Journal of minimally invasive gynecology最新文献

Study objective: To identify the type of endometriosis education and surgical training colorectal surgery residents are exposed to during training. To determine the current surgical management of endometriosis among recently graduated colorectal surgeons and their level of comfort.

Design: A qualitative cross-sectional study was performed. An anonymous questionnaire was emailed to colorectal surgery residents of 2023 and recent graduates for completion. Data was then extracted and analyzed from REDCap. A chi-square test was performed on the primary outcome variables.

Setting: A REDCap electronic survey was administered through email to each participant.

Patients: All colorectal surgery residents in 2023 and recent graduates from Colon and Rectal Surgery subspecialty from 2012 to 2022.

Interventions: A 17-item anonymous questionnaire was sent via email through REDCap.

Measurements and main results: The survey was completed by 70 participants. Most respondents (58.5%) did not receive formal education on bowel endometriosis. Forty percent of participants (28/70) did not feel they received adequate training for surgical management of bowel endometriosis. In terms of surgical exposure, 3.8% (2) responded they had been involved in >15 bowel endometriosis cases and 18 (25.7%) had been exposed to 1-5 cases during colorectal training. Factors that predicted feeling adequately trained in managing endometriosis included formal endometriosis education (OR 4.70, 95% CI 1.37-16.12, p-value .027) and surgical exposure during training (OR 4.38, 95% CI 1.18-16.26, p-value .014). Additionally, the number of cases exposed during training is highly correlated with feeling adequately trained.

Conclusion: More than half of colorectal surgeons did not receive formal education on bowel endometriosis and the majority had only been exposed to 1-5 cases during their colorectal training. An overwhelming majority were interested in further education. This study highlights opportunities for improvement in the exposure to education and surgical management of endometriosis among colorectal surgery trainees.

Objective: The objective of this study is to compare intraoperative and postoperative outcomes in women undergoing removal of adnexal structures by either posterior culdotomy or abdominal extraction.

Design: This is a retrospective cohort study conducted via medical record review. Demographic, clinical, and operative variables were abstracted from the medical records. Statistical analysis consisted of descriptive statistics, Fisher's exact tests, Wilcoxon rank sum tests, and multivariable logistic regression models.

Setting: Single academic tertiary care center between 2010 and 2022.

Participants: A total of 718 patients were identified and included in our analysis who underwent minimally invasive ovarian cystectomy or oophorectomy. Patients were excluded if they underwent concomitant hysterectomy.

Interventions: Patients underwent minimally invasive oophorectomy or ovarian cystectomy, and specimens were extracted by either abdominal extraction (AE) or culdotomy extraction (CE).

Measurements and main results: Of the 718 patients who met inclusion criteria, 127 (17.7%) underwent CE, and 591 (82.3%) underwent abdominal extraction. The CE group had longer operative times (113 minutes vs 96 minutes, p <.001) and higher estimated blood loss (25 mL vs 10 mL, p <.001) compared to the abdominal extraction group. There were more malignancies in the CE than the abdominal extraction group (15.7% vs 8.1%, respectively, p <.001). After adjusting for potential confounders, those who underwent CE were more likely to have 2 or more clinic visits (OR 2.89; 95% confidence interval, 1.66-5.03; p <.001) and call or message the clinic (OR 2.08; 95% confidence interval, 1.35-3.20; p <.001). There were no incidences of cuff dehiscence, cuff cellulitis, or pelvic abscess in either group.

Conclusion: Removal of adnexal specimens via abdominal port site or posterior culdotomy incision is a feasible option for specimen extraction and can be individualized based on patient and surgeon preference and patient factors. Those undergoing CE may require more preoperative counseling due to higher rate of postoperative messages seen in our cohort.

Study objective: Use machine learning to characterize the content of endometriosis online community posts and comments.

Design: Retrospective Descriptive Study.

Setting: Endometriosis online health communities (OHCs) on the platform Reddit.

Participants: Users of the endometriosis OHCs r/Endo and r/endometriosis.

Interventions: Machine learning was used to analyze thousands of posts made to endometriosis OHCs. Content of posts and comments was interpreted using topic modeling, persona identification, and intent labeling. Measurements included baseline characteristics of users, posts, and comments to the OHCs. Machine-learning techniques; topic modeling, intent labeling, and persona identification were used to identify the most common topics of conversation, the intents behind the posts, and the subjects of people discussed in posts. System performance was assessed via accuracy at F₁-score.

Results: A total of 34 715 posts and 353 162 comments responding to posts were evaluated. The topics most likely to be a subject of a post were menstruation (8%), sharing symptoms (8%), medical appointments (8%), medical story (9%), and empathy (7%). The majority of posts were written with the intent of seeking information about endometriosis (49%) or seeking the experiences of others with endometriosis (29%). Users expressed a strong preference for surgeons performing excision rather than ablation of endometriosis.

Conclusion: Endometriosis OHCs are mostly used to learn about symptoms of endometriosis and share one's medical experiences. Posts and comments from users highlight the need for more empathy in the clinical care of endometriosis and easier access for patients to high-quality information about endometriosis.

Study objective: To describe how the knowledge from standard imaging practices can be translated into 3-dimensional visualization techniques and used in the surgical planning and management of endometriosis.

Design: Two case studies of patients with endometriosis are described.

Setting: Tertiary care academic center.

Interventions: Transvaginal ultrasound [1], magnetic resonance imaging, 3-dimensional printing [2], and 3-dimensional virtual reality modeling [3] were used during patient workup and preparation. Three-dimensional modeling was performed by a virtual reality technician and verified for accuracy by a fellowship-trained radiologist. Surgical management for endometriosis was performed.

Conclusion: Although expert transvaginal ultrasound and magnetic resonance imaging suffice for most cases, 3-dimensional printing and virtual reality modeling are a novel adjunct to standard imaging modalities. Rendering 2-dimensional images into a 3-dimensional representation allows users to interact with the anatomy and is particularly useful when distorted by complex pathology. These techniques contributed to improved patient understanding and experience and helped medical learners better grasp regular imaging techniques and its translation to pelvic anatomy. Finally, it augmented surgeon comprehension of the relationship between the pelvic structures, allowing for enhanced surgical planning and intraoperative decision making. Further study is being performed to quantify these effects.