Journal of minimally invasive gynecology最新文献

Objective: Cheek acupuncture, a recently established microneedle therapy, has been proven to effectively reduce pain, but its potential antiemetic effects remain unconfirmed. Thus, This study aimed to compare the antiemetic efficacy of cheek acupuncture with ondansetron and evaluate the cumulative effect in patients undergoing laparoscopic gynecological surgery.

Design: A single-center randomized controlled trial SETTING: A university teaching hospital.

Patients: A Total of 150 Adult patients who underwent laparoscopic gynecological surgery between July 2023 to December 2023 .

Interventions: Cheek acupuncture, IV ondansetron, or both.

Measurements and main results: The incidence and severity of PONV as well as the postoperative requirement of rescue antiemetic agent were comparable between the cheek acupuncture and ondansetron group in 48 hours postoperatively (p > 0.05), but all of which were significantly reduced in the combination group (p < 0.05). Compared with the ondansetron group, the cheek acupuncture and combination group exhibited reduced pain intensity at 3 and 48 hours postoperatively (p < 0.05). The use of cheek acupuncture was associated with higher satisfaction scores with anesthesia and shorter time of first flatus. Furthermore, no significant differences in other outcomes were found among the three groups (p > 0.05).

Conclusion: Cheek acupuncture had a prominent antiemetic effect in reducing the incidence and severity of PONV in patients undergoing gynecological laparoscopic surgery.

Data availability statement: The data are available at https://data.mendeley.com/datasets/sngg3trx69/1.

Study subject: To investigate the impact of preoperative hormonal medication, including combined oral contraceptives (COCs) or dienogest, on operative findings in ovarian endometrioma surgery.

Design: A single-center, retrospective study.

Setting: Department of Gynecology, Samsung Medical Center, Republic of Korea.

Participants: Among patients who underwent ovarian endometrioma surgery for the first time at Samsung Medical Center between January 2020 and July 2023, those who started hormonal medication at another institution before their initial visit to our center, those with a waiting period of less than three months until the surgery date, and those with an endometrioma size of less than 4cm at the initial visit were excluded. A total 140 remaining patients were included in the study. The patients were divided into two groups: the group that received preoperative hormonal medication (COCs or dienogest) and the group that did not receive medication.

Interventions: To evaluate the impacts of preoperative hormonal medication on ovarian endometrioma patients, the operative findings were compared between the groups.

Results: Of the140 patients, 65 were in the no-medication group and 75 were in the medication group. Except for the median duration of follow-up and age, there were no differences in the baseline characteristics between the two groups. Operative findings were quantified using the revised American Society for Reproductive Medicine (rASRM) score. Although medication significantly reduced the size of the ovarian endometrioma, there were no significant differences in rASRM score between the two groups. However, the medication group experienced significant preoperative pain relief.

Conclusion: Preoperative hormonal medication can reduce the size of ovarian endometriomas but does not significantly affect the overall operative findings. Nevertheless, preoperative medication is helpful in reducing pain in patients before surgery.

Study objective: A desire for curriculum standardization in obstetrics and gynecology residencies has been identified. No prior investigation of educational experiences in Fellowship in Minimally Invasive Gynecologic Surgery (FMIGS) programs has been completed. The purpose of this study was to determine the state of FMIGS didactic education and the perceptions that fellowship directors and fellows have regarding a standardized curriculum.

Design: National survey SETTING: Web-based survey platform PARTICIPANTS: AAGL FMIGS program directors and fellows INTERVENTIONS: N/A RESULTS: A total of 87 out of 151 fellowship directors responded to the survey resulting in a response rate of 57.6%. A total of 58 of 97 fellows responded to the survey with a response rate of 59.8%. When participants were asked if their programs had structured didactic education curriculums, 98.9% of fellowship directors replied yes while only 77.6% of fellows responded yes (p<.001). Approximately 97% fellowship directors reported that structured didactic time is protected from clinical duties. However, only 67.2% of fellows reported that didactic time was protected (p<.001). Participants (71.3% of fellowship directors and 84.5% of fellows) strongly agreed/agreed that their didactic education could be improved. A large majority of participants agreed that all MIGS fellows should learn the same content in their didactics curriculums, that fellows should have access to the same educational resources and that participating in a standardized didactic curriculum would allow for better transition into independent practice.

Conclusion: Fellowship directors and fellows are aligned in the desire for improvement in their current didactic education programs and the need for a centrally located, structured, and standardized fellowship education curriculum.

Objective: Recent advancements of minimally invasive gynecologic surgery have led to the development of transvaginal natural orifice translumenal endoscopic surgery (vNOTES) [1,2]. Robot-assisted vNOTES has also been explored as a method providing accurate and fine surgical procedures with improved ergonomics, visualization, wristed instruments, elimination of the hand tremor [3,4]. The objective of this video is to demonstrate the technical and anatomical highlights of a vaginal-assisted NOTES hysterectomy (VANH) using the da Vinci SP (SP).

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

Participants: A 51-year-old woman, para 2 with no previous history of abdominal surgery, who presented with dysmenorrhea and urinary frequency. Magnetic resonance imaging revealed a large uterus with multiple fibroids.

Interventions: The surgical steps are completely identical to conventional laparoscopic or robotic VANH [2,3]. This suggests that conventional laparoscopic skills are highly transferrable to SP. SP offer several advantages, including high-resolution three-dimensional visualization, articulating instruments, and improved dexterity and range of motion. In addition, conventional multi-arm robotic platforms have difficulty docking and adjusting the arm angle for vNOTES, but SP allows easy docking due to its single-arm design [5]. A Gelpoint V-Path is used as the vNOTES platform to hold the SP metal cannula. This cannula contains four channels, allowing the use of three instruments and a camera. The double bipolar method is used since this facilitates precise dissection with minimal thermal spread. The total operative time was 102 minutes. The estimated blood loss was 50ml without any complications. The uterus weighed 970 g. The postoperative course was uneventful.

Conclusion: VANH using SP is technically safe and feasible for benign uterine diseases in selected patients. Maneuverability of articulating instruments used in SP may allow broad expansion of the indication for vNOTES to more challenging cases. VIDEO ABSTRACT.

Study objective: To investigate whether intracervical injection of terlipressin during hysteroscopic surgery could reduce the amount of intravasation, the incidence and severity of gas embolism, and the COHb levels in the blood.

Design: Randomized double-blind controlled trial.

Setting: Gynecologic surgical unit in a general hospital.

Patients: Patients who were scheduled for transcervical resection of type 1 or type 2 myomas (TCR-M), or for extensive transcervical endometrium resection (TCR-E).

Interventions: Patients were randomized to receive either terlipressin 0.85 mg or placebo injections intracervical at the beginning of the procedure.

Measurements: The amount of intravasation and level of COHb was measured at the end of the procedure. The incidence and severity of gas embolisms was determined during the procedure by transesophageal echocardiography (TEE). Study groups were compared using an Independent Samples T-Test or a Mann-Whitney U test as indicated.

Main results: Forty-four patients were included in this study. No significant differences were found in intravasation volume, venous emboli and post-surgery COHb between study groups. There was a trend towards more severe embolisms (grade IV embolisms: 12 versus 6, p = .08), paradoxical embolisms (4 versus 2, p = .55) and a shorter operation time (mean of 43 versus 36 minutes, p = .09) in patients who received placebo compared to terlipressin.

Conclusion: This study could not demonstrate a clear beneficial effect of intracervical terlipressin administration. However, further research is needed to investigate if terlipressin can reduce operation time, severe embolisms and the need for redo procedures.