Journal of minimally invasive gynecology最新文献

{"title":"Laparoscopic Davydov Neovagina Creation in Mayer-Rokitansky-Küster-Hauser Syndrome with Pancake Kidney and a Solitary Ureter Using Dual Indocyanine Green Fluorescence Guidance.","authors":"Marie Josee Salem, Maria Abi Akl, Zaki Sleiman","doi":"10.1016/j.jmig.2026.02.043","DOIUrl":"https://doi.org/10.1016/j.jmig.2026.02.043","url":null,"abstract":"<p><strong>Objective: </strong>To demonstrate a novel dual indocyanine green (ICG) fluorescence-guided laparoscopic Davydov procedure for neovagina creation in a patient with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome and a pancake kidney with a solitary ureter.</p><p><strong>Setting: </strong>Tertiary referral center.</p><p><strong>Participants: </strong>A 24-year-old woman with MRKH syndrome and a right-sided pancake kidney with a single ureter, presenting for definitive surgical management.</p><p><strong>Interventions: </strong>Total laparoscopic Davydov neovagina creation was performed with dual fluorescence guidance. Prophylactic intravenous cefazolin (2 g) was administered at induction in accordance with institutional guidelines. An ICG-soaked rectal pad was positioned to delineate the rectal boundary during rectovaginal tunnel development under near-infrared imaging. Cystoscopy confirmed solitary ureteral anatomy, followed by selective ureteral catheterization and intraluminal ICG instillation to enable continuous real-time visualization during peritoneal mobilization and suturing. The neovaginal pouch was constructed using mobilized peritoneum circumferentially sutured to the introitus with extracorporeal knot-tying, followed by standardized postoperative stenting and dilation.</p><p><strong>Conclusion: </strong>Dual-structure ICG fluorescence guidance represents an innovative and reproducible adjunct for laparoscopic Davydov neovagina creation. Simultaneous visualization of the rectum and a solitary ureter in the setting of complex renal fusion anomalies enhances anatomic precision and may improve surgical safety during technically demanding MRKH reconstructions.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147390313","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}

{"title":"Non-invasive blood-based detection of endometriosis can improve standard-of-care by facilitating early diagnosis and clinical management among symptomatic women.","authors":"Wing Hing Wong, Yanqin Yu, Yao Hu, Yirong Shen, Jipeng Chen, Kayla Jarvis, Nicholas Sanford, Kayla A Knudson, Richard Gersh, Charmaine Yisha Ye, Brittney Bastow, Payam Katebi Kashi, Matthew Palmer, Getnet Gedefaw Azeze, Ronald Chi Chiu Wang, James Segars, Farideh Z Bischoff","doi":"10.1016/j.jmig.2026.02.042","DOIUrl":"https://doi.org/10.1016/j.jmig.2026.02.042","url":null,"abstract":"<p><strong>Study objective: </strong>To develop and validate a non-invasive, blood-based diagnostic assay for endometriosis that performs accurately across menstrual cycl phases and complements existing imaging modalities.</p><p><strong>Design: </strong>Multi-center case-control study with machine learning classification and independent cohort validation.</p><p><strong>Setting: </strong>Clinical and search settings involving symptomatic women evaluated for suspected endometriosis.</p><p><strong>Patients: </strong>A total of 298 reproductive-age women were included. The training cohort comprised 218 participants (137 endometriosis-positive and 81 controls). A modest, independent and retrospective validation cohort included 80 participants (40 endometriosis-positive and 40 controls).</p><p><strong>Interventions: </strong>Peripheral blood sampling with quantification of three microRNAs via qPCR, three protein biomarkers, one steroid hormone using immunoassay, as well as the participant's age and body mass index. Biomarker data were integrated using a random forest machine learning model to classify disease status.</p><p><strong>Measurements and main results: </strong>In the independent validation cohort, the assay achieved an area under the curve (AUC) of 0.944, sensitivity of 0.80, and specificity of 0.975. Subgroup analysis by menstrual cycle phase demonstrated consistent performance: proliferative-phase samples achieved an AUC of 0.935, sensitivity of 0.767, and specificity of 0.962, while secretory-phase samples achieved an AUC of 0.993, sensitivity of 0.90, and specificity of 1.00. Compared with transvaginal ultrasound and/or MRI, the blood-based assay identified 61.5% histologically confirmed endometriosis cases that were missed by the imaging modalities.</p><p><strong>Conclusion: </strong>A minimally invasive, multi-omic blood-based assay integrating molecular biomarkers with machine learning can accurately detect endometriosis across menstrual cycle phases and provides complementary diagnostic values. This approach has the potential to improve early detection, and guide timely clinical intervention. A prospective validation is ongoing in geographically and ethnically diverse populations to further assess its broad clinical utility.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147369714","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}

{"title":"Evaluation of the Effect of Hand Size on Forearm Muscle Activity While Using Laparoscopic Instruments","authors":"Emily Olig MD ,&nbsp;Matthew Buras MS ,&nbsp;Sara Wilson PhD ,&nbsp;Nandita Keole MD ,&nbsp;Johnny Yi MD","doi":"10.1016/j.jmig.2025.12.001","DOIUrl":"10.1016/j.jmig.2025.12.001","url":null,"abstract":"<div><h3>Objective</h3><div>Percent maximum voluntary contraction (%MVC) provides a normalized assessment of muscle exertion that can be compared between individuals. A higher %MVC during tasks can lead to more rapid muscle fatigue and increased risk of injury. This study evaluates the %MVC of forearm muscles while manipulating four laparoscopic energy devices and compares the differences in muscle activity between surgeons with different hand sizes.</div></div><div><h3>Design</h3><div>Nonexperimental correlational study.</div></div><div><h3>Setting</h3><div>Testing was performed in a simulation lab at Mayo Clinic Arizona.</div></div><div><h3>Participants</h3><div>Surgeons and surgical trainees that regularly perform robotic/laparoscopic surgery.</div></div><div><h3>Interventions</h3><div>Demographic information, glove size, and grip strength were collected. Four advanced energy devices were assessed. Surface electromyography (sEMG) electrodes were applied to the flexor digitorum superficialis (FDS), extensor carpi ulnaris (ECU), extensor carpi radialis longus (ECR), and extensor pollicis longus (EPL) of the dominant hand. Isometric MVC was performed on each muscle. Participants performed opening, closing, and activation cycles for each instrument. EMG output was filtered and normalized to provide %MVC.</div></div><div><h3>Measurements and Main Results</h3><div>Twenty-four individuals participated. Fourteen were female. Glove sizes ranged from 5.5 to 8.5, with 6.5 being the most common (n = 8). Glove size analysis was split between small (≤ 6.5) and large (&gt;6.5).</div><div>When adjusting for training level and instrument used, FDS and ECR displayed statistically significantly higher levels of activation in the small-handed group (p = .0012 and 0.013, respectively). 15% MVC was selected as a cutoff for evaluation due to increased risk of muscle fatigue and injury with sustained use above this threshold. Of the 16 muscle/instrument combinations, 10 showed a mean %MVC of greater than 15% for small hands, with one combination over 15% for large hands.</div></div><div><h3>Conclusion</h3><div>: Smaller-handed surgeons demonstrate increased forearm muscle activation when using laparoscopic instruments. Industry partners should consider variations in surgeon hand size when developing instruments to prevent disproportionate risk of injury to surgeons with smaller hands.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"33 3","pages":"Pages 291-296"},"PeriodicalIF":3.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145701314","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}

{"title":"Onabotulinumtoxin A Injections for Patients With Pelvic Floor Dysfunction","authors":"Gabrielle T. Whitmore MD,&nbsp;Jenny Tam MD,&nbsp;Megan S. Orlando MD","doi":"10.1016/j.jmig.2025.07.005","DOIUrl":"10.1016/j.jmig.2025.07.005","url":null,"abstract":"<div><h3>Study Objective</h3><div>To review the current literature surrounding onabotulinum toxin A injections for patients with pelvic floor dysfunction and to show how to perform these injections.</div></div><div><h3>Setting</h3><div>Academic tertiary care hospital</div></div><div><h3>Design</h3><div>It is estimated that about 50% to 90% of patients with chronic pelvic pain have pain that originates from myofascial sources, including the pelvic floor muscles. In patients with pelvic floor dysfunction, management consists of pelvic floor physical therapy with the addition of pelvic floor trigger point injections with a local anesthetic as needed. We offer onabotulinum toxin A to individuals who require long-term repeat trigger point injections, have barriers to accessing monthly injections, or show no durable improvement.</div></div><div><h3>Intervention</h3><div>We show a comprehensive pelvic floor exam and techniques for administering of onabotulinum toxin A to pelvic floor muscles in individuals with pelvic floor dysfunction, as well as a demonstration on a live patient. We perform an exam while the patient is awake, either in the clinic or at the time of the procedure, and examine the pubococcygeus, iliococcygeus, and obturator internus muscles to assess for hypertonicity and tenderness to palpation. Once sedation is initiated, 200 units of onabotulinum toxin A are then reconstituted with 20 mL of normal saline. The pudendal nerve kit allows for 1 cm depth of penetration with the needle. Approximately 1 to 2 mL of onabotulinumtoxin A are injected sequentially in multiple locations along the above-mentioned pelvic floor muscles. Medication effects may last up to 3 to 6 months, with a reduction in pain scores starting at 6 weeks and lasting through 12 weeks based on published literature. Adverse effects may include constipation, urinary incontinence, urinary tract infections, fecal incontinence, or urinary retention.</div></div><div><h3>Conclusions</h3><div>Onabotulinumtoxin A may be helpful in patients with refractory pelvic floor dysfunction. We show how to perform these injections with a safe and reproducible technique.</div></div><div><h3>Video Abstract</h3><div>Video: Onabotulinumtoxin A may be helpful in patients with refractory pelvic floor dysfunction, and we demonstrate how to perform these injections safely<span><span><span><span><video><source></source></video></span><span><span>Download: <span>Download video (24MB)</span></span></span></span></span></span></div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"33 3","pages":"Page 257"},"PeriodicalIF":3.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144718032","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}

{"title":"Low-grade Appendiceal Mucinous Neoplasm Presenting as Ovarian Cyst","authors":"Qiaofei Lyu MD,&nbsp;Xiaoyan Chen MD","doi":"10.1016/j.jmig.2025.04.010","DOIUrl":"10.1016/j.jmig.2025.04.010","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"33 3","pages":"Pages 247-248"},"PeriodicalIF":3.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144011876","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}

{"title":"Endometriosis Among Transgender and Gender Diverse Patients Imaging Study (ETRIS)","authors":"Maddalena Giacomozzi MD, MGH ,&nbsp;Donna Ruumpol BSc ,&nbsp;Robert de Leeuw MD, PhD ,&nbsp;Norah van Mello MD, PhD ,&nbsp;Maciej Krasinski MBBS, BSc ,&nbsp;Rufus Cartwright MD, PhD, MRCOG ,&nbsp;Richard Flint MD, MRCOG ,&nbsp;Laura Spinnewijn MD, PhD ,&nbsp;Petra Verdonk PhD ,&nbsp;Annemiek Nap MD, PhD","doi":"10.1016/j.jmig.2025.08.021","DOIUrl":"10.1016/j.jmig.2025.08.021","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the prevalence of surgically confirmed endometriosis among assigned-female-at-birth (AFAB) transgender and gender diverse (TGD) individuals undergoing laparoscopic pelvic surgery.</div></div><div><h3>Design</h3><div>Retrospective multicenter cohort study from 2021 to 2024.</div></div><div><h3>Setting</h3><div>Three academic medical centers in the Netherlands and the United Kingdom.</div></div><div><h3>Participants</h3><div>Eligible participants were AFAB TGD individuals aged ≥18 years who underwent pelvic laparoscopic surgery for any indication, including gender incongruence/dysphoria.</div></div><div><h3>Interventions</h3><div>Data on demographics, medical history, and diagnostic imaging were analyzed using descriptive statistics. Surgical confirmation of endometriosis was the primary outcome.</div></div><div><h3>Results</h3><div>Among 325 participants, endometriosis prevalence was 3.1% (n = 10). The mean age of participants was 27.2 years and the mean body mass index (BMI) 24.9. Testosterone was predominantly used before surgery (95.4%), and among these users, 38.5% had been on testosterone for 5 or more years at the time of surgery. Overall, 6% of the sample reported dysmenorrhea, and among those with endometriosis, 30% experienced dysmenorrhea.</div></div><div><h3>Conclusion</h3><div>Endometriosis was present in 3.1% of the sample. This finding differs from previous literature as it reports a lower prevalence compared to cisgender women and to other studies on TGD people. This is potentially due to prolonged use of testosterone and early initiation of gender-affirming care (GAC).</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"33 3","pages":"Pages 308-315"},"PeriodicalIF":3.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957617","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}

{"title":"Risk Factors for Reoperation and Subsequent Uterine Preservation in Congenital Cervical Malformation","authors":"Shuwen Zhang MD ,&nbsp;Na Chen MD ,&nbsp;Si Su MD ,&nbsp;Jia Kang MD ,&nbsp;Shuang Song MD ,&nbsp;Lan Zhu MD","doi":"10.1016/j.jmig.2025.11.011","DOIUrl":"10.1016/j.jmig.2025.11.011","url":null,"abstract":"<div><h3>Objective</h3><div>To primarily evaluate the occurrence, causes, and risk factors of reoperation in patients with congenital cervical malformation, and secondarily to investigate the determinants of subsequent uterine preservation in this population.</div></div><div><h3>Design</h3><div>Retrospective case-control study.</div></div><div><h3>Setting</h3><div>A tertiary referring hospital in China.</div></div><div><h3>Participants</h3><div>A total of 82 patients with congenital cervical malformation between January 2003 and April 2024.</div></div><div><h3>Interventions</h3><div>Retrospective chart review and follow-up of patients diagnosed with congenital cervical malformation, including collection of data on demographics, disease characteristics, surgical details, reoperation timing and causes, and uterine preservation outcomes.</div></div><div><h3>Results</h3><div>Among 82 patients, 47 (57.3%) underwent only one surgery without requiring reoperation, while 35 (42.7%) underwent reoperation. The median age at initial surgery was 13 (interquartile range, 12–16) years. The interval between primary and secondary surgeries ranged from 2 weeks to 12 years (mean 32.6 months). The main causes for reoperation included infection with fever, pelvic mass formation, restenosis or obstruction, and persistent abdominal pain. An accurate initial diagnosis and the placement of a cervical stent during the initial procedure were associated with prolonged reoperation-free survival (p &lt; .05). Among the 35 patients who underwent reoperation, 19 (54.29%) successfully preserved the uterus, while 16 (45.71%) ultimately required hysterectomy. Cervical obstruction type was independently associated with successful uterine preservation (p = .005).</div></div><div><h3>Conclusion</h3><div>An accurate initial diagnosis and intraoperative placement of a cervical stent were associated with longer reoperation-free intervals. Notably, patients with cervical obstruction demonstrated higher success rates with uterine-sparing procedures compared to those with other types of congenital cervical malformation.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"33 3","pages":"Pages 325-331"},"PeriodicalIF":3.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145634599","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}

{"title":"Postoperative Hysterectomy Complications: Comparing Novel Versus Traditional Hemoglobin A1c Cut-Offs","authors":"Noelle Matese MD ,&nbsp;Xi Wang BS ,&nbsp;Suman Sahil MBA ,&nbsp;An-Lin Cheng PhD ,&nbsp;Carsen Steele BS ,&nbsp;Alleana Corpin BA ,&nbsp;Jonathan P. Shepherd MD ,&nbsp;Gary Sutkin MD","doi":"10.1016/j.jmig.2025.11.016","DOIUrl":"10.1016/j.jmig.2025.11.016","url":null,"abstract":"<div><h3>Study Objective</h3><div>To investigate the correlation between HbA_1c and complications after hysterectomies.</div></div><div><h3>Design</h3><div>Retrospective cohort analysis.</div></div><div><h3>Setting</h3><div>Cerner Health Facts (519 million patient encounters from 750 hospitals).</div></div><div><h3>Patients</h3><div>Patients undergoing laparoscopic ± robotic-assisted, vaginal, or abdominal hysterectomy, January 2010 to November 2018. We included patients with perioperative HbA_1c values, including those diagnosed with diabetes or undergoing screening.</div></div><div><h3>Interventions</h3><div>We performed univariable and multivariable logistic regressions with the outcome a composite of any post-op complication. We adjusted for HbA_1c as continuous and categorical variables using HbA_1c (&gt;8.0% based on guidelines and &gt;8.85% based on receiver operating characteristic analysis from current dataset) as cut-points.</div></div><div><h3>Measurements and Main Results</h3><div>Of 86,420 hysterectomies, 2693 (3.1%) had nonexcluded HbA_1c, including 514 (19.1%) with complications and 2179 (80.9%) without. Median time to complication was 18 days. Patients were 75.2% white, 83.2% in urban hospitals. Route was predominantly minimally invasive: 30.5% laparoscopic, 25.6% vaginal, 43.9% abdominal, with 69.8% adnexa removed. Patients with complications were older (60.5 ± 15.9 vs 58.4 ± 14.2 years, p = .004), more likely from the Southern US (24.5% vs 18.5%, p = .006), used tobacco (26.7% vs 19.0%, p &lt; .001), and were obese (32.3% vs 23.3%, p &lt; .001). Most complications were infectious (87.4%). Higher HbA_1c was associated with more complications, whether continuous (p = .03), HbA_1c &gt; 8.0% (p = .01), or HbA_1c &gt; 8.85% (p = .001). HbA_1c &gt; 8.85% optimized test characteristics (sensitivity = 0.14, specificity = 0.91, PPV = 0.27, NPV = 0.82). Predictive value improved with confounders (area under the curve = 0.71–0.72), and multivariable analysis demonstrated HbA_1c &gt; 8.85% increased complications (odds ratio [OR] = 1.71, 95% CI = 1.25–2.32). Obesity (OR = 1.31, 95% CI = 1.04–1.64) and urogynecological diagnoses, including urinary frequency, history of urinary tract infection, and dysuria (OR = 2.31, 3.71, 3.98, respectively), also increased complications.</div></div><div><h3>Conclusion</h3><div>HbA_1c as a continuous variable impacted complications, so HbA_1c reductions will likely decrease complications. For surgeons deciding to proceed with hysterectomy based on preoperative HbA_1c, 8.0% and 8.85% are both acceptable cut-points. Multivariable models outperformed HbA_1c alone, warranting further research to predict complications.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"33 3","pages":"Pages 275-282"},"PeriodicalIF":3.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145648846","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}

{"title":"The Current State of AAGL–Fellowship in Minimally Invasive Gynecologic Surgery: Surgical Volume and Case Types","authors":"Katie Kwon MD ,&nbsp;Francesca Lim MS ,&nbsp;Courtney Lim MD ,&nbsp;Stephanie Morris MD ,&nbsp;Hye-Chun Hur MD, MPH","doi":"10.1016/j.jmig.2025.12.002","DOIUrl":"10.1016/j.jmig.2025.12.002","url":null,"abstract":"<div><h3>Study Objective</h3><div>To describe the current state of the American Association of Gynecologic Laparoscopists (AAGL)–Fellowship in Minimally Invasive Gynecologic Surgery (FMIGS) programs, assessing case volume, case types, and differences among programs.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting</h3><div>FMIGS in the United States.</div></div><div><h3>Patients</h3><div>All fellows who started and completed an AAGL-FMIGS program in the United States between 2020 and 2024.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Measurements and Main Results</h3><div>During the study period, 130 fellows completed a 2 or 3-year fellowship from start to finish among 52 fellowships. The median number of total cases completed in a 2-year fellowship was 510 (interquartile range [IQR], 428–586). The most common procedure was hysterectomy (median, 210 [IQR, 174–255]), followed by peritoneal procedures, which included retroperitoneal dissection and adhesiolysis (median, 125 [IQR 91–167]), and endometriosis procedures (median, 89 [IQR, 56–132]). The medians for other case types were as follows: myomectomies (including hysteroscopic), 62 (IQR, 40–95); adnexal surgeries, 39 (IQR, 25–67); and hysteroscopies (excluding hysteroscopic myomectomy), 45 (IQR, 35–77). Among the 130 fellows, 67% (n = 87) had FMIGS-trained program directors and 33% (n = 43) had non-FMIGS-trained program directors. Fellows from programs with FMIGS-trained program directors had greater surgical volume than fellows with non-FMIGS-trained program directors (median number of cases per fellow, 537 [IQR, 468–620] vs 464 [IQR, 367–551]; p = .03). Furthermore, fellows from programs with FMIGS-trained program directors compared with those with non-FMIGS-trained program directors completed a median of 108 vs 58 endometriosis surgeries (p = .01), 71 vs 44 myomectomies (p = .01), 52 vs 39 hysteroscopies (p = .06), and 215 vs 187 hysterectomies (p = .27), respectively.</div></div><div><h3>Conclusion</h3><div>Adopting the Accreditation Council for Graduate Medical Education case log system provided greater insight into the volume and types of cases completed in AAGL-FMIGS programs. Overall, AAGL-FMIGS programs have robust surgical volume with program director training affecting volume and case types. Fellows from programs with FMIGS-trained program directors have significantly greater total case volume, myomectomies, and endometriosis surgeries.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"33 3","pages":"Pages 297-307"},"PeriodicalIF":3.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145708467","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}

{"title":"Safe Without Suction: Double-Blind Randomized Controlled Trial Challenges Routine Gastric Decompression in Laparoscopy","authors":"Kristina Karlson MD, Capt, USAF, MC ,&nbsp;Annie Gauf MD ,&nbsp;Petra Voigt MD ,&nbsp;Lulu Yu MD ,&nbsp;Linda Yang MD ,&nbsp;Angela Chaudhari MD ,&nbsp;Susan Tsai MD ,&nbsp;Jungwha Lee PhD, MPH ,&nbsp;Magdy P. Milad MD, MS","doi":"10.1016/j.jmig.2025.12.016","DOIUrl":"10.1016/j.jmig.2025.12.016","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to evaluate the necessity of intraoperative gastric decompression during gynecologic laparoscopy.</div></div><div><h3>Methods</h3><div>This study is a double-blind randomized controlled trial in which participants undergoing any benign gynecologic laparoscopy procedure with umbilical entry were block randomized (1:1) to either receive gastric decompression or not. Individuals were screened for eligibility based on surgical scheduling for gynecologic laparoscopy undergoing umbilical entry. The intervention was performed after the patient was intubated and while the surgeon was out of the operating room to maintain blinding. At the time of laparoscopic entry, surgeons subjectively assessed the degree of stomach decompression, risk of gastric injury, and distance between the umbilicus and inferior gastric margin. A sample size calculation determined that 73 participants per group were needed.</div></div><div><h3>Results</h3><div>From November 2023 to March 2025, 155 participants were consented to participate and 146 were enrolled and randomized. Participants in the study and control groups did not significantly vary based on age (37.8 vs 36.8), body mass index (27.3 vs 27.9), or procedure type. The primary outcome, stomach well decompressed, was achieved in 97.2% of participants in the study group without an orogastric (OG) tube and 98.5% in the control group with an OG tube (difference, −1.3%; 95% confidence interval, −8.8 to 6.2; p = .01 for noninferiority), with noninferiority margin set at −10%. There were no cases of gastric injury in both groups.</div></div><div><h3>Conclusion</h3><div>Routine gastric decompression during gynecologic laparoscopy with umbilical entry is not necessary for low-risk participants. Regardless of the placement of an OG tube, the stomach was adequately decompressed, not at risk of injury, and without negative postoperative participant experience.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"33 3","pages":"Pages 332-338"},"PeriodicalIF":3.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145762979","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}