Journal of minimally invasive gynecology最新文献_第6页

MEDL Score: A Novel MRI Protocol That Can Predict Endometriosis With High Accuracy MEDL 评分：可高精度预测子宫内膜异位症的新型磁共振成像方案

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Journal of minimally invasive gynecology

Pub Date : 2024-11-01 DOI: 10.1016/j.jmig.2024.09.069

J Siufi Neto , MP Andres , CC Barbisan , K Seidel , Y Ota , YO Tanaka , M Yamamoto , R Takubo , M Carrick , J Matsushima , MS Abrão

Study Objective

In a previous research, we established a novel MRI protocol for evaluating the severity of endometriosis called MEDL. In the present study, we revised the protocol to evaluate the severity of endometriosis using MRI in comparison to laparoscopy.

Design

An observational retrospective study.

Setting

A tertiary hospital.

Patients or Participants

71 patients diagnosed with endometriosis were enrolled in this study. All patients underwent clinical evaluation, pre-operative MRI, and laparoscopic surgery.

Interventions

The MEDL score is a novel MRI scoring system developed using a two (Absent/Present) or three-category (None/Mild/Severe) system to measure the disease severity and level of adhesions between organs due to endometriosis. All pre-operative MRIs were evaluated by three independent radiologists using MEDL score to assess disease severity and the anatomical location of the adhesions. All recorded surgeries were evaluated by two independent surgeons to map the lesions and their adhesion severity. All results were submitted for statistical analysis to determine the agreement rate between MRI and laparoscopic mapping.

Measurements and Main Results

For adhesion between organs and lesion severity on the uterine wall, the agreement rate (kappa) between MRI and laparoscopy finding was calculated. The results of adhesion between organs were 0.80∼0.97 for Present/Absent and 0.72∼0.97 for None/Mild/Severe (n=67∼69). The results of lesion severity on the uterine wall were 0.70∼0.96 for Present /Absent and 0.64∼0.96 for None/Mild/Severe (n=65∼69). For the three-category evaluation of all items, the total score was calculated for each patient, with None=0, Mild=1, Severe=2, and the Spearman's rank correlation coefficient between laparoscopy and MRI total scores was 0.81(n=61).

Conclusion

The results showed that pre operative MRI under the MEDL score had a high agreement compared to laparoscopy and can be used to accurately map endometriotic lesions. This is a promising method applicable not only to assess disease severity but in the near future might be used to measure drug therapy response before and after treatment.

研究目的在之前的一项研究中，我们建立了一种用于评估子宫内膜异位症严重程度的新型核磁共振成像方案，称为MEDL。在本研究中，我们对该方案进行了修订，与腹腔镜手术相比，使用磁共振成像评估子宫内膜异位症的严重程度。干预措施MEDL评分是一种新型磁共振成像评分系统，采用两级（无/有）或三级（无/轻度/严重）系统来衡量子宫内膜异位症的疾病严重程度和器官间粘连程度。所有术前核磁共振成像均由三位独立的放射科医生使用 MEDL 评分进行评估，以评估疾病严重程度和粘连的解剖位置。所有记录在案的手术均由两名独立外科医生进行评估，以绘制病灶及其粘连严重程度图。所有结果均提交进行统计分析，以确定核磁共振成像和腹腔镜绘图的吻合率。测量和主要结果对于器官间粘连和子宫壁病变严重程度，计算了核磁共振成像和腹腔镜检查结果的吻合率（kappa）。器官间粘连的存在/不存在吻合率为0.80∼0.97，无/轻度/严重吻合率为0.72∼0.97（n=67∼69）。子宫壁病变严重程度的结果为：有/无为 0.70∼0.96，无/轻度/严重为 0.64∼0.96（n=65∼69）。结果显示，与腹腔镜检查相比，MEDL 评分下的术前 MRI 具有较高的一致性，可用于准确绘制子宫内膜病变图。这是一种很有前途的方法，不仅可用于评估疾病的严重程度，在不久的将来还可用于测量治疗前后的药物治疗反应。

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引用次数: 0

Board Of Directors-Ed Calendar 董事会-教育日历

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Journal of minimally invasive gynecology

Pub Date : 2024-11-01 DOI: 10.1016/S1553-4650(24)00779-9

引用次数: 0

The Use of Foley Catheters in Hysteroscopy Combined With Laparoscopy for the Treatment of Post-Cesarean Section Uterine Diverticulum 宫腔镜联合腹腔镜手术中使用福里导管治疗剖腹产后子宫憩室

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Journal of minimally invasive gynecology

Pub Date : 2024-11-01 DOI: 10.1016/j.jmig.2024.09.035

X Liang

Study Objective

To evaluate the effectiveness and utility of a Foley catheter as an innovative support tool in managing a large and rare cesarean scar diverticulum during laparoscopic repair, aiming to address post-cesarean section complications related to prolonged menstruation.

Design

This video demonstrates a combined laparoscopic and hysteroscopic surgical technique, with a special emphasis on using the Foley catheter as a support tool to enhance the surgical field and precision. Once the diverticulum is located via hysteroscopy, the Foley catheter is deployed to stabilize and delineate the diverticulum, followed by precise dissection and repair of the diverticulum walls under laparoscopy.

Setting

The procedure was conducted in a high-tech operating room at a university hospital.

Patients or Participants

The patient is a 35-year-old woman with a history of one cesarean section who had been experiencing prolonged menstrual bleeding for one year. Diagnostic imaging showed a large and rare cystic structure measuring 30mm x 30mm on the right side of the uterus.

Interventions

A Foley catheter was inserted into the diverticulum under hysteroscopic guidance to act as a mechanical scaffold, which enhanced visualization and stability of the diverticulum during laparoscopic surgery. This was followed by the precise dissection and repair of the diverticulum walls, improving the safety and effectiveness of the surgery.

Measurements and Main Results

Postoperative assessments indicated a significant reduction in menstrual bleeding and resolution of the diverticulum issues. The use of the Foley catheter provided essential structural support, enabling more effective manipulation and treatment of the scar tissue.

Conclusion

This case highlights the pivotal role of the Foley catheter in managing a large and rare cesarean scar diverticulum. It introduces a new surgical technique that could offer an effective surgical option for managing post-cesarean section complications, providing a replicable and effective method for managing similar cases.

研究目的评估在腹腔镜修补术中使用Foley导管作为一种创新的支持工具来处理巨大而罕见的剖宫产疤痕憩室的有效性和实用性，旨在解决与经期过长相关的剖宫产术后并发症。通过宫腔镜确定憩室位置后，部署 Foley 导管以稳定和划定憩室，然后在腹腔镜下对憩室壁进行精确剥离和修复。干预措施在宫腔镜引导下将 Foley 导管插入憩室，作为一个机械支架，从而在腹腔镜手术中增强了憩室的可视性和稳定性。术后评估显示，月经出血量明显减少，憩室问题得到解决。使用 Foley 导管提供了重要的结构支持，使疤痕组织的操作和治疗更加有效。结论本病例强调了 Foley 导管在处理巨大而罕见的剖宫产疤痕憩室中的关键作用。它介绍了一种新的手术技术，为处理剖宫产术后并发症提供了一种有效的手术选择，为处理类似病例提供了一种可复制的有效方法。

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引用次数: 0

Risk of Self-Harm Among Individuals Diagnosed With Endometriosis: A Population-Based Cohort Study 子宫内膜异位症患者的自我伤害风险：基于人群的队列研究

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Journal of minimally invasive gynecology

Pub Date : 2024-11-01 DOI: 10.1016/j.jmig.2024.09.072

P Thiel , O Bougie , J Pudwell , J Shellenberger , MP Velez , A Murji

Study Objective

To assess the association between endometriosis and the composite outcome of self-harm, which included suicide, intentional self-harm, and drug overdose.

Design

A population-based retrospective matched cohort study.

Setting

We used linked administrative data from a government-administered single-payer provincial healthcare system in Ontario, Canada between January 1, 2010, to July 1, 2022.

Patients or Participants

Women age 18 to 50 years with a first-time diagnosis of endometriosis.

Interventions

None.

Measurements and Main Results

Endometriosis exposure was determined using a validated set of diagnostic codes from physician billing and from outpatient and in-hospital visits. Individuals with endometriosis were matched 1:2 on age, sex, geography, and history of self-harm to unexposed individuals without a history of endometriosis. To account for psychiatric care utilization in the 2-years prior to study entry, we also matched endometriosis patients to controls based on a psychiatric utilization gradient score (0-no psychiatric utilization; 1-outpatient; 2-emergency care; and 3-hospital admission). The primary outcome was a composite of the first occurrence of suicide, intentional self-harm, or overdose. Secondary outcomes were the individual components of the composite. Cox regression models were used to generate hazard ratios with adjustment for all baseline covariates including in other comorbidities, income quintile, infertility, immigration status.

We included 168,159 individuals: 56,053 diagnosed with endometriosis (40.7% medically, 59.3% surgically) and 112,106 unexposed individuals. Compared to unexposed, patients with endometriosis were at increased risk of the composite outcome of self-harm (aHR 1.42, 95%CI 1.27–1.59, cumulative incidence of 2.47% vs 1.75%). Endometriosis conferred increased risk of intentional self-harm (aHR 1.37, 95%CI 1.22–1.54) and overdose (aHR 1.42, 95% CI 1.29–1.56) but not for suicide (aHR 1.21, 95%CI, 0.62–2.35), although only 42 suicide events were recorded over the study period.

Conclusion

A diagnosis of endometriosis is associated with an increased risk of self-harm. Mental health screening in the endometriosis population is warranted with targeted interventions for self-harm prevention.

研究目的评估子宫内膜异位症与自残综合结果（包括自杀、故意自残和药物过量）之间的关系.设计基于人群的回顾性匹配队列研究.研究背景我们使用了加拿大安大略省政府管理的单方付费省级医疗保健系统在2010年1月1日至2022年7月1日期间的相关管理数据。患者或参与者首次诊断为子宫内膜异位症的 18 至 50 岁女性。干预措施无。测量和主要结果子宫内膜异位症的暴露程度是通过一套经过验证的诊断代码确定的，这些代码来自医生账单以及门诊和住院就诊记录。子宫内膜异位症患者与无子宫内膜异位症病史的未暴露者在年龄、性别、地域和自残史方面进行了1:2配对。为了考虑到研究开始前两年的精神病治疗使用情况，我们还根据精神病治疗使用梯度评分（0-无精神病治疗使用；1-门诊；2-急诊；3-入院）将子宫内膜异位症患者与对照组进行了配对。主要结果是首次发生自杀、故意自残或用药过量的综合结果。次要结果是综合结果的各个组成部分。我们使用 Cox 回归模型生成危险比，并对所有基线协变量（包括其他合并症、收入五分位数、不孕症、移民身份）进行调整：我们共纳入了 168 159 名患者：56 053 名确诊为子宫内膜异位症患者（40.7% 通过药物治疗，59.3% 通过手术治疗）和 112 106 名未暴露于子宫内膜异位症的患者。与未暴露者相比，子宫内膜异位症患者发生自残这一综合结果的风险更高（aHR 1.42，95%CI 1.27-1.59，累计发生率为 2.47% vs 1.75%）。子宫内膜异位症会增加故意自残（aHR 1.37，95%CI 1.22-1.54）和用药过量（aHR 1.42，95%CI 1.29-1.56）的风险，但不会增加自杀（aHR 1.21，95%CI，0.62-2.35）的风险，尽管在研究期间仅记录了 42 起自杀事件。有必要对子宫内膜异位症患者进行心理健康筛查，并采取有针对性的干预措施预防自残。

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引用次数: 0

Evaluation of Rectal Endometriosis Treatment With HIFU Versus Surgery: A Comparative Retrospective Bicentric Study HIFU 与手术治疗直肠子宫内膜异位症的评估：双中心回顾性比较研究

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Journal of minimally invasive gynecology

Pub Date : 2024-11-01 DOI: 10.1016/j.jmig.2024.09.074

G Dubernard , C Devantay , CA Philip , S Warembourg , E Nguyen-BA , T Dennis , B Merlot , H Roman

Study Objective

Comparing rectal endometriosis treatment with HIFU and surgery in terms of symptoms at 6 months and treatments-related morbidity.

Design

Comparative retrospective, bicentric study in 2 endometriosis reference centers.

Setting

Patients operated by HIFU or laparoscopic resection in the operating room under anesthesia.

Patients or Participants

120 patients, including 60 patients in each arm, were treated and followed for 6 months.

Interventions

Endo-rectal HIFU treatment versus laparoscopic surgery of rectal endometriosis nodule.

Measurements and Main Results

Patients’ symptomatology was assessed with questionnaires prior to receiving treatment then again 6 months later using questionnaires: gynecological and digestive symptoms (VAS), health status (MOSSF-36), fecal incontinence (WEXNER), constipation (KESS) and overall sexual health (FSFI). We also assessed the morbidity of both treatments according to the Clavien-Dindo classification. 120 patients, 60 in each group, received HIFU or rectal surgery. Rectal nodules characteristics were comparable in both groups. In the HIFU and surgery groups, Clavien-Dindo grade 2 and 3 complication rates were respectively 3.3% vs. 21.7% (p=0.002) and 0% vs. 10% (p=0.01). Hospitalization duration was also significantly shorter for HIFU group (1 day vs. 3 days, p<0.001). In the HIFU group, significative improvement was observed in acute pelvic pain/dysmenorrhea, dyspareunia, diarrhea, rectal spasms, pain during bowel movement and urinary urgency. In the surgical arm, significative improvement was observed in acute pelvic pain/dysmenorrhea, diarrhea, rectal spasms and pain during bowel movement. In both groups, we can witness an improvement in FSFI, KESS and WEXNER scores and health status at 6 months.

Conclusion

HIFU treatment enables significant reduction in the risk of postoperative complications while allowing at least similar symptoms and quality of life outcomes and could be used as an alternative to surgical treatment for suitable patients. Long-term complications and relapse risks require further research.

研究目的比较直肠子宫内膜异位症HIFU治疗和手术治疗6个月后的症状以及治疗相关的发病率.设计在2个子宫内膜异位症参考中心进行的比较性回顾性双中心研究.设置患者在手术室麻醉下进行HIFU手术或腹腔镜切除术.患者或参与者120例患者（包括每组60例患者）接受治疗并随访6个月.干预措施直肠HIFU治疗与直肠子宫内膜异位症结节腹腔镜手术。测量和主要结果患者在接受治疗前通过问卷对症状进行评估，6个月后再次通过问卷对症状进行评估：妇科和消化系统症状（VAS）、健康状况（MOSSF-36）、大便失禁（WEXNER）、便秘（KESS）和整体性健康（FSFI）。我们还根据 Clavien-Dindo 分类法评估了两种治疗方法的发病率。120 名患者接受了 HIFU 或直肠手术治疗，每组 60 人。两组患者的直肠结节特征相当。在 HIFU 组和手术组中，克拉维恩-丁度 2 级和 3 级并发症发生率分别为 3.3% 对 21.7%（P=0.002）和 0% 对 10%（P=0.01）。HIFU 组的住院时间也明显缩短（1 天 vs. 3 天，p<0.001）。在 HIFU 组，急性盆腔疼痛/痛经、排便困难、腹泻、直肠痉挛、排便时疼痛和尿急等症状均有明显改善。在手术组中，急性盆腔疼痛/痛经、腹泻、直肠痉挛和排便时疼痛均有显著改善。两组患者的 FSFI、KESS 和 WEXNER 评分以及 6 个月后的健康状况均有所改善。结论 HIFU 治疗可显著降低术后并发症的风险，同时至少可获得相似的症状和生活质量，适合患者作为手术治疗的替代方案。长期并发症和复发风险需要进一步研究。

{"title":"Evaluation of Rectal Endometriosis Treatment With HIFU Versus Surgery: A Comparative Retrospective Bicentric Study","authors":"G Dubernard , C Devantay , CA Philip , S Warembourg , E Nguyen-BA , T Dennis , B Merlot , H Roman","doi":"10.1016/j.jmig.2024.09.074","DOIUrl":"10.1016/j.jmig.2024.09.074","url":null,"abstract":"<div><h3>Study Objective</h3><div>Comparing rectal endometriosis treatment with HIFU and surgery in terms of symptoms at 6 months and treatments-related morbidity.</div></div><div><h3>Design</h3><div>Comparative retrospective, bicentric study in 2 endometriosis reference centers.</div></div><div><h3>Setting</h3><div>Patients operated by HIFU or laparoscopic resection in the operating room under anesthesia.</div></div><div><h3>Patients or Participants</h3><div>120 patients, including 60 patients in each arm, were treated and followed for 6 months.</div></div><div><h3>Interventions</h3><div>Endo-rectal HIFU treatment versus laparoscopic surgery of rectal endometriosis nodule.</div></div><div><h3>Measurements and Main Results</h3><div>Patients’ symptomatology was assessed with questionnaires prior to receiving treatment then again 6 months later using questionnaires: gynecological and digestive symptoms (VAS), health status (MOSSF-36), fecal incontinence (WEXNER), constipation (KESS) and overall sexual health (FSFI). We also assessed the morbidity of both treatments according to the Clavien-Dindo classification. 120 patients, 60 in each group, received HIFU or rectal surgery. Rectal nodules characteristics were comparable in both groups. In the HIFU and surgery groups, Clavien-Dindo grade 2 and 3 complication rates were respectively 3.3% vs. 21.7% (p=0.002) and 0% vs. 10% (p=0.01). Hospitalization duration was also significantly shorter for HIFU group (1 day vs. 3 days, p<0.001). In the HIFU group, significative improvement was observed in acute pelvic pain/dysmenorrhea, dyspareunia, diarrhea, rectal spasms, pain during bowel movement and urinary urgency. In the surgical arm, significative improvement was observed in acute pelvic pain/dysmenorrhea, diarrhea, rectal spasms and pain during bowel movement. In both groups, we can witness an improvement in FSFI, KESS and WEXNER scores and health status at 6 months.</div></div><div><h3>Conclusion</h3><div>HIFU treatment enables significant reduction in the risk of postoperative complications while allowing at least similar symptoms and quality of life outcomes and could be used as an alternative to surgical treatment for suitable patients. Long-term complications and relapse risks require further research.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"31 11","pages":"Page S5"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658182","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

Is There More Than Meets the Eye? Pattern of Visible and Occult Peritoneal Endometriosis in Patients with Pelvic Pain 子宫内膜异位症远不止这些？盆腔疼痛患者可见和隐匿性腹膜子宫内膜异位症的模式

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Journal of minimally invasive gynecology

Pub Date : 2024-11-01 DOI: 10.1016/j.jmig.2024.09.075

G Namazi , N Chauhan , S Knapp , M Stuparich , J Cruz , S Nahas , S Behbehani

Study Objective

Pattern of visible and occult peritoneal endometriosis in patients with pelvic pain undergoing complete peritonectomy(CP).

Design

Retrospective observational.

Setting

Academic medical center.

Patients or Participants

Patients with chronic pelvic pain undergoing a laparoscopic or robotic CP between 2018-2024. Patients with stage four endometriosis were excluded. A pilot analysis of 56 patients are included in this study.

Interventions

Minimally invasive CP with documentation of intraoperative location of endometriosis performed by fellowship-trained surgeons experienced in endometriosis excision. CP was defined as excision of left and right pelvic brims, pelvic side-walls, ovarian fossae, uterosacral ligaments, posterior cul-de-sac and bladder peritoneum.

Measurements and Main Results

Records were coded as 1(surgeon positive) or 0(surgeon negative) and 1(pathology positive) and 0(pathology negative). Discordance was calculated (surgeon positive-pathology negative=1; pathology negative-surgeon positive=-1). 89.3% of patients (28.7% of total regions) had at least one instance of discordance. In 61.6% of those cases, the operative report identified areas of suspected endometriosis, but the pathology showed no endometriosis. Of those cases 47.8% showed evidence of fibrosis or chronic inflammation. Hormonal medication and history of previous surgery were not related to surgeon positive/pathology negative discordance (chi-square, p = .07). In the other 38.4% of discordant cases, the operative report did NOT identify areas of suspected endometriosis, but the pathology report DID identify endometriosis. The area with the most identified endometriosis was the left ovarian fossa (80% positive pathology).

Conclusion

Evidence for surgical excision of endometriosis for improving pain is robust. Debate regarding the optimal technique continues. Our findings further support the emerging data suggesting the role of CP given that even with expert, well-trained eyes, microscopic endometriosis can be missed. Furthermore, presence of fibrosis or chronic inflammation in nearly half of the cases where the pathology report did not show endometriosis is an intriguing finding. Studies are needed to assess the role of CP in reducing the risk of repeated surgical interventions.

研究目的接受全腹膜切除术（CP）的盆腔疼痛患者中可见和隐匿性腹膜子宫内膜异位症的模式.设计回顾性观察.设置学术医疗中心.患者或参与者2018-2024年间接受腹腔镜或机器人CP的慢性盆腔疼痛患者。不包括子宫内膜异位症四期患者。本研究纳入了对 56 名患者的试点分析。干预措施由受过研究培训、在子宫内膜异位症切除方面经验丰富的外科医生实施微创 CP，并记录术中子宫内膜异位症的位置。微创子宫内膜异位症的定义是切除左右盆腔边缘、盆腔侧壁、卵巢窝、子宫骶骨韧带、后穹窿和膀胱腹膜。计算不一致性（外科医生阳性-病理阴性=1；病理阴性-外科医生阳性=-1）。89.3%的患者（占总区域的28.7%）至少有一次不一致。在 61.6% 的病例中，手术报告确定了疑似子宫内膜异位症的区域，但病理结果显示没有子宫内膜异位症。在这些病例中，47.8%有纤维化或慢性炎症的迹象。荷尔蒙药物和既往手术史与外科医生阳性/病理阴性不一致无关（卡方，P = 0.07）。在其他 38.4% 的不一致病例中，手术报告没有发现疑似子宫内膜异位症的区域，但病理报告确实发现了子宫内膜异位症。结论手术切除子宫内膜异位症以改善疼痛的证据确凿。关于最佳技术的争论仍在继续。我们的研究结果进一步支持了新出现的数据，这些数据表明了 CP 的作用，因为即使是训练有素的专家，也可能会漏诊显微镜下的子宫内膜异位症。此外，在病理报告未显示子宫内膜异位症的病例中，有近一半存在纤维化或慢性炎症，这也是一个耐人寻味的发现。需要进行研究，以评估 CP 在降低重复手术干预风险方面的作用。

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引用次数: 0

Surgical Approach to a Type 8 Vaginal Myoma in the Endopelvic Fascia 骨盆内筋膜 8 型阴道肌瘤的手术方法

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Journal of minimally invasive gynecology

Pub Date : 2024-11-01 DOI: 10.1016/j.jmig.2024.09.066

M Keslar, N Pillalamarri, E Crihfield

Study Objective

To review the literature for the prevalence of vaginal myomas and to demonstrate a case of isolated vaginal myoma excision.

Design

Case report with surgical videos.

Setting

Tertiary care hospital.

Patients or Participants

One patient.

Interventions

Patient was a 39 y/o G2P2 with vaginal fullness and bleeding that was found to have a 6 cm vaginal myoma that was filling the vaginal vault and was attached only to the anterior vagina based on office exam and vaginoscopy. MRI was performed and demonstrated a vaginal myoma with no other myomas, though location of the attachment on imaging was not clear. Plan was made for vaginal approach to excision, and this was performed with both hysteroscopy and cystoscopy to inspect possible involvement of surrounding structures. Key steps of procedure included use of vasopressin to assist with hemostasis, blunt dissection in the myoma capsule planes to remove myoma without injuring surrounding structures, and suture plication after excision to repair the endopelvic fascia and vaginal mucosa.

Measurements and Main Results

Vaginal myoma was removed successfully with no injury to nearby urethra or bladder. Vaginal wall defect was repaired successfully in the style of an anterior vaginal repair with good restoration of normal anatomy noted postoperatively and at post-op visit. Surgical techniques are reviewed in the surgical video.

Conclusion

Isolated type 8 vaginal myomas are rare and identifying their attachments to surrounding structures prior to excision is crucial, but vaginal approach to excision can be safely performed with care being taken to not injure surrounding structures and with endopelvic fascia repair performed after removal.

研究目的回顾有关阴道肌瘤发病率的文献，并展示一例孤立的阴道肌瘤切除术。设计病例报告，附带手术视频。进行了核磁共振检查，结果显示有一个阴道肌瘤，但没有其他肌瘤，不过成像上的附着位置并不清楚。医生制定了阴道切除计划，并同时进行了宫腔镜和膀胱镜检查，以了解周围结构可能受累的情况。手术的关键步骤包括使用血管加压素协助止血、在肌瘤囊平面钝性剥离以切除肌瘤而不损伤周围结构，以及在切除后缝合骨盆内筋膜和阴道粘膜。阴道壁缺损以阴道前壁修补术的方式成功修复，术后和术后访视时均发现正常解剖结构恢复良好。手术视频中回顾了手术技巧。结论孤立的8型阴道肌瘤非常罕见，切除前确定其与周围结构的附着物至关重要，但阴道切除术可以安全进行，注意不要损伤周围结构，并在切除后进行骨盆内筋膜修复。

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引用次数: 0

Diaphragmatic Endometriosis Adjacent to Pericardium and Heart, a Mullerian Defect Removed by En Bloc Peritonectomy 邻近心包和心脏的横膈膜子宫内膜异位症，通过整体腹膜切除术切除的穆勒氏缺损

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Journal of minimally invasive gynecology

Pub Date : 2024-11-01 DOI: 10.1016/j.jmig.2024.09.134

I Chiminacio , C Obrzut , A Nishimura , JF Petry , H Sabadin

Study Objective

To present a form of diaphragmatic endometriosis in the central tendon area near to the pericardium and heart removed en bloc by peritonectomy. And to discuss the Mullerian origin of endometriosis based on the sites of involvement.

Design

Edited didactic video showing en bloc peritonectomy applied to the removal of diaphragmatic and pelvic endometriosis.

Setting

Laparoscopic surgery using the latest generation of ultrasonic scissors for dissection and peritonectomy.

Patients or Participants

24 yo patient with intense pelvic, abdome and chest pain, presenting with grade IV AAGL endometriosis and diaphragmatic lesions near to pericardium and heart.

Interventions

Considering the location and distribution of the endometriosis lesions following a pattern called the Mullerian Path track and the layers of connective tissue below the peritoneum, the technique of en bloc removal by extensive peritonectomy was applied to all affected areas in the pelvis (Toldt's fascia, left parametrium, rectum and rectum), right parametrium, right iliac fossa and appendage, above the right kidney and in the diaphragm, including the central tendon area near the pericardium and heart.

Measurements and Main Results

As could be seen in the video, endometriosis follows a distribution path of probable Mullerian embryonic origin that is completely related to the simultaneous construction of the colon in the process of gastrulation. This determines the involvement of the pelvis and the right diaphragm that can reach close to the heart. It is also possible to see the usefulness of en bloc removal with peritonectomy using the ultrasonic device via the laparoscopic route. It can also be seen that endometriosis forms extensive "marble-like" lesions within the connective tissue, as opposed to simply spots on the surface of the peritoneum.

Conclusion

The technique presented seems effective and safe both for diaphragmatic lesions, including those close to the pericardium and heart, and for pelvic endometriosis. The technique may also be reproduced.

研究目的介绍一种通过腹膜切除术将靠近心包和心脏的中央腱区的膈肌子宫内膜异位症整体切除的病例。患者或参与者24 岁患者，骨盆、腹部和胸部剧烈疼痛，伴有 IV 级 AAGL 子宫内膜异位症和靠近心包和心脏的膈肌病变。干预措施考虑到子宫内膜异位症病灶的位置和分布遵循一种称为穆勒氏路径的模式，以及腹膜下方的结缔组织层，采用广泛腹膜切除术对骨盆（Toldt筋膜、左侧宫旁、直肠和直肠）、右侧宫旁、右侧髂窝和阑尾、右肾上方和膈肌的所有受影响区域（包括靠近心包和心脏的中央腱区）进行整体切除。测量结果和主要结果从视频中可以看出，子宫内膜异位症的分布路径可能起源于穆勒胚胎，这与在胚胎发育过程中结肠的同时形成完全相关。这就决定了子宫内膜异位症会累及骨盆和右横膈膜，并可接近心脏。通过腹腔镜途径，使用超声波装置进行腹膜切除术，也可以看到整体切除的作用。此外，还可以看到子宫内膜异位症在结缔组织内形成广泛的 "大理石样 "病变，而不仅仅是腹膜表面的点状病变。结论所介绍的技术似乎对膈肌病变（包括靠近心包和心脏的病变）和盆腔子宫内膜异位症都有效且安全。该技术也可以复制。

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引用次数: 0

The Impact of Body Mass Index on Surgical Complications in Minimally Invasive Hysterectomy for Adenomyosis 身体质量指数对微创子宫腺肌症切除术手术并发症的影响

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Journal of minimally invasive gynecology

Pub Date : 2024-11-01 DOI: 10.1016/j.jmig.2024.09.131

C Liao , RJ Schneyer , KN Wright

Study Objective

To determine the impact of BMI on 30-day postoperative complications for patients undergoing minimally invasive hysterectomy (MIH) for adenomyosis in the United States.

Design

A cohort study of prospectively collected data.

Setting

American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2012 – 2020.

Patients or Participants

Patients with adenomyosis undergoing MIH.

Interventions

Minimally invasive hysterectomy.

Measurements and Main Results

Patients who underwent MIH for adenomyosis were classified into BMI subgroups based on the WHO classification system. Postoperative minor and major complications occurring within 30 days, defined according to the Clavien-Dindo classification, were compared across the BMI subgroups.

A total of 14,879 patients were included in the cohort. Higher BMI classes were associated with longer operative times (range 110.5-135.6 minutes, p<0.001).

The overall rate of complications ranged 7.1%-10.9% between groups, with the highest in the underweight group. There was a significant difference in the rates of any and major complications between groups (p=0.006 and p=0.020 respectively). When analyzing specific complications, higher BMI was associated with increased risk of superficial surgical site infection (p<0.001). Risks of septic shock or death were highest in the obesity class 3 group, but remained low (0.2% for both complications in obesity class 3).

In multivariable regression analysis comparing low and high BMI groups (</≥BMI 37.6), higher BMI was associated with increased odds for major complications [aOR 95% CI =1.29 (1.01-1.66)]. There was no significant association between low and high BMI and minor complications.

In multivariable regression analysis comparing BMI subgroups, BMI categories were not independently associated with any, minor, or major complications compared to the normal BMI category.

Conclusion

After adjusting for confounding factors, BMI ≥37.6 is independently associated with increased risk of major complications, but not with minor complications. Stratification by BMI groups did not reveal increased risk groups. These findings are reassuring and can help counsel and prepare patients for surgery.

研究目的确定BMI对美国接受微创子宫切除术（MIH）治疗子宫腺肌症患者术后30天并发症的影响.设计对前瞻性收集的数据进行队列研究.研究背景美国外科学院国家外科质量改进计划（NSQIP）数据库（2012-2020年）.患者或参与者接受微创子宫切除术的子宫腺肌症患者.干预措施微创子宫切除术.测量和主要结果根据世界卫生组织的分类系统将接受微创子宫切除术的子宫腺肌症患者分为BMI亚组。根据 Clavien-Dindo 分类法，比较了各 BMI 亚组在术后 30 天内发生的轻微和主要并发症。体重指数越高，手术时间越长（范围为 110.5-135.6 分钟，p<0.001）。各组的总并发症发生率为 7.1%-10.9%，体重不足组的并发症发生率最高。各组间任何并发症和主要并发症的发生率有明显差异（分别为 p=0.006 和 p=0.020）。在分析具体并发症时，体重指数越高，手术部位表皮感染的风险越高（p<0.001）。在比较低体重指数组和高体重指数组（</≥BMI 37.6）的多变量回归分析中，较高的体重指数与主要并发症几率增加有关[aOR 95% CI =1.29 (1.01-1.66)]。在比较 BMI 亚组的多变量回归分析中，与正常 BMI 类别相比，BMI 类别与任何、轻微或主要并发症均无独立关联。按 BMI 组别进行分层并未发现风险增加的组别。这些研究结果令人欣慰，有助于为患者提供咨询并为手术做好准备。

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引用次数: 0

Performance Evaluation of AI-Powered Pelvic Lymph Nodes Dissection Support System 人工智能盆腔淋巴结清扫辅助系统的性能评估

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Journal of minimally invasive gynecology

Pub Date : 2024-11-01 DOI: 10.1016/j.jmig.2024.09.088

S Takenaka , H Matsuzaki , Y Nakanishi , M Homma , N Takeshita , H Tanabe , Y Tsukada

Study Objective

The objective was to build a pelvic lymph node dissection support system using AI, evaluate the performance of the model, and verify whether this model provides an additional effect on physician organ recognition ability.

Design

This is a retrospective cohort study.

Setting

Using image data from 263 cases of pelvic lymphadenectomy from a national multi-center surgical database (111 gynecology, 118 colorectal, 34 urology), totaling 19,301 images, we constructed four organ recognition models (ureter, obturator nerve, external iliac artery/vein) using Feature Pyramid Networks (FPN). Subsequently, total of 1,920 videos were then created, including videos with and without each organ present.

Patients or Participants

Four obstetricians and gynecologists, two colorectal surgeons, two urologists.

Interventions

In the performance evaluation test, the accuracy of each organ was measured as Dice coefficient. In the additional evaluation test, surgeons were tested to determine the presence or absence of the organs and their locations in the videos without AI support. Next, the same test was conducted using videos with AI support.

Measurements and Main Results

In the performance evaluation test, the Dice coefficients were: ureter 0.700, nerve 0.835, artery 0.864, vein 0.862. In the additional effect test, sensitivity increased significantly for all organs except the artery: ureter +20.0% (43.4% → 63.4%), nerve +7.2% (68.4% → 75.6%), artery +5.9% (69.7% → 75.6%), and vein +11.5% (69.1% → 80.6%). Specificity also improved: ureter +4.4% (86.9% → 91.3%), nerve +7.5% (85.3% → 92.8%), artery +1.9% (93.4% → 95.3%), and vein +7.9% (83.4% → 91.3%), with no decline due to AI support.

Conclusion

The AI model showed a notable enhancement in surgeons' organ recognition ability. Future tests will involve surgeons of varying skill levels across three specialties to validate the model.

研究目的利用人工智能建立盆腔淋巴结清扫辅助系统，评估该模型的性能，并验证该模型是否能提高医生的器官识别能力。研究背景利用全国多中心手术数据库（妇科111例、结直肠118例、泌尿科34例）中263例盆腔淋巴结切除术的图像数据，共计19,301张图像，我们利用特征金字塔网络（FPN）构建了四个器官识别模型（输尿管、闭孔神经、髂外动脉/静脉）。患者或参与者四名妇产科医生、两名结直肠外科医生、两名泌尿科医生。干预措施在性能评估测试中，每个器官的准确性都以骰子系数来衡量。在附加评估测试中，在没有人工智能支持的情况下，对外科医生进行测试，以确定视频中是否存在器官及其位置。测量和主要结果在性能评估测试中，骰子系数分别为：输尿管 0.700、神经 0.835、动脉 0.864、静脉 0.862。在附加效应测试中，除动脉外，所有器官的灵敏度都有显著提高：输尿管 +20.0%（43.4% → 63.4%），神经 +7.2%（68.4% → 75.6%），动脉 +5.9%（69.7% → 75.6%），静脉 +11.5%（69.1% → 80.6%）。特异性也有所提高：输尿管 +4.4%（86.9% → 91.3%），神经 +7.5%（85.3% → 92.8%），动脉 +1.9%（93.4% → 95.3%），静脉 +7.9%（83.4% → 91.3%），没有因为人工智能的支持而下降。未来的测试将涉及三个专科不同技能水平的外科医生，以验证该模型。

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引用次数: 0