和微创子宫切除术的途径：参与2019年医疗成本与利用项目的医院和医院附属门诊手术中心：干预措施：不适用测量和主要结果：在75838例因子宫异常出血（不包括子宫肌瘤和恶性肿瘤）而进行的子宫切除术中，10.1%是腹腔手术，89.9%是微创手术。在对混杂因素进行调整后，黑人患者接受腹腔子宫切除术的几率比白人患者高出38%（OR 1.38，CI 1.12-1.70 p=0.002）。因此，黑人种族与开腹手术有独立关联：结论：尽管排除了子宫肌瘤作为腹式子宫切除术的风险因素，但黑人种族仍是腹式子宫切除术与微创子宫切除术的独立预测因素，黑人患者接受腹式子宫切除术的比例高于白人患者。

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引用次数: 0

A case control study of vNOTES vs conventional laparoscopic salpingectomy for ectopic pregnancy. vNOTES与传统腹腔镜输卵管切除术治疗宫外孕的病例对照研究。

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Journal of minimally invasive gynecology

Pub Date : 2024-08-30 DOI: 10.1016/j.jmig.2024.08.016

Wai Yoong, Joachim Ho, Vanessa Mathieu, Sarah Wiley, Wasim Lodhi, Schahrazed Rouabhi

Study objective: While the laparoscopic approach is the surgical treatment of choice for ectopic pregnancy, vNOTES is emerging as an alternative route with its good optical visibility and avoidance of abdominal incisions. The authors compare demographics and outcome data of vNOTES vs conventional laparoscopic salpingectomy for the surgical management of ectopic pregnancy.

Design: Case control study SETTING: A London University hospital PATIENTS: Women with ectopic pregnancy unsuitable for medical management who underwent surgical management INTERVENTION: 25 cases of vNOTES vs 25 conventional laparoscopic salpingectomy MEASUREMENTS AND MAIN RESULTS: The mean patient age (29.7±53 vs 31.4±6.7 days), parity (1.2±1.1 vs 1.6±2.1), BMI (26.7±5.3 vs 27.2±5.4 kg/m³), gestation age (8.44±2.1 vs 7.3±1.7 weeks) and βhCG levels (3725.4±3674.8 vs 4376.5±6493.4 IU/litre) were comparable (p>0.05, t test) between patients having vNOTES vs conventional laparoscopic salpingectomy. While estimated blood loss was similar (218.2±491.7 vs 173.5±138.7 mls)(p>0.001), vNOTES patients had statistically shorter duration of surgery (35.8±14.4 vs 75.8±19.7 mins)(p<0.001, t test) and length of stay (median: 11.5 vs 19.7 hours)(U=72, p<0.05, Mann-Whitney U test). Less patients in the vNOTES group required postoperative opioids (9% vs 25%) and median Visual Analogue Score (/10) for pain at 24 hours was significantly lower (2.0 vs 4.0)(U=75, p<0.05, Mann-Whitney U test). Patients from the vNOTES group were able to return to normal daily activity 11.3 days quicker (5.8±4.3 vs 17.1±8.2 days)(p<0.05, t test). vNOTES cases cost approximately USD150 more due to the price of the commercial kits but this is offset by reduced intraoperative time, length of stay and need for postprocedure analgesia.

Conclusion: Patients undergoing vNOTES have shorter intraoperative times and length of stays, less postoperative pain and more rapid recovery, which help mitigate higher cost incurred by commercial kits. While the vNOTES approach for ectopic pregnancy appears safe and efficacious, more robust data from larger randomised studies are needed.

研究目的：虽然腹腔镜方法是治疗宫外孕的首选手术方法，但vNOTES凭借其良好的光学可视性和避免腹部切口的优势，正在成为一种替代方法。作者比较了 vNOTES 与传统腹腔镜输卵管切除术在异位妊娠手术治疗中的人口统计学和结果数据：设计：病例对照研究患者：患有宫外孕且不适合接受腹腔镜手术的女性：测量和主要结果：患者平均年龄（29.7±53 天 vs 31.4±6.7 天）、胎次（1.2±1.1 vs 1.6±2.1）、体重指数（26.7±5.3 vs 27.2±5.4kg/m3）、孕龄（8.44±2.1 vs 7.3±1.7周）和βhCG水平（3725.4±3674.8 vs 4376.5±6493.4IU/升）在vNOTES与传统腹腔镜输卵管切除术患者之间具有可比性（p>0.05，t检验）。虽然估计失血量相似（218.2±491.7 vs 173.5±138.7毫升）（P>0.001），但vNOTES患者的手术时间（35.8±14.4 vs 75.8±19.7分钟）在统计学上更短（P结论：接受vNOTES治疗的患者术中时间和住院时间更短，术后疼痛更轻，恢复更快，这有助于降低商业套件所产生的较高成本。虽然vNOTES方法治疗宫外孕似乎安全有效，但还需要更大规模的随机研究提供更可靠的数据。

{"title":"A case control study of vNOTES vs conventional laparoscopic salpingectomy for ectopic pregnancy.","authors":"Wai Yoong, Joachim Ho, Vanessa Mathieu, Sarah Wiley, Wasim Lodhi, Schahrazed Rouabhi","doi":"10.1016/j.jmig.2024.08.016","DOIUrl":"https://doi.org/10.1016/j.jmig.2024.08.016","url":null,"abstract":"<p><strong>Study objective: </strong>While the laparoscopic approach is the surgical treatment of choice for ectopic pregnancy, vNOTES is emerging as an alternative route with its good optical visibility and avoidance of abdominal incisions. The authors compare demographics and outcome data of vNOTES vs conventional laparoscopic salpingectomy for the surgical management of ectopic pregnancy.</p><p><strong>Design: </strong>Case control study SETTING: A London University hospital PATIENTS: Women with ectopic pregnancy unsuitable for medical management who underwent surgical management INTERVENTION: 25 cases of vNOTES vs 25 conventional laparoscopic salpingectomy MEASUREMENTS AND MAIN RESULTS: The mean patient age (29.7±53 vs 31.4±6.7 days), parity (1.2±1.1 vs 1.6±2.1), BMI (26.7±5.3 vs 27.2±5.4 kg/m<sup>3</sup>), gestation age (8.44±2.1 vs 7.3±1.7 weeks) and βhCG levels (3725.4±3674.8 vs 4376.5±6493.4 IU/litre) were comparable (p>0.05, t test) between patients having vNOTES vs conventional laparoscopic salpingectomy. While estimated blood loss was similar (218.2±491.7 vs 173.5±138.7 mls)(p>0.001), vNOTES patients had statistically shorter duration of surgery (35.8±14.4 vs 75.8±19.7 mins)(p<0.001, t test) and length of stay (median: 11.5 vs 19.7 hours)(U=72, p<0.05, Mann-Whitney U test). Less patients in the vNOTES group required postoperative opioids (9% vs 25%) and median Visual Analogue Score (/10) for pain at 24 hours was significantly lower (2.0 vs 4.0)(U=75, p<0.05, Mann-Whitney U test). Patients from the vNOTES group were able to return to normal daily activity 11.3 days quicker (5.8±4.3 vs 17.1±8.2 days)(p<0.05, t test). vNOTES cases cost approximately USD150 more due to the price of the commercial kits but this is offset by reduced intraoperative time, length of stay and need for postprocedure analgesia.</p><p><strong>Conclusion: </strong>Patients undergoing vNOTES have shorter intraoperative times and length of stays, less postoperative pain and more rapid recovery, which help mitigate higher cost incurred by commercial kits. While the vNOTES approach for ectopic pregnancy appears safe and efficacious, more robust data from larger randomised studies are needed.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142108267","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

Near-Infrared Imaging for Better Identifying the Cleavage Plane Between the Uterine Fibroid and its Pseudocapsule. 通过近红外成像更好地识别子宫肌瘤与假包膜之间的裂隙面

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Journal of minimally invasive gynecology

Pub Date : 2024-08-29 DOI: 10.1016/j.jmig.2024.08.012

Antoine Naem, Antonio Simone Laganà, Zaki Sleiman

引用次数: 0

Robotic buccal mucosa grafting for distal ureter stricture related to deep endometriosis. 机器人口腔黏膜移植术治疗与深部子宫内膜异位症有关的输尿管远端狭窄。

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Journal of minimally invasive gynecology

Pub Date : 2024-08-29 DOI: 10.1016/j.jmig.2024.08.014

Romeo Micu, Dan Boitor-Borza, Nicolae Crisan

引用次数: 0

Minimally Invasive Treatment of Abdominal Pregnancy Implanted on the Ileocecal Junction. 微创治疗植入回盲部交界处的腹腔妊娠。

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Journal of minimally invasive gynecology

Pub Date : 2024-08-28 DOI: 10.1016/j.jmig.2024.08.013

Michael T Solotke, Anum Naseem, Jenna Marcus, Linda C Yang

We report a case of a 32-year-old gravida 1 para 0 with a copper intrauterine device in place and a newly diagnosed pregnancy at 5 weeks gestation. Serum human chorionic gonadotropin (hCG) was 23,940 mIU/mL and transvaginal ultrasound demonstrated a presumed right adnexal ectopic pregnancy with fetal cardiac activity. Upon laparoscopic entry, a 3 cm vascular mass consistent with ectopic pregnancy was noted densely adherent to the cecum, adjacent to the ileocecal junction. Given difficult tissue plane dissection and bleeding, a 4 cm mini-laparotomy was made and the mass was bluntly dissected away from the bowel implantation site. The bowel was oversewn. The patient's postoperative course was uncomplicated.

我们报告了一例 32 岁的 1 型 0 号孕妇，她在妊娠 5 周时放置了铜宫内节育器并被诊断为新妊娠。血清人绒毛膜促性腺激素（hCG）为 23,940 mIU/mL，经阴道超声显示推测为右侧附件异位妊娠，胎儿有心脏活动。腹腔镜入路时，发现一个3厘米长的血管肿块与异位妊娠一致，密集地附着在盲肠上，紧邻回盲交界处。考虑到组织平面剥离困难和出血情况，医生进行了一个 4 厘米的小切口，钝性剥离了肿块，使其远离肠道植入部位。肠管被重新缝合。患者术后恢复顺利。

引用次数: 0

The thoracic surgeon: "The icing on the cake" in the treatment of epithelial ovarian cancer. 胸外科医生：治疗上皮性卵巢癌的 "锦上添花"。

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Journal of minimally invasive gynecology

Pub Date : 2024-08-28 DOI: 10.1016/j.jmig.2024.08.015

Vincenzo Dario Mandato, Massimiliano Paci, Lorenzo Aguzzoli

In patients with ovarian cancer, VATS should be used to exclude or confirm the presence of supradiaphragmatic disease and possibly remove it completely. The simultaneous use of laparoscopy and VATS allows for an accurate selection of patients to be sent, in a very short time, to primary surgery or neoadjuvant chemotherapy. Therefore the thoracic surgeon should be part of the multidisciplinary team in every ovarian cancer center.

对于卵巢癌患者，应使用 VATS 来排除或确认是否存在膈上疾病，并在可能的情况下将其完全切除。同时使用腹腔镜和 VATS 可以在很短的时间内对患者进行准确的选择，以便送去进行初级手术或新辅助化疗。因此，胸外科医生应成为每个卵巢癌中心多学科团队的一员。

引用次数: 0

Perforated intrauterine device in the abdomen: leave or retrieve? 腹部宫内节育器穿孔：留下还是取出？

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Journal of minimally invasive gynecology

Pub Date : 2024-08-24 DOI: 10.1016/j.jmig.2024.07.025

Erin Seto, Emily N Liu, Nigel Pereira

引用次数: 0

Ruptured Heterotopic Pregnancy within suspected endometriosis lesion. 疑似子宫内膜异位症病灶内的异位妊娠破裂。

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Journal of minimally invasive gynecology

Pub Date : 2024-08-23 DOI: 10.1016/j.jmig.2024.08.011

Zhao Tian, Linru Fu, Zhijing Sun

引用次数: 0

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