Pub Date : 2024-10-01DOI: 10.1016/j.jmig.2024.09.365
Daniel Y Lovell, Emily Sendukas, Qiannan Yang, Xiaoming Guan
Objective: To demonstrate the time to place temporary bilateral stents with indocyanine green (ICG) injection, time to intra-operative identification of bilateral ureters - with and without the use of ICG, and number of times for ICG activation in endometriosis excision surgery.
Design: Retrospective cross-sectional study SETTING: Single Tertiary Academic Hospital PARTICIPANTS: 50 serial patients with functioning pelvic ureters, who underwent vaginal natural orifice transluminal endoscopic surgery (vNOTES) for all stages of endometriosis excision between September 2023 and May 2024.
Interventions: Placement of temporary bilateral ureteral stents with indocyanine green injection before the start of vNOTES, noting the time needed to identify intra-peritoneal ureters with and without ICG activation, and average number of times ICG was activated for endometriosis excision.
Results: The median time to place bilateral ureteral stents with ICG injection was 229 seconds. The median time for intra-operative ureteral identification with ICG was 1s (L) and 1s (R). The median time for intra-operative ureteral identification without ICG was 17s (L) and 17s (R). The median time ICG was activated for ureteral identification to perform endometriosis excision was 12 times (L), 11 times (R). From the observations previously described, we share the potential of improved efficiency and efficacy in using ICG in ureteral identification for endometriosis surgery.
Conclusion: Placement of temporary bilateral ureteral stents with ICG has the potential for more efficient ureteral identification even after including time for ureteral stent placement and ICG injection. The upfront time needed to place stents may prove to lead to a safer, more efficient procedure.
{"title":"Surgical enhancement with the placement of temporary bilateral ureteral stents with Indocyanine Green injection for all stages of endometriosis in vNOTES: Retrospective cross-sectional study.","authors":"Daniel Y Lovell, Emily Sendukas, Qiannan Yang, Xiaoming Guan","doi":"10.1016/j.jmig.2024.09.365","DOIUrl":"https://doi.org/10.1016/j.jmig.2024.09.365","url":null,"abstract":"<p><strong>Objective: </strong>To demonstrate the time to place temporary bilateral stents with indocyanine green (ICG) injection, time to intra-operative identification of bilateral ureters - with and without the use of ICG, and number of times for ICG activation in endometriosis excision surgery.</p><p><strong>Design: </strong>Retrospective cross-sectional study SETTING: Single Tertiary Academic Hospital PARTICIPANTS: 50 serial patients with functioning pelvic ureters, who underwent vaginal natural orifice transluminal endoscopic surgery (vNOTES) for all stages of endometriosis excision between September 2023 and May 2024.</p><p><strong>Interventions: </strong>Placement of temporary bilateral ureteral stents with indocyanine green injection before the start of vNOTES, noting the time needed to identify intra-peritoneal ureters with and without ICG activation, and average number of times ICG was activated for endometriosis excision.</p><p><strong>Results: </strong>The median time to place bilateral ureteral stents with ICG injection was 229 seconds. The median time for intra-operative ureteral identification with ICG was 1s (L) and 1s (R). The median time for intra-operative ureteral identification without ICG was 17s (L) and 17s (R). The median time ICG was activated for ureteral identification to perform endometriosis excision was 12 times (L), 11 times (R). From the observations previously described, we share the potential of improved efficiency and efficacy in using ICG in ureteral identification for endometriosis surgery.</p><p><strong>Conclusion: </strong>Placement of temporary bilateral ureteral stents with ICG has the potential for more efficient ureteral identification even after including time for ureteral stent placement and ICG injection. The upfront time needed to place stents may prove to lead to a safer, more efficient procedure.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372094","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 : 2024-10-01DOI: 10.1016/j.jmig.2024.06.011
Study Objective
To evaluate the effectiveness of using vascular clips to seal targeted lymphatics in gynecological malignancies for the prevention of postoperative pelvic lymphocele and symptomatic lymphocele after laparoscopic pelvic lymphadenectomy.
Design
Retrospective analysis.
Setting
Single-center academic hospital.
Patients
In total, 217 patients with gynecological malignancies were included.
Interventions
Patients were classified into two groups: group 1 (vascular clips were used to seal the targeted lymphatics) and group 2 (electrothermal instruments were used to seal the targeted lymphatics). The patients were followed up 4–6 weeks after surgery to evaluate the incidence of lymphoceles by ultrasound or CT. Symptomatic lymphoceles are defined as those that cause infection, deep vein thrombosis with or without swelling of the extremities, edema (swelling) of the extremities or perineum, hydronephrosis, and/or moderate to severe pain.
Measurements and Main Results
One hundred and thirteen patients were enrolled in group 1, and 104 patients were enrolled in group 2. Lymphoceles were observed in 46 (21.2%) patients. Fewer lymphoceles occurred in group 1 than in group 2 (8 [7.1%] vs. 38 [36.5%], p <.001). The percentage of significantly sized lymphoceles was lower in group 1 than that in group 2 (4 [3.5%] vs. 30 [28.8%], p <.001]. Symptomatic lymphoceles occurred in 18 patients (8.3%), and only one (1.0%) occurred in group 1, while 17 (16.3%) occurred in group 2 (p <.001). A multivariate analysis revealed that vascular clips were the only independent factor for preventing lymphocele (OR = 7.65, 95% CI = [3.30–17.13], p <.001) and symptomatic lymphocele (OR = 22.03, 95% CI = [2.84–170.63], p = .003).
Conclusion
The results indicate that the use of vascular clips may be useful for the prevention of the development of lymphocele and symptomatic lymphocele secondary to pelvic lymphadenectomy performed via laparoscopy.
{"title":"Vascular Clips for Preventing Lymphocele and Symptomatic Lymphocele in Patients With Gynecologic Malignancies After Laparoscopic Pelvic Lymphadenectomy","authors":"","doi":"10.1016/j.jmig.2024.06.011","DOIUrl":"10.1016/j.jmig.2024.06.011","url":null,"abstract":"<div><h3>Study Objective</h3><div>To evaluate the effectiveness of using vascular clips to seal targeted lymphatics in gynecological malignancies for the prevention of postoperative pelvic lymphocele and symptomatic lymphocele after laparoscopic pelvic lymphadenectomy.</div></div><div><h3>Design</h3><div>Retrospective analysis.</div></div><div><h3>Setting</h3><div>Single-center academic hospital.</div></div><div><h3>Patients</h3><div>In total, 217 patients with gynecological malignancies were included.</div></div><div><h3>Interventions</h3><div>Patients were classified into two groups: group 1 (vascular clips were used to seal the targeted lymphatics) and group 2 (electrothermal instruments were used to seal the targeted lymphatics). The patients were followed up 4–6 weeks after surgery to evaluate the incidence of lymphoceles by ultrasound or CT. Symptomatic lymphoceles are defined as those that cause infection, deep vein thrombosis with or without swelling of the extremities, edema (swelling) of the extremities or perineum, hydronephrosis, and/or moderate to severe pain.</div></div><div><h3>Measurements and Main Results</h3><div>One hundred and thirteen patients were enrolled in group 1, and 104 patients were enrolled in group 2. Lymphoceles were observed in 46 (21.2%) patients. Fewer lymphoceles occurred in group 1 than in group 2 (8 [7.1%] vs. 38 [36.5%], p <.001). The percentage of significantly sized lymphoceles was lower in group 1 than that in group 2 (4 [3.5%] vs. 30 [28.8%], p <.001]. Symptomatic lymphoceles occurred in 18 patients (8.3%), and only one (1.0%) occurred in group 1, while 17 (16.3%) occurred in group 2 (p <.001). A multivariate analysis revealed that vascular clips were the only independent factor for preventing lymphocele (OR = 7.65, 95% CI = [3.30–17.13], p <.001) and symptomatic lymphocele (OR = 22.03, 95% CI = [2.84–170.63], p = .003).</div></div><div><h3>Conclusion</h3><div>The results indicate that the use of vascular clips may be useful for the prevention of the development of lymphocele and symptomatic lymphocele secondary to pelvic lymphadenectomy performed via laparoscopy.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141468685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/S1553-4650(24)00380-7
{"title":"Board Of Directors-Ed Calendar","authors":"","doi":"10.1016/S1553-4650(24)00380-7","DOIUrl":"10.1016/S1553-4650(24)00380-7","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142416292","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 : 2024-10-01DOI: 10.1016/j.jmig.2024.05.025
{"title":"Cotyledonoid Dissecting Leiomyoma of the Uterus: A Benign Uterine Tumor That Resembles Malignancy","authors":"","doi":"10.1016/j.jmig.2024.05.025","DOIUrl":"10.1016/j.jmig.2024.05.025","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141158462","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 : 2024-10-01DOI: 10.1016/j.jmig.2024.05.024
{"title":"Surgical Considerations for Minimally Invasive Gynecologic Surgery in Patient With Skeletal Dysplasia","authors":"","doi":"10.1016/j.jmig.2024.05.024","DOIUrl":"10.1016/j.jmig.2024.05.024","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141158467","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 : 2024-10-01DOI: 10.1016/j.jmig.2024.06.003
<div><h3>Study Objective</h3><div><span><span>Pelvic exenteration (PE) is an aggressive surgical procedure that implies a large hard-to-fill pelvic defect. Different reconstruction techniques were proposed to improve abdominal organ support and reduce complications (infections, pelvic organs herniation, vaginal stump dehiscence, </span>bowel prolapse and obstruction) [</span><span><span>1</span></span>], with conflicting results [<span><span>2</span></span>]. Because of young age and survival greater than 50% at 5 years in patients with no residual tumor after surgery [<span><span>3</span></span><span>], a new approach with better clinical results to pelvic reconstruction is needed.</span></div></div><div><h3>Design</h3><div><span>The aim of this surgical film is to present an unusual presentation of vaginal sarcoma, successfully managed with a minimally invasive approach, and to illustrate our contextual multilayer technique of pelvic reconstruction using a combination of pedicled omental flap (POF) and human </span>acellular dermal matrix (HADM).</div></div><div><h3>Setting</h3><div>Tertiary level academic hospital. A 42-year-old obese patient with recurrent and symptomatic myxoid leiomyosarcoma<span>, previously underwent vaginal-assisted laparoscopic surgery<span> at a primary care center for the removal of a vaginal swelling.</span></span></div></div><div><h3>Interventions</h3><div><span>The multidisciplinary board determined anterior PE as the optimal therapeutic approach. Given the patient's body mass index (33 kg/m</span><sup>2</sup><span>), young age, and the favorable outcomes of robotic surgery in obese patients compared with other approaches [</span><span><span>3</span></span>,<span><span>4</span></span><span>], we proposed a combined robotic and vaginal surgery for both exenteration and reconstructive procedures [</span><span><span>5</span></span><span>]. During surgery, we initially explored the abdominal cavity<span><span><span> to exclude macroscopic metastasis, followed by anterior PE. </span>Urinary diversion was achieved with a </span>Bricker ileal conduit<span><span><span> by means of an ileoileal laterolateral anastomosis and an uretero-ileo-cutaneostomy. The pelvic dead space was partially filled with a POF on the left </span>gastroepiploic artery. Subsequently, the pelvic defect was covered by a 15 × 10 mm HADM inlay inserted circumferentially at the pelvic brim, fixed with a barbed thread suture on residual pelvic structures. The final pathology confirmed the recurrence of myxoid leiomyosarcoma and indicated tumor-free resection margins. The intraoperative and </span>postoperative periods were uneventful. The patient was discharged 14 days after surgery and underwent adjuvant doxorubicin- and dacarbazine-based chemotherapy, which was initiated 45 days after the surgery. Currently the patient is asymptomatic and disease free at the sixth month of follow-up.</span></span></span></div></div><div><h3>Conclusion</h3><div>Roboti
{"title":"Combined Robotic and Vaginal Surgery for Pelvic Exenteration Due to Vaginal Sarcoma Relapse in an Obese Woman","authors":"","doi":"10.1016/j.jmig.2024.06.003","DOIUrl":"10.1016/j.jmig.2024.06.003","url":null,"abstract":"<div><h3>Study Objective</h3><div><span><span>Pelvic exenteration (PE) is an aggressive surgical procedure that implies a large hard-to-fill pelvic defect. Different reconstruction techniques were proposed to improve abdominal organ support and reduce complications (infections, pelvic organs herniation, vaginal stump dehiscence, </span>bowel prolapse and obstruction) [</span><span><span>1</span></span>], with conflicting results [<span><span>2</span></span>]. Because of young age and survival greater than 50% at 5 years in patients with no residual tumor after surgery [<span><span>3</span></span><span>], a new approach with better clinical results to pelvic reconstruction is needed.</span></div></div><div><h3>Design</h3><div><span>The aim of this surgical film is to present an unusual presentation of vaginal sarcoma, successfully managed with a minimally invasive approach, and to illustrate our contextual multilayer technique of pelvic reconstruction using a combination of pedicled omental flap (POF) and human </span>acellular dermal matrix (HADM).</div></div><div><h3>Setting</h3><div>Tertiary level academic hospital. A 42-year-old obese patient with recurrent and symptomatic myxoid leiomyosarcoma<span>, previously underwent vaginal-assisted laparoscopic surgery<span> at a primary care center for the removal of a vaginal swelling.</span></span></div></div><div><h3>Interventions</h3><div><span>The multidisciplinary board determined anterior PE as the optimal therapeutic approach. Given the patient's body mass index (33 kg/m</span><sup>2</sup><span>), young age, and the favorable outcomes of robotic surgery in obese patients compared with other approaches [</span><span><span>3</span></span>,<span><span>4</span></span><span>], we proposed a combined robotic and vaginal surgery for both exenteration and reconstructive procedures [</span><span><span>5</span></span><span>]. During surgery, we initially explored the abdominal cavity<span><span><span> to exclude macroscopic metastasis, followed by anterior PE. </span>Urinary diversion was achieved with a </span>Bricker ileal conduit<span><span><span> by means of an ileoileal laterolateral anastomosis and an uretero-ileo-cutaneostomy. The pelvic dead space was partially filled with a POF on the left </span>gastroepiploic artery. Subsequently, the pelvic defect was covered by a 15 × 10 mm HADM inlay inserted circumferentially at the pelvic brim, fixed with a barbed thread suture on residual pelvic structures. The final pathology confirmed the recurrence of myxoid leiomyosarcoma and indicated tumor-free resection margins. The intraoperative and </span>postoperative periods were uneventful. The patient was discharged 14 days after surgery and underwent adjuvant doxorubicin- and dacarbazine-based chemotherapy, which was initiated 45 days after the surgery. Currently the patient is asymptomatic and disease free at the sixth month of follow-up.</span></span></span></div></div><div><h3>Conclusion</h3><div>Roboti","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141310913","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 : 2024-10-01DOI: 10.1016/j.jmig.2024.04.014
<div><h3>Objective</h3><div><span><span>During radical pelvic surgeries<span> fibers of the autonomic pelvic nervous network can be accidentally damaged leading to significant visceral sequelae<span>, which dramatically affect women's quality of life because of </span></span></span>urinary, anorectal, and sexual postoperative dysfunctions.</span><span><span><sup>1</sup></span></span><sup>,</sup><span><span><sup>2</sup></span></span><span><span> Direct visualization is one way to preserve hypogastric nerves<span><span> (HNs), pelvic splanchnic nerves (PSNs), and the </span>bladder branches from the inferior </span></span>hypogastric plexus<span> (IHP). However, the literature lacks critical photos and/or illustrations that are necessary to understand the precise anatomy needed to preserve the pelvic autonomic fibers.</span></span></div></div><div><h3>Design</h3><div>Narrated laparoscopic video footage for identifying, dissecting, and preserving the autonomic nerve bundles during pelvic surgery.</div></div><div><h3>Setting</h3><div>Tertiary level hospital—“IRCCS Istituto Nazionale dei Tumori”, Milano, Italy.</div></div><div><h3>Interventions</h3><div><span><span>Visceral pelvic innervation is established by the superior hypogastric plexus(SHP) located anteriorly to the </span>aortic bifurcation<span> and the median sacral vessels and carries mostly sympathetic fibers. SHP divides in front of the sacrum into the right and left HN. At the level of the paracervix, the HNs join the parasympathetic PSNs coming out from sacral root S2, S3, S4 to form the IHP.</span></span><span><span>2</span></span>, <span><span>3</span></span>, <span><span>4</span></span>, <span><span>5</span></span><span> Here, we performed laparoscopic surgery<span>, before “Laparoscopic Approach to Cervical Cancer” trial (LACC) era, identifying key anatomic landmarks<span> useful to highlight the path of the most commonly encountered autonomic pelvic nerves in gynecologic radical surgery: during the narration we describe and illustrate the procedure to identify all autonomic pelvic nerves, the sympathetic fibers, the PSNs, and the bladder branch emerging from the IHP in order to preserve their anatomic and functional integrity. This technique is anatomically and surgically indicated for adequate removal of the parametrical issues and vagina while preserving the total pelvic nervous system.</span></span></span></div></div><div><h3>Conclusion</h3><div>Nerve-sparing surgery reduces bowel-, bladder- and sexual dysfunction without decreasing surgical efficacy.<span><span><sup>1</sup></span></span><sup>,</sup><span><span><sup>2</sup></span></span> To accomplish safe and effective surgery, comprehension of the 3 dimensional structure of the vascular and nerve anatomy in the pelvis is essential. This video provides a great resource to educate surgeons, especially the youngest ones, about the retroperitoneal nervous networking: we identified the autonomic nerve pathway from adjacent tissues
{"title":"Pelvic Neuro-Visualization: An Anatomical Illustration of the Autonomic Pelvic Nervous Network in Gynecologic Surgery","authors":"","doi":"10.1016/j.jmig.2024.04.014","DOIUrl":"10.1016/j.jmig.2024.04.014","url":null,"abstract":"<div><h3>Objective</h3><div><span><span>During radical pelvic surgeries<span> fibers of the autonomic pelvic nervous network can be accidentally damaged leading to significant visceral sequelae<span>, which dramatically affect women's quality of life because of </span></span></span>urinary, anorectal, and sexual postoperative dysfunctions.</span><span><span><sup>1</sup></span></span><sup>,</sup><span><span><sup>2</sup></span></span><span><span> Direct visualization is one way to preserve hypogastric nerves<span><span> (HNs), pelvic splanchnic nerves (PSNs), and the </span>bladder branches from the inferior </span></span>hypogastric plexus<span> (IHP). However, the literature lacks critical photos and/or illustrations that are necessary to understand the precise anatomy needed to preserve the pelvic autonomic fibers.</span></span></div></div><div><h3>Design</h3><div>Narrated laparoscopic video footage for identifying, dissecting, and preserving the autonomic nerve bundles during pelvic surgery.</div></div><div><h3>Setting</h3><div>Tertiary level hospital—“IRCCS Istituto Nazionale dei Tumori”, Milano, Italy.</div></div><div><h3>Interventions</h3><div><span><span>Visceral pelvic innervation is established by the superior hypogastric plexus(SHP) located anteriorly to the </span>aortic bifurcation<span> and the median sacral vessels and carries mostly sympathetic fibers. SHP divides in front of the sacrum into the right and left HN. At the level of the paracervix, the HNs join the parasympathetic PSNs coming out from sacral root S2, S3, S4 to form the IHP.</span></span><span><span>2</span></span>, <span><span>3</span></span>, <span><span>4</span></span>, <span><span>5</span></span><span> Here, we performed laparoscopic surgery<span>, before “Laparoscopic Approach to Cervical Cancer” trial (LACC) era, identifying key anatomic landmarks<span> useful to highlight the path of the most commonly encountered autonomic pelvic nerves in gynecologic radical surgery: during the narration we describe and illustrate the procedure to identify all autonomic pelvic nerves, the sympathetic fibers, the PSNs, and the bladder branch emerging from the IHP in order to preserve their anatomic and functional integrity. This technique is anatomically and surgically indicated for adequate removal of the parametrical issues and vagina while preserving the total pelvic nervous system.</span></span></span></div></div><div><h3>Conclusion</h3><div>Nerve-sparing surgery reduces bowel-, bladder- and sexual dysfunction without decreasing surgical efficacy.<span><span><sup>1</sup></span></span><sup>,</sup><span><span><sup>2</sup></span></span> To accomplish safe and effective surgery, comprehension of the 3 dimensional structure of the vascular and nerve anatomy in the pelvis is essential. This video provides a great resource to educate surgeons, especially the youngest ones, about the retroperitoneal nervous networking: we identified the autonomic nerve pathway from adjacent tissues ","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140761290","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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