Pub Date : 2024-11-01DOI: 10.1016/j.jmig.2024.07.012
Chunyan Wang MM , Xingmei Yu MM , Chen Chen MM , Lubin Liu MD
{"title":"A Case of Lithopedion in a Postmenopausal Woman","authors":"Chunyan Wang MM , Xingmei Yu MM , Chen Chen MM , Lubin Liu MD","doi":"10.1016/j.jmig.2024.07.012","DOIUrl":"10.1016/j.jmig.2024.07.012","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"31 11","pages":"Pages 905-907"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141734378","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}
Pub Date : 2024-11-01DOI: 10.1016/j.jmig.2024.09.119
CR Mathias, N Dahiya
Study Objective
A video presentation of caesarean scar defect resection and repair using firefly technology and methylene blue dye.
Design
A 6 min video presentation with background regarding caesarean scar defects, pathogenesis, symptomology, case presentation, imaging and surgical video highlighting steps and key points for resection and repair.
Setting
Nepean Hospital, Sydney, NSW, Australia.
Patients or Participants
Single patient surgical video.
Interventions
Video highlighting surgical steps for caesarean scar defect repair using firefly technology and methylene blue dye.
Measurements and Main Results
Surgical steps for caesarean scar defect repair explained using additional aids like firefly technology and methylene blue dye.
Conclusion
Use of near-infrared fluorescence of the Robot Firefly system improves anatomical detail provided through hysteroscopic transillumination of Caesarean scar defects, hence conferring greater surgical safety and accuracy.
{"title":"Green to Identify, Blue for Integrity - Robot-Assisted Caesarean Scar Defect Resection and Repair","authors":"CR Mathias, N Dahiya","doi":"10.1016/j.jmig.2024.09.119","DOIUrl":"10.1016/j.jmig.2024.09.119","url":null,"abstract":"<div><h3>Study Objective</h3><div>A video presentation of caesarean scar defect resection and repair using firefly technology and methylene blue dye.</div></div><div><h3>Design</h3><div>A 6 min video presentation with background regarding caesarean scar defects, pathogenesis, symptomology, case presentation, imaging and surgical video highlighting steps and key points for resection and repair.</div></div><div><h3>Setting</h3><div>Nepean Hospital, Sydney, NSW, Australia.</div></div><div><h3>Patients or Participants</h3><div>Single patient surgical video.</div></div><div><h3>Interventions</h3><div>Video highlighting surgical steps for caesarean scar defect repair using firefly technology and methylene blue dye.</div></div><div><h3>Measurements and Main Results</h3><div>Surgical steps for caesarean scar defect repair explained using additional aids like firefly technology and methylene blue dye.</div></div><div><h3>Conclusion</h3><div>Use of near-infrared fluorescence of the Robot Firefly system improves anatomical detail provided through hysteroscopic transillumination of Caesarean scar defects, hence conferring greater surgical safety and accuracy.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"31 11","pages":"Page S28"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658075","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}
Pub Date : 2024-11-01DOI: 10.1016/j.jmig.2024.09.138
E Trieu, T King, G Bello, ME Shockley, LC Ramirez-Caban
Study Objective
To demonstrate surgical management of bladder endometriosis.
Design
Surgical Video.
Setting
Academic medical center.
Patients or Participants
A 29-year-old female with a history of anxiety presenting with dysmenorrhea, bladder spasms, and deep and superficial dyspareunia. MRI showed a 2.5 cm hypointense focus between the inferior uterine body and superior aspect of the urinary bladder.
Interventions
On diagnostic laparoscopy, the patient was found to have deeply infiltrating endometriosis in the anterior cul-de-sac. On cystoscopy, a bulging mass concerning for endometriosis was visible in the bladder but did not invade the bladder mucosa. The patient was scheduled for a joint case with urology for resection of the bladder lesion. At the beginning of the case, repeat cystoscopy redemonstrated the mass and bilateral ureteral stents were placed. On robotic assisted laparoscopy, the mass was found to be densely adhered to the anterior aspect of the uterus and the vesicovaginal septum. Attempts were made to dissect the endometriotic nodule off the detrusor muscle but, due to the extent of muscle invasion, the decision was made to incise the bladder mucosa. An intentional cystotomy was made and carried out circumferentially to remove the entirety of the lesion. Cystotomy was repaired in two layers with 2-0 vicryl in running fashion. A leak test confirmed watertight closure.
Measurements and Main Results
Following resection of bladder lesion, patient reported complete resolution of her dysmenorrhea, bladder spasms, and dyspareunia. Cystogram two weeks later was negative for extravasation.
Conclusion
Bladder endometriosis is a common variant of deep infiltrating endometriosis. A partial cystectomy is a safe and effective treatment option.
{"title":"Identification and Resection of Bladder Endometriosis","authors":"E Trieu, T King, G Bello, ME Shockley, LC Ramirez-Caban","doi":"10.1016/j.jmig.2024.09.138","DOIUrl":"10.1016/j.jmig.2024.09.138","url":null,"abstract":"<div><h3>Study Objective</h3><div>To demonstrate surgical management of bladder endometriosis.</div></div><div><h3>Design</h3><div>Surgical Video.</div></div><div><h3>Setting</h3><div>Academic medical center.</div></div><div><h3>Patients or Participants</h3><div>A 29-year-old female with a history of anxiety presenting with dysmenorrhea, bladder spasms, and deep and superficial dyspareunia. MRI showed a 2.5 cm hypointense focus between the inferior uterine body and superior aspect of the urinary bladder.</div></div><div><h3>Interventions</h3><div>On diagnostic laparoscopy, the patient was found to have deeply infiltrating endometriosis in the anterior cul-de-sac. On cystoscopy, a bulging mass concerning for endometriosis was visible in the bladder but did not invade the bladder mucosa. The patient was scheduled for a joint case with urology for resection of the bladder lesion. At the beginning of the case, repeat cystoscopy redemonstrated the mass and bilateral ureteral stents were placed. On robotic assisted laparoscopy, the mass was found to be densely adhered to the anterior aspect of the uterus and the vesicovaginal septum. Attempts were made to dissect the endometriotic nodule off the detrusor muscle but, due to the extent of muscle invasion, the decision was made to incise the bladder mucosa. An intentional cystotomy was made and carried out circumferentially to remove the entirety of the lesion. Cystotomy was repaired in two layers with 2-0 vicryl in running fashion. A leak test confirmed watertight closure.</div></div><div><h3>Measurements and Main Results</h3><div>Following resection of bladder lesion, patient reported complete resolution of her dysmenorrhea, bladder spasms, and dyspareunia. Cystogram two weeks later was negative for extravasation.</div></div><div><h3>Conclusion</h3><div>Bladder endometriosis is a common variant of deep infiltrating endometriosis. A partial cystectomy is a safe and effective treatment option.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"31 11","pages":"Page S35"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658146","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}
Pub Date : 2024-11-01DOI: 10.1016/j.jmig.2024.09.115
SD Vellani, N Salamat-Saberi
Study Objective
Demonstrate the safety and feasibility of laparoscopic-assisted extracorporeal ovarian cystectomy of a large benign adnexal mass. To exhibit spillage-free drainage methods in management of a large adnexal mass aligning with the goal of fertility-preservation in a patient with previous unilateral oophorectomy.
Design
Case presentation.
Setting
A university hospital.
Patients or Participants
31-yo G1P1001 with history of right oophorectomy presenting with abdominal pain/fullness, heartburn, and SOB. CT-A/P finding of a 24 cm adnexal mass described as multiloculated, mainly cystic with solid components that contain fat and calcification. Tumor markers were negative.
Interventions
Laparoscopic-assisted extracorporeal ovarian cystectomy of 24-cm adnexal mass by spill-free drainage techniques and fertility sparing intervention with reconstruction of the remaining left ovary.
Measurements and Main Results
The laparoscopic-assisted extracorporeal ovarian cystectomy was completed without complications including spillage with an EBL of 100 cc. The pathology confirmed a cystic mature teratoma. At post-operative follow-up in two weeks and six weeks, the patient was doing well without concerns with plans for pregnancy in the following year.
Conclusion
Laparoscopic-assisted extracorporeal ovarian cystectomy is a safe and minimally invasive approach for removal of large benign adnexal masses. The technique displayed in this video shows a spill-free drainage method for management of large adnexal masses by a minimally invasive approach.
{"title":"The Trifecta: A Spill-Free, Fertility Sparing, Minimally Invasive Approach for a Large Adnexal Mass","authors":"SD Vellani, N Salamat-Saberi","doi":"10.1016/j.jmig.2024.09.115","DOIUrl":"10.1016/j.jmig.2024.09.115","url":null,"abstract":"<div><h3>Study Objective</h3><div>Demonstrate the safety and feasibility of laparoscopic-assisted extracorporeal ovarian cystectomy of a large benign adnexal mass. To exhibit spillage-free drainage methods in management of a large adnexal mass aligning with the goal of fertility-preservation in a patient with previous unilateral oophorectomy.</div></div><div><h3>Design</h3><div>Case presentation.</div></div><div><h3>Setting</h3><div>A university hospital.</div></div><div><h3>Patients or Participants</h3><div>31-yo G1P1001 with history of right oophorectomy presenting with abdominal pain/fullness, heartburn, and SOB. CT-A/P finding of a 24 cm adnexal mass described as multiloculated, mainly cystic with solid components that contain fat and calcification. Tumor markers were negative.</div></div><div><h3>Interventions</h3><div>Laparoscopic-assisted extracorporeal ovarian cystectomy of 24-cm adnexal mass by spill-free drainage techniques and fertility sparing intervention with reconstruction of the remaining left ovary.</div></div><div><h3>Measurements and Main Results</h3><div>The laparoscopic-assisted extracorporeal ovarian cystectomy was completed without complications including spillage with an EBL of 100 cc. The pathology confirmed a cystic mature teratoma. At post-operative follow-up in two weeks and six weeks, the patient was doing well without concerns with plans for pregnancy in the following year.</div></div><div><h3>Conclusion</h3><div>Laparoscopic-assisted extracorporeal ovarian cystectomy is a safe and minimally invasive approach for removal of large benign adnexal masses. The technique displayed in this video shows a spill-free drainage method for management of large adnexal masses by a minimally invasive approach.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"31 11","pages":"Pages S27-S28"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658448","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}
Pub Date : 2024-11-01DOI: 10.1016/j.jmig.2024.09.096
T Khalife , SL Rassier , AL Brien , AR Carrubba , K Butler , K Casper , MP Griffith , S Afsar
Study Objective
To compare the diagnostic accuracy of hysteroscopic sampling versus blind sampling in detecting concurrent endometrial carcinoma (EC) in patients with endometrial intraepithelial neoplasia (EIN).
Design
This is a retrospective cross-sectional cohort study. Statistical data was based on frequency data, with quantitative variables expressed as means and standard deviations. For known confounding variables, univariate and multivariate regression analysis was performed.
Setting
Patients included patients who were diagnosed with EIN in a clinic or operating room setting using hysteroscopy or blind sampling tools.
Patients or Participants
151 patients diagnosed with EIN during endometrial sampling who underwent a hysterectomy within three months in the Mayo Clinic enterprise between January 1, 2018, and January 1, 2023.
Interventions
Those diagnosed with hysteroscopy-directed biopsy (grasp biopsy and global sampling) were compared to blind-sampling methods (pipelle or dilation and curettage) using the pathology results of the hysterectomy specimen as the gold standard comparator.
Measurements and Main Results
The mean (SD) patient age was 60.45 (±11.48) years for the hysteroscopy-directed group (n=76) and 63.95 (±10.73) years for the blind-sampling group (n=75). There was a reduced risk of concurrent EC on the final hysterectomy pathology for women who were diagnosed with EIN via hysteroscopy-directed biopsy (OR=0.44, 95% CI=0.20–0.95, p = 0.033). In univariate analysis, body mass index ≥30 was associated with an elevated risk of EC on final pathology (OR=4.17, 95% CI=1.51-11.51, p = 0.004). The risk of EC was higher in patients >60 years of age (OR=5.56, 95% CI=1.22-35.21, p<0.001). In multivariate analysis, diabetes mellitus was the only independent variable associated with a higher risk of EIN on final pathology (OR=7.01, 95% CI=1.40-35.04, p = 0.018). Age, BMI, and endometrial thickness on pre-biopsy ultrasound were not associated with EC on final hysterectomy pathology on univariate and multivariate analyses.
Conclusion
Hysteroscopic-directed biopsy reduces the risk of missing a concurrent EC during endometrial sampling in women with EIN.
研究目的比较宫腔镜取样与盲法取样在检测子宫内膜上皮内瘤变患者并发子宫内膜癌（EC）方面的诊断准确性。统计数据以频率数据为基础，定量变量以均数和标准差表示。对于已知的混杂变量，进行了单变量和多变量回归分析.Setting患者包括在诊所或手术室环境中使用宫腔镜或盲法取样工具诊断出EIN的患者.Patients or Participants151名患者在子宫内膜取样过程中诊断出EIN，并于2018年1月1日至2023年1月1日期间在梅奥诊所企业中接受了3个月内的子宫切除术。干预措施以子宫切除术标本的病理结果作为金标准比较指标，将宫腔镜引导活检（抓取活检和整体取样）与盲法取样（管式或扩张刮宫）诊断的患者进行比较。测量和主要结果宫腔镜引导组（n=76）患者的平均年龄为60.45（±11.48）岁，盲法取样组（n=75）患者的平均年龄为63.95（±10.73）岁。通过宫腔镜引导活检确诊为EIN的女性在最终子宫切除病理中并发EC的风险较低（OR=0.44，95% CI=0.20-0.95，P=0.033）。在单变量分析中，体重指数≥30与最终病理结果显示的EC风险升高有关（OR=4.17，95% CI=1.51-11.51，p=0.004）。60岁患者的EC风险更高（OR=5.56，95% CI=1.22-35.21，p<0.001）。在多变量分析中，糖尿病是唯一与最终病理结果显示EIN风险较高相关的自变量（OR=7.01，95% CI=1.40-35.04，p=0.018）。在单变量和多变量分析中，年龄、体重指数和活检前超声检查的子宫内膜厚度与最终子宫切除病理结果中的EC无关。
{"title":"Evaluating the Role of Hysteroscopy Guided Biopsy in Triaging Endometrial Intraepithelial Neoplasia for Subspecialty Referral","authors":"T Khalife , SL Rassier , AL Brien , AR Carrubba , K Butler , K Casper , MP Griffith , S Afsar","doi":"10.1016/j.jmig.2024.09.096","DOIUrl":"10.1016/j.jmig.2024.09.096","url":null,"abstract":"<div><h3>Study Objective</h3><div>To compare the diagnostic accuracy of hysteroscopic sampling versus blind sampling in detecting concurrent endometrial carcinoma (EC) in patients with endometrial intraepithelial neoplasia (EIN).</div></div><div><h3>Design</h3><div>This is a retrospective cross-sectional cohort study. Statistical data was based on frequency data, with quantitative variables expressed as means and standard deviations. For known confounding variables, univariate and multivariate regression analysis was performed.</div></div><div><h3>Setting</h3><div>Patients included patients who were diagnosed with EIN in a clinic or operating room setting using hysteroscopy or blind sampling tools.</div></div><div><h3>Patients or Participants</h3><div>151 patients diagnosed with EIN during endometrial sampling who underwent a hysterectomy within three months in the Mayo Clinic enterprise between January 1, 2018, and January 1, 2023.</div></div><div><h3>Interventions</h3><div>Those diagnosed with hysteroscopy-directed biopsy (grasp biopsy and global sampling) were compared to blind-sampling methods (pipelle or dilation and curettage) using the pathology results of the hysterectomy specimen as the gold standard comparator.</div></div><div><h3>Measurements and Main Results</h3><div>The mean (SD) patient age was 60.45 (±11.48) years for the hysteroscopy-directed group (n=76) and 63.95 (±10.73) years for the blind-sampling group (n=75). There was a reduced risk of concurrent EC on the final hysterectomy pathology for women who were diagnosed with EIN via hysteroscopy-directed biopsy (OR=0.44, 95% CI=0.20–0.95, p = 0.033). In univariate analysis, body mass index ≥30 was associated with an elevated risk of EC on final pathology (OR=4.17, 95% CI=1.51-11.51, p = 0.004). The risk of EC was higher in patients >60 years of age (OR=5.56, 95% CI=1.22-35.21, p<0.001). In multivariate analysis, diabetes mellitus was the only independent variable associated with a higher risk of EIN on final pathology (OR=7.01, 95% CI=1.40-35.04, p = 0.018). Age, BMI, and endometrial thickness on pre-biopsy ultrasound were not associated with EC on final hysterectomy pathology on univariate and multivariate analyses.</div></div><div><h3>Conclusion</h3><div>Hysteroscopic-directed biopsy reduces the risk of missing a concurrent EC during endometrial sampling in women with EIN.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"31 11","pages":"Page S22"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658354","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}
Pub Date : 2024-11-01DOI: 10.1016/j.jmig.2024.09.053
E Olig , J Yi
Study Objective
This video depicts a hysterectomy using single port robotic assistance and describes the inherent differences between operating with this console versus multiport setups.
Design
Single patient case report.
Setting
Academic medical center.
Patients or Participants
The patient is a 44-year-old G0 with a history of previous multiport robotic myomectomy. She presented with recurrent bulk symptoms and new fibroid burden. She desired definitive management and had no interest in fertility.
Interventions
Patient underwent uncomplicated single port robotic hysterectomy with bilateral salpingectomy. The patient's procedure was uncomplicated, and she recovered without difficulty and with excellent pain control.
Measurements and Main Results
Single port robotic surgery provides similar functionality to multiport robotics with potentially decreased postoperative pain and improved cosmesis. Surgical technique for single port hysterectomy is similar to multiport hysterectomy. Special considerations in single port surgery include instrument selection and movement of instruments and camera as a unit.
Conclusion
Further implementation and study of single port robotics in gynecology should be considered.
{"title":"Single Port Robotic Hysterectomy of an Enlarged Uterus","authors":"E Olig , J Yi","doi":"10.1016/j.jmig.2024.09.053","DOIUrl":"10.1016/j.jmig.2024.09.053","url":null,"abstract":"<div><h3>Study Objective</h3><div>This video depicts a hysterectomy using single port robotic assistance and describes the inherent differences between operating with this console versus multiport setups.</div></div><div><h3>Design</h3><div>Single patient case report.</div></div><div><h3>Setting</h3><div>Academic medical center.</div></div><div><h3>Patients or Participants</h3><div>The patient is a 44-year-old G0 with a history of previous multiport robotic myomectomy. She presented with recurrent bulk symptoms and new fibroid burden. She desired definitive management and had no interest in fertility.</div></div><div><h3>Interventions</h3><div>Patient underwent uncomplicated single port robotic hysterectomy with bilateral salpingectomy. The patient's procedure was uncomplicated, and she recovered without difficulty and with excellent pain control.</div></div><div><h3>Measurements and Main Results</h3><div>Single port robotic surgery provides similar functionality to multiport robotics with potentially decreased postoperative pain and improved cosmesis. Surgical technique for single port hysterectomy is similar to multiport hysterectomy. Special considerations in single port surgery include instrument selection and movement of instruments and camera as a unit.</div></div><div><h3>Conclusion</h3><div>Further implementation and study of single port robotics in gynecology should be considered.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"31 11","pages":"Page S11"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658446","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}
Pub Date : 2024-11-01DOI: 10.1016/j.jmig.2024.09.127
AS Farrell , N Posever , E Gagliardi , AM Modest
Study Objective
The Society of Gynecologic Oncology recommends opportunistic salpingectomy during benign hysterectomy to reduce the risk of epithelial ovarian cancers. A previous study indicated racial discrepancies in the adoption rates of risk-reducing salpingectomies at time of hysterectomy from 2011-2018. We performed an updated analysis to determine if these differences persist.
Design
Retrospective cohort study.
Setting
Over 700 academic and community hospitals in the American College of Surgeons National Surgical Quality Improvement Program.
Patients or Participants
Patients 18-50 years old undergoing minimally invasive benign hysterectomy from 2016-2021.
Interventions
Billing codes were used to identify patients who underwent total laparoscopic hysterectomy (TLH), total vaginal hysterectomy (TVH), or laparoscopic-assisted vaginal hysterectomy (LAVH), with or without bilateral salpingectomy. Patients were identified in the dataset as Non-Hispanic White (NHW), Non-Hispanic Black (NHB), or Hispanic. Log-binomial regression was used to calculate risk ratio (RR) and 95% confidence intervals (CI) of salpingectomy for NHB, and Hispanic patients compared to NHW patients.
Measurements and Main Results
Of 117,587 patients, 65% were NHW, 17.1% NHB, and 17.8% Hispanic. Of these patients, 70.6% underwent TLH, 12.8% TVH, and 16.6% LAVH. 86.9% of all patients underwent salpingectomy. When compared to NHW patients undergoing TLH, NHB and Hispanic patients were as likely to undergo salpingectomy [NHB RR 0.98 (CI 0.97-0.98); Hispanic RR 0.99 (CI 0.99-0.999)]. The same was true for patients undergoing TVH [NHB RR 1.04 (CI 0.997-1.1); Hispanic RR 1.1 (CI 1.1-1.2)] and LAVH [NHB RR 0.95 (CI 0.93-0.97); Hispanic 0.997 (CI 0.98-1.01)]. RRs remained similar after adjusting for age, diabetes, smoking, hypertension, American Society of Anesthesiologists class, and year of operation.
Conclusion
These findings suggest minimal differences in salpingectomy rates among racial and ethnic groups between 2016-2021. This is a change from prior studies and may indicate national improvements in reducing health disparities associated with opportunistic salpingectomy.
{"title":"Rates of Opportunistic Salpingectomy During Minimally-Invasive Benign Hysterectomy By Race/Ethnicity from 2016 to 2021","authors":"AS Farrell , N Posever , E Gagliardi , AM Modest","doi":"10.1016/j.jmig.2024.09.127","DOIUrl":"10.1016/j.jmig.2024.09.127","url":null,"abstract":"<div><h3>Study Objective</h3><div>The Society of Gynecologic Oncology recommends opportunistic salpingectomy during benign hysterectomy to reduce the risk of epithelial ovarian cancers. A previous study indicated racial discrepancies in the adoption rates of risk-reducing salpingectomies at time of hysterectomy from 2011-2018. We performed an updated analysis to determine if these differences persist.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting</h3><div>Over 700 academic and community hospitals in the American College of Surgeons National Surgical Quality Improvement Program.</div></div><div><h3>Patients or Participants</h3><div>Patients 18-50 years old undergoing minimally invasive benign hysterectomy from 2016-2021.</div></div><div><h3>Interventions</h3><div>Billing codes were used to identify patients who underwent total laparoscopic hysterectomy (TLH), total vaginal hysterectomy (TVH), or laparoscopic-assisted vaginal hysterectomy (LAVH), with or without bilateral salpingectomy. Patients were identified in the dataset as Non-Hispanic White (NHW), Non-Hispanic Black (NHB), or Hispanic. Log-binomial regression was used to calculate risk ratio (RR) and 95% confidence intervals (CI) of salpingectomy for NHB, and Hispanic patients compared to NHW patients.</div></div><div><h3>Measurements and Main Results</h3><div>Of 117,587 patients, 65% were NHW, 17.1% NHB, and 17.8% Hispanic. Of these patients, 70.6% underwent TLH, 12.8% TVH, and 16.6% LAVH. 86.9% of all patients underwent salpingectomy. When compared to NHW patients undergoing TLH, NHB and Hispanic patients were as likely to undergo salpingectomy [NHB RR 0.98 (CI 0.97-0.98); Hispanic RR 0.99 (CI 0.99-0.999)]. The same was true for patients undergoing TVH [NHB RR 1.04 (CI 0.997-1.1); Hispanic RR 1.1 (CI 1.1-1.2)] and LAVH [NHB RR 0.95 (CI 0.93-0.97); Hispanic 0.997 (CI 0.98-1.01)]. RRs remained similar after adjusting for age, diabetes, smoking, hypertension, American Society of Anesthesiologists class, and year of operation.</div></div><div><h3>Conclusion</h3><div>These findings suggest minimal differences in salpingectomy rates among racial and ethnic groups between 2016-2021. This is a change from prior studies and may indicate national improvements in reducing health disparities associated with opportunistic salpingectomy.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"31 11","pages":"Pages S31-S32"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658067","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}
Pub Date : 2024-11-01DOI: 10.1016/j.jmig.2024.09.059
LE Larson , NR King
Study Objective
To demonstrate several reproducible strategies used to overcome the surgical challenges of laparoscopic trachelectomy.
Design
N/A.
Setting
The patient was placed in dorsal lithotomy position, in steep Trendelenburg to aid in the performance of pelvic laparoscopy. Insufflation was carried out to 15mmHg. A primary 10mm umbilical trocar was used for the camera through the mini lap and three additional 5mm assist ports were placed.
Patients or Participants
The patient is a 41-year-old G1P1001 with history of supracervical hysterectomy who presented with persistent pelvic/back pain and vaginal bleeding. Extensive workup for alternative causes were unrevealing and remaining cervix was suspected source of symptoms. With appropriate options counseling and shared-decision making, patient elected to undergo laparoscopic trachelectomy.
Interventions
Laparoscopic trachelectomy with bilateral ureteral stent placement.
Measurements and Main Results
Uncomplicated surgery with same-day discharge followed by uneventful post-operative recovery.
Conclusion
Laparoscopic trachelectomy poses many challenges to the surgeon. In this video, we present a step-wise approach and several reproducible strategies to overcome these obstacles encountered in laparoscopic trachelectomy.
{"title":"Surgical Approach to Laparoscopic Trachelectomy","authors":"LE Larson , NR King","doi":"10.1016/j.jmig.2024.09.059","DOIUrl":"10.1016/j.jmig.2024.09.059","url":null,"abstract":"<div><h3>Study Objective</h3><div>To demonstrate several reproducible strategies used to overcome the surgical challenges of laparoscopic trachelectomy.</div></div><div><h3>Design</h3><div>N/A.</div></div><div><h3>Setting</h3><div>The patient was placed in dorsal lithotomy position, in steep Trendelenburg to aid in the performance of pelvic laparoscopy. Insufflation was carried out to 15mmHg. A primary 10mm umbilical trocar was used for the camera through the mini lap and three additional 5mm assist ports were placed.</div></div><div><h3>Patients or Participants</h3><div>The patient is a 41-year-old G1P1001 with history of supracervical hysterectomy who presented with persistent pelvic/back pain and vaginal bleeding. Extensive workup for alternative causes were unrevealing and remaining cervix was suspected source of symptoms. With appropriate options counseling and shared-decision making, patient elected to undergo laparoscopic trachelectomy.</div></div><div><h3>Interventions</h3><div>Laparoscopic trachelectomy with bilateral ureteral stent placement.</div></div><div><h3>Measurements and Main Results</h3><div>Uncomplicated surgery with same-day discharge followed by uneventful post-operative recovery.</div></div><div><h3>Conclusion</h3><div>Laparoscopic trachelectomy poses many challenges to the surgeon. In this video, we present a step-wise approach and several reproducible strategies to overcome these obstacles encountered in laparoscopic trachelectomy.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"31 11","pages":"Page S9"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658138","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}
Pub Date : 2024-11-01DOI: 10.1016/j.jmig.2024.09.032
MA Merida , S Sharma , E Cetin , SK Joseph , J Holmes , MI Abuzeid
Study Objective
Hysteroscopy represents the gold standard for diagnosing and treating intracavitary uterine pathology. It is rarely associated with complications, but 50% are related to uterine cavity entry. The false passage is correlated with early procedure termination or abortion. The objective is to educate about this pathology and to describe the different management techniques.
Design
This is a review of the literature on diagnosing and managing false passage and a video presentation of an innovative technique for hysteroscopic intracervical bridge division.
Setting
University-associated community hospital.
Patients or Participants
Two patients undergoing hysteroscopy were diagnosed with false passage.
Interventions
Diagnostic hysteroscopy, Hysteroscopic bridge division with scissors, hydrodissection, and tilt technique.
Measurements and Main Results
False passage was identified during diagnostic hysteroscopy in two patients. In the first case, characterized by an anteverted uterus, a posterior false passage was successfully managed using a combination of hydrodissection and the tilt technique. In the second case, featuring a retroverted uterus, an anterior false passage was effectively addressed through intracervical bridge division with hysteroscopic scissors. Notably, both procedures were completed as planned, showcasing the efficacy of the implemented techniques.
Conclusion
False passage during cervical dilation poses multifactorial challenges, potentially leading to premature procedure termination and concerns of uterine perforation. Mitigation and management of this complication require a systematic approach. Various techniques have been explored for its management, among which hysteroscopic division of the cervical bridge with scissors emerges as a practical and easily accessible strategy, offering promise in reducing early hysteroscopic termination and associated abortion rates.
{"title":"Navigating False Passages: Strategies for Effective Hysteroscopy Management","authors":"MA Merida , S Sharma , E Cetin , SK Joseph , J Holmes , MI Abuzeid","doi":"10.1016/j.jmig.2024.09.032","DOIUrl":"10.1016/j.jmig.2024.09.032","url":null,"abstract":"<div><h3>Study Objective</h3><div>Hysteroscopy represents the gold standard for diagnosing and treating intracavitary uterine pathology. It is rarely associated with complications, but 50% are related to uterine cavity entry. The false passage is correlated with early procedure termination or abortion. The objective is to educate about this pathology and to describe the different management techniques.</div></div><div><h3>Design</h3><div>This is a review of the literature on diagnosing and managing false passage and a video presentation of an innovative technique for hysteroscopic intracervical bridge division.</div></div><div><h3>Setting</h3><div>University-associated community hospital.</div></div><div><h3>Patients or Participants</h3><div>Two patients undergoing hysteroscopy were diagnosed with false passage.</div></div><div><h3>Interventions</h3><div>Diagnostic hysteroscopy, Hysteroscopic bridge division with scissors, hydrodissection, and tilt technique.</div></div><div><h3>Measurements and Main Results</h3><div>False passage was identified during diagnostic hysteroscopy in two patients. In the first case, characterized by an anteverted uterus, a posterior false passage was successfully managed using a combination of hydrodissection and the tilt technique. In the second case, featuring a retroverted uterus, an anterior false passage was effectively addressed through intracervical bridge division with hysteroscopic scissors. Notably, both procedures were completed as planned, showcasing the efficacy of the implemented techniques.</div></div><div><h3>Conclusion</h3><div>False passage during cervical dilation poses multifactorial challenges, potentially leading to premature procedure termination and concerns of uterine perforation. Mitigation and management of this complication require a systematic approach. Various techniques have been explored for its management, among which hysteroscopic division of the cervical bridge with scissors emerges as a practical and easily accessible strategy, offering promise in reducing early hysteroscopic termination and associated abortion rates.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"31 11","pages":"Page S15"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142657998","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}
Pub Date : 2024-11-01DOI: 10.1016/j.jmig.2024.09.100
JE Dotto Sr., Mila PG Da Graca, MA Bigozzi Jr
Study Objective
To develop a screening strategy for high-risk asymptomatic patients for endometrial cancer.
Design
Single Prospective Cohort.
Setting
Gynecological Medical Office. We did not use anesthesia.
Patients or Participants
We developed screening protocol for high-risk asymptomatic patients, conducting triennial screenings with OH from Jan 2003 to Jan 2023. Used Dotto et al. Classification for Hysteroscopic Risk Assessment. Studied 2076 high-risk patients (35-65 yo, mean age 51.4 yo) with risk factors including obesity, diabetes, cancer history, tamoxifen use, PCOS, HRT. Hypertension required an additional risk factor for enrollment. 41 patients excluded; final population 2035. All asymptomatic at recruitment. Diagnosed patients with endometrial cancer were removed from program for treatment.
Interventions
Office Hysteroscopy.
Measurements and Main Results
Screening protocol for high-risk asymptomatic patients for endometrial cancer, performing a screening office (OH) every three years in the targeted group. Between 2003 and 2023 we performed a total of 14439 OH in high-risk patients for endometrial cancer. Findings: 2003: 27 AH (Atypical Hyperplasia) 24 CA (carcinomas) PMDR 2.5% (Premalignant + Malignant Detection Rate) 2006: AH 22 CA 16 PMDR 1.93%, 2009 AH 24 CA 18 PMDR 2.25%, 2012: AH 27 CA14 PMDR 3.32%, 2015 AH 23 CA 13 PMDR 2.09%, 2018 AH 29 CA 22 PMDR 3% 2021 AH26 CA 15 PMDR 2.54% 2023: AH 28 CA 31 PMDR 3.66%.
Conclusion
We propose the use of office hysteroscopy as a screening method for high-risk for endometrial cancer asymptomatic patients. OH has the capacity of detecting lesions at an earlier stage, this widens the therapeutic window providing the patients with a greater chance of cure. This technique allowed us to diagnose endometrial cancer and premalignant lesions that were missed by transvaginal ultrasound.
{"title":"Office Hysteroscopy: Its Relevance as a Screening Method in High-Risk Asymptomatic Patients.","authors":"JE Dotto Sr., Mila PG Da Graca, MA Bigozzi Jr","doi":"10.1016/j.jmig.2024.09.100","DOIUrl":"10.1016/j.jmig.2024.09.100","url":null,"abstract":"<div><h3>Study Objective</h3><div>To develop a screening strategy for high-risk asymptomatic patients for endometrial cancer.</div></div><div><h3>Design</h3><div>Single Prospective Cohort.</div></div><div><h3>Setting</h3><div>Gynecological Medical Office. We did not use anesthesia.</div></div><div><h3>Patients or Participants</h3><div>We developed screening protocol for high-risk asymptomatic patients, conducting triennial screenings with OH from Jan 2003 to Jan 2023. Used Dotto et al. Classification for Hysteroscopic Risk Assessment. Studied 2076 high-risk patients (35-65 yo, mean age 51.4 yo) with risk factors including obesity, diabetes, cancer history, tamoxifen use, PCOS, HRT. Hypertension required an additional risk factor for enrollment. 41 patients excluded; final population 2035. All asymptomatic at recruitment. Diagnosed patients with endometrial cancer were removed from program for treatment.</div></div><div><h3>Interventions</h3><div>Office Hysteroscopy.</div></div><div><h3>Measurements and Main Results</h3><div>Screening protocol for high-risk asymptomatic patients for endometrial cancer, performing a screening office (OH) every three years in the targeted group. Between 2003 and 2023 we performed a total of 14439 OH in high-risk patients for endometrial cancer. Findings: 2003: 27 AH (Atypical Hyperplasia) 24 CA (carcinomas) PMDR 2.5% (Premalignant + Malignant Detection Rate) 2006: AH 22 CA 16 PMDR 1.93%, 2009 AH 24 CA 18 PMDR 2.25%, 2012: AH 27 CA14 PMDR 3.32%, 2015 AH 23 CA 13 PMDR 2.09%, 2018 AH 29 CA 22 PMDR 3% 2021 AH26 CA 15 PMDR 2.54% 2023: AH 28 CA 31 PMDR 3.66%.</div></div><div><h3>Conclusion</h3><div>We propose the use of office hysteroscopy as a screening method for high-risk for endometrial cancer asymptomatic patients. OH has the capacity of detecting lesions at an earlier stage, this widens the therapeutic window providing the patients with a greater chance of cure. This technique allowed us to diagnose endometrial cancer and premalignant lesions that were missed by transvaginal ultrasound.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"31 11","pages":"Pages S23-S24"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658398","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}
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