Journal of minimally invasive gynecology最新文献_第7页

Bowel Endometriosis Excision: Approaches and Outcomes Including Hand Sewing of Discoid Excision 肠道子宫内膜异位症切除术：包括盘状切除的手工缝合在内的方法和结果。

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.2024.07.019

Louisa R. Chatroux MD, MPH, Parmida Maghsoudlou BA, Mobolaji O. Ajao MD, MPH, Louise P. King MD, JD, Jon I. Einarsson MD, PhD, MPH

Study Objective

To examine the outcomes of surgery performed for bowel endometriosis including shaving, discoid resections with hand-sewn closure, and segmental resection.

Design

Retrospective cohort study.

Setting

Large academic hospital.

Patients

All patients with bowel wall endometriosis who underwent surgical excision with the Division of Minimally Invasive Gynecologic Surgery between 2009 and 2022.

Interventions

No interventions administered.

Measurements and Main Results

From 2009 to 2022, a total of 112 patients underwent laparoscopic excision of endometriosis involving the rectum. From this cohort, 82 underwent shaving, 23 underwent discoid excision, and 7 had segmental bowel resection. The discoid excisions were closed in multiple layers with hand sewing and were not closed with a staple device. Average lesion size on preoperative imaging was 20.9 mm in the shave group, 22.5 mm in the discoid group, and 38.5 mm in the segmental group. Complication requiring reoperation for anastomotic leak occurred in 3 cases (3.66%) of the shave group and 1 case (4.35%) of the discoid excision group, but did not occur in any of the segmental resections. The number of layers of closure and type of suture used did not appear to have an effect on complication rate, however, this study was not powered to detect a meaningful difference.

Conclusion

Our data shows a similar rate of anastomotic leak complication for each closure type as that reported in the literature (2.2%, 9.7%, and 9.9% reported for shave, discoid and segmental resection, respectively). While our study is underpowered, these findings support that hand sewing for discoid excision is a safe and reasonable alternative to circular stapler closures and can be considered with an experienced surgeon. Further study is warranted to confirm safety and explore potential cost savings associated with this technique as well as applications in areas with less resources available.

研究目的研究肠道子宫内膜异位症手术的效果，包括刮除、盘状切除加手缝合和节段切除：设计：回顾性队列研究：大型学术医院患者：所有肠壁子宫内膜异位症患者2009年至2022年期间在妇科微创外科（MIGS）接受手术切除的所有肠壁子宫内膜异位症患者：未采取干预措施：2009年至2022年期间，共有112名患者接受了腹腔镜直肠子宫内膜异位症切除术。在这批患者中，82 人接受了刮除术，23 人接受了盘状切除术，7 人接受了肠段切除术。盘状切除术采用多层手工缝合，不使用订书机。术前造影显示，剃除组的平均病灶大小为20.9毫米，盘状切除组为22.5毫米，节段切除组为38.5毫米。3例（3.66%）剃除组和1例（4.35%）盘状切除组患者因吻合口漏而需要再次手术，但没有任何节段切除患者出现这种并发症。闭合层数和缝合线类型似乎对并发症发生率没有影响，但本研究并不具备检测有意义差异的能力：我们的数据显示，每种闭合类型的吻合口漏并发症发生率与文献报道的相似（刮除术、盘状切除术和节段切除术的并发症发生率分别为 2.2%、9.7% 和 9.9%）。虽然我们的研究动力不足，但这些研究结果支持盘状切除术的手工缝合是环形订书机闭合的一种安全、合理的替代方法，有经验的外科医生可以考虑采用这种方法。有必要进行进一步研究，以确认该技术的安全性，探索其潜在的成本节约以及在资源匮乏地区的应用。

{"title":"Bowel Endometriosis Excision: Approaches and Outcomes Including Hand Sewing of Discoid Excision","authors":"Louisa R. Chatroux MD, MPH, Parmida Maghsoudlou BA, Mobolaji O. Ajao MD, MPH, Louise P. King MD, JD, Jon I. Einarsson MD, PhD, MPH","doi":"10.1016/j.jmig.2024.07.019","DOIUrl":"10.1016/j.jmig.2024.07.019","url":null,"abstract":"<div><h3>Study Objective</h3><div>To examine the outcomes of surgery performed for bowel endometriosis including shaving, discoid resections with hand-sewn closure, and segmental resection.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting</h3><div>Large academic hospital.</div></div><div><h3>Patients</h3><div>All patients with bowel wall endometriosis who underwent surgical excision with the Division of Minimally Invasive Gynecologic Surgery between 2009 and 2022.</div></div><div><h3>Interventions</h3><div>No interventions administered.</div></div><div><h3>Measurements and Main Results</h3><div>From 2009 to 2022, a total of 112 patients underwent laparoscopic excision of endometriosis involving the rectum. From this cohort, 82 underwent shaving, 23 underwent discoid excision, and 7 had segmental bowel resection. The discoid excisions were closed in multiple layers with hand sewing and were not closed with a staple device. Average lesion size on preoperative imaging was 20.9 mm in the shave group, 22.5 mm in the discoid group, and 38.5 mm in the segmental group. Complication requiring reoperation for anastomotic leak occurred in 3 cases (3.66%) of the shave group and 1 case (4.35%) of the discoid excision group, but did not occur in any of the segmental resections. The number of layers of closure and type of suture used did not appear to have an effect on complication rate, however, this study was not powered to detect a meaningful difference.</div></div><div><h3>Conclusion</h3><div>Our data shows a similar rate of anastomotic leak complication for each closure type as that reported in the literature (2.2%, 9.7%, and 9.9% reported for shave, discoid and segmental resection, respectively). While our study is underpowered, these findings support that hand sewing for discoid excision is a safe and reasonable alternative to circular stapler closures and can be considered with an experienced surgeon. Further study is warranted to confirm safety and explore potential cost savings associated with this technique as well as applications in areas with less resources available.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"31 11","pages":"Pages 951-955.e1"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141875116","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

Live Surgery: Educational Gold or Just Surgical Reality TV? 直播手术：教育金矿还是手术真人秀？

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.2024.09.019

Nancy Peters MBBS, MHLM, FRANZCOG, Michael R. Wynn-Williams MBChB, FRANZCOG

引用次数: 0

Endometriosis and Mental Health: A Population-Based Cohort Study 子宫内膜异位症与心理健康：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.2024.09.070

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

Study Objective

To assess the association between endometriosis and the risk of mental health conditions.

Design

Matched population-based retrospective cohort study.

Setting

Ontario, Canada, from January 1, 2010, to July 1, 2022.

Patients or Participants

: Women aged 18 to 50 with a first-time diagnosis of endometriosis.

Interventions

N/A.

Measurements and Main Results

Endometriosis exposure was determined through either medical or surgical diagnostic criteria. A medical diagnosis was defined with diagnostic codes from outpatient and in-hospital visits, while a surgical diagnosis was identified through inpatient or same-day surgeries. Individuals with endometriosis were matched 1:2 on age, sex, and geography to unexposed individuals without a history of endometriosis. The primary outcome was the first occurrence of any mental health condition after endometriosis diagnosis. Individuals with a mental health diagnosis in the two years before study entry were excluded.

A total of 107,832 individuals were included, 35,944 diagnosed with endometriosis (29.5% medically, 60.5% surgically, 10.0% medically with surgical confirmation) and 71,888 unexposed individuals. Over the study period, the incidence rate was 105.3 mental health events per 1,000 person-years in the endometriosis group compared to 66.5 mental health events per 1,000 person-year for unexposed individuals. Relative to the unexposed, the aHR for a mental health diagnosis was 1.28 (95% CI 1.24 – 1.33) in patients with medically diagnosed endometriosis, 1.33 (95% CI 1.16 – 1.52) in surgically diagnosed patients, and 1.36 (95% CI 1.2 – 1.6) in those diagnosed medically then confirmed surgically. The risk of receiving a mental health diagnosis was highest in the first year after endometriosis diagnosis and declined in subsequent years. The cumulative incidence of a severe mental health condition requiring hospital visits was 7.0% in endometriosis patients compared to 4.6% for unexposed individuals (HR 1.56, 95%CI 1.53-1.59).

Conclusion

Endometriosis is associated with an increased risk of mental health conditions. The elevated risk is particularly evident in the years immediately after diagnosis.

研究目的评估子宫内膜异位症与精神健康状况风险之间的关联。设计基于人群的匹配回顾性队列研究。研究地点加拿大安大略省，时间为 2010 年 1 月 1 日至 2022 年 7 月 1 日：干预措施N/A.测量和主要结果子宫内膜异位症的暴露是通过内科或外科诊断标准确定的。内科诊断是根据门诊和医院就诊的诊断代码确定的，而外科诊断是通过住院或当日手术确定的。子宫内膜异位症患者与无子宫内膜异位症病史的未接触者在年龄、性别和地域上按 1:2 进行配对。主要结果是确诊子宫内膜异位症后首次出现任何精神健康问题。研究共纳入 107,832 人，其中 35,944 人确诊患有子宫内膜异位症（29.5% 通过药物治疗，60.5% 通过手术治疗，10.0% 通过药物治疗并经手术确诊），71,888 人未接触过子宫内膜异位症。在研究期间，子宫内膜异位症组的发病率为每千人年 105.3 例精神健康事件，而未暴露者的发病率为每千人年 66.5 例精神健康事件。与未暴露者相比，经医学诊断的子宫内膜异位症患者的精神健康诊断aHR为1.28（95% CI 1.24 - 1.33），经手术诊断的患者为1.33（95% CI 1.16 - 1.52），经医学诊断并经手术确诊的患者为1.36（95% CI 1.2 - 1.6）。子宫内膜异位症确诊后第一年的精神健康诊断风险最高，随后几年有所下降。子宫内膜异位症患者需要到医院就诊的严重精神健康状况的累积发生率为 7.0%，而未接触过的患者为 4.6%（HR 1.56，95%CI 1.53-1.59）。子宫内膜异位症与精神健康状况的风险增加有关，这种风险的增加在确诊后的几年内尤为明显。

{"title":"Endometriosis and Mental Health: A Population-Based Cohort Study","authors":"P Thiel , O Bougie , J Pudwell , J Shellenberger , MP Velez , A Murji","doi":"10.1016/j.jmig.2024.09.070","DOIUrl":"10.1016/j.jmig.2024.09.070","url":null,"abstract":"<div><h3>Study Objective</h3><div>To assess the association between endometriosis and the risk of mental health conditions.</div></div><div><h3>Design</h3><div>Matched population-based retrospective cohort study.</div></div><div><h3>Setting</h3><div>Ontario, Canada, from January 1, 2010, to July 1, 2022.</div></div><div><h3>Patients or Participants</h3><div>: Women aged 18 to 50 with a first-time diagnosis of endometriosis.</div></div><div><h3>Interventions</h3><div>N/A.</div></div><div><h3>Measurements and Main Results</h3><div>Endometriosis exposure was determined through either medical or surgical diagnostic criteria. A medical diagnosis was defined with diagnostic codes from outpatient and in-hospital visits, while a surgical diagnosis was identified through inpatient or same-day surgeries. Individuals with endometriosis were matched 1:2 on age, sex, and geography to unexposed individuals without a history of endometriosis. The primary outcome was the first occurrence of any mental health condition after endometriosis diagnosis. Individuals with a mental health diagnosis in the two years before study entry were excluded.</div><div>A total of 107,832 individuals were included, 35,944 diagnosed with endometriosis (29.5% medically, 60.5% surgically, 10.0% medically with surgical confirmation) and 71,888 unexposed individuals. Over the study period, the incidence rate was 105.3 mental health events per 1,000 person-years in the endometriosis group compared to 66.5 mental health events per 1,000 person-year for unexposed individuals. Relative to the unexposed, the aHR for a mental health diagnosis was 1.28 (95% CI 1.24 – 1.33) in patients with medically diagnosed endometriosis, 1.33 (95% CI 1.16 – 1.52) in surgically diagnosed patients, and 1.36 (95% CI 1.2 – 1.6) in those diagnosed medically then confirmed surgically. The risk of receiving a mental health diagnosis was highest in the first year after endometriosis diagnosis and declined in subsequent years. The cumulative incidence of a severe mental health condition requiring hospital visits was 7.0% in endometriosis patients compared to 4.6% for unexposed individuals (HR 1.56, 95%CI 1.53-1.59).</div></div><div><h3>Conclusion</h3><div>Endometriosis is associated with an increased risk of mental health conditions. The elevated risk is particularly evident in the years immediately after diagnosis.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"31 11","pages":"Page S2"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658055","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

Mastering Robotic Myomectomy: Harnessing Knowledge, Technique and Technology for Surgical Excellence 掌握机器人子宫肌瘤切除术：利用知识、技术和科技打造卓越手术

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.2024.09.063

M Corinti, G Arcas, J Trevizo Pagotto, Lottenberg C Pita, P Pessoa, F Dishchekenian, G Barison

Study Objective

To assess the efficacy and safety of minimally invasive robot-assisted myomectomy in treating a patient with multiple uterine fibroids.

Design

Case report detailing the surgical intervention and outcomes of a patient with symptomatic uterine fibroids.

Setting

Patient in lithotomy position, robot docking at patient pelvic left side, with 3 robotic trocars and one laparoscopic 11mm assistant port.

Patients or Participants

Case report of a 39-year-old woman.

Interventions

The patient underwent treatment with Goserelin acetate to reduce the size of the uterus, followed by minimally invasive robot-assisted myomectomy. During the surgery, uterine arteries and round ligaments were located, clipped, and temporarily clamped to minimize bleeding. Fibroids were meticulously dissected and removed using laparoscopic ultrasound guidance.

Measurements and Main Results

The surgery lasted approximately 3 hours, during which 14 fibroids were removed. Blood loss was minimal, with the patient losing only 100ml. Postoperative recovery was favorable, with the patient experiencing mild abdominal pain and being discharged within 20 hours. Pathology confirmed the removal of all leiomyomas.

Conclusion

Minimally invasive robot-assisted myomectomy, combined with meticulous identification and clipping of uterine arteries, proved effective in reducing uterine size and improving symptoms in this patient with multiple uterine fibroids. This approach offers a promising option for the management of symptomatic fibroids, enhancing patient outcomes and quality of life.

研究目的评估微创机器人辅助子宫肌瘤剔除术治疗多发性子宫肌瘤患者的有效性和安全性。患者或参与者一名39岁女性的病例报告干预患者接受醋酸戈舍瑞林治疗以缩小子宫体积，随后接受微创机器人辅助子宫肌瘤剔除术。手术中，找到子宫动脉和圆韧带，剪断并暂时夹住，以减少出血。手术持续了约3个小时，共切除了14个肌瘤。失血量极少，患者仅失血100毫升。术后恢复良好，患者腹痛轻微，20小时内出院。结论事实证明，微创机器人辅助子宫肌瘤剔除术结合细致的子宫动脉识别和剪切，能有效缩小子宫体积并改善这名多发性子宫肌瘤患者的症状。这种方法为治疗有症状的子宫肌瘤提供了一种很有前景的选择，可提高患者的治疗效果和生活质量。

{"title":"Mastering Robotic Myomectomy: Harnessing Knowledge, Technique and Technology for Surgical Excellence","authors":"M Corinti, G Arcas, J Trevizo Pagotto, Lottenberg C Pita, P Pessoa, F Dishchekenian, G Barison","doi":"10.1016/j.jmig.2024.09.063","DOIUrl":"10.1016/j.jmig.2024.09.063","url":null,"abstract":"<div><h3>Study Objective</h3><div>To assess the efficacy and safety of minimally invasive robot-assisted myomectomy in treating a patient with multiple uterine fibroids.</div></div><div><h3>Design</h3><div>Case report detailing the surgical intervention and outcomes of a patient with symptomatic uterine fibroids.</div></div><div><h3>Setting</h3><div>Patient in lithotomy position, robot docking at patient pelvic left side, with 3 robotic trocars and one laparoscopic 11mm assistant port.</div></div><div><h3>Patients or Participants</h3><div>Case report of a 39-year-old woman.</div></div><div><h3>Interventions</h3><div>The patient underwent treatment with Goserelin acetate to reduce the size of the uterus, followed by minimally invasive robot-assisted myomectomy. During the surgery, uterine arteries and round ligaments were located, clipped, and temporarily clamped to minimize bleeding. Fibroids were meticulously dissected and removed using laparoscopic ultrasound guidance.</div></div><div><h3>Measurements and Main Results</h3><div>The surgery lasted approximately 3 hours, during which 14 fibroids were removed. Blood loss was minimal, with the patient losing only 100ml. Postoperative recovery was favorable, with the patient experiencing mild abdominal pain and being discharged within 20 hours. Pathology confirmed the removal of all leiomyomas.</div></div><div><h3>Conclusion</h3><div>Minimally invasive robot-assisted myomectomy, combined with meticulous identification and clipping of uterine arteries, proved effective in reducing uterine size and improving symptoms in this patient with multiple uterine fibroids. This approach offers a promising option for the management of symptomatic fibroids, enhancing patient outcomes and quality of life.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"31 11","pages":"Page S6"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658211","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

Tips and Tricks for Cervical Myomectomy 宫颈肌瘤切除术的技巧和窍门

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.2024.09.067

C Liao , RJ Schneyer , K Hamilton , MD Truong

Study Objective

Removal of large cervical fibroids is often surgically challenging. Their location can distort normal anatomy and make it difficult to visualize vital structures needed to safely remove these types of fibroids. In this video, we provide tips and tricks for successfully managing cervical fibroids. The objectives of this video are to review relevant anatomy that may be distorted by large cervical fibroids, to discuss tips and tricks for performing myomectomy for cervical fibroids, and to demonstrate the application of these techniques during a robotic-assisted cervical myomectomy.

Design

Surgical video.

Setting

Academic tertiary care hospital.

Patients or Participants

32-year-old patient with large posterior cervical fibroid.

Interventions

Robotic-assisted myomectomy.

Measurements and Main Results

N/A.

Conclusion

In this video, we review tips for approaching cervical fibroids including hemostasis techniques, use of methylene blue, ureterolysis, vertical hysterotomy, and posterior suturing. Cervical myomectomy can be done safely and efficiently using these techniques.

研究目的切除大的宫颈肌瘤通常具有手术挑战性。肌瘤的位置会扭曲正常的解剖结构，难以观察到安全切除这类肌瘤所需的重要结构。在本视频中，我们将提供成功处理宫颈肌瘤的技巧和窍门。本视频的目的是回顾可能被巨大宫颈肌瘤扭曲的相关解剖结构，讨论进行宫颈肌瘤剔除术的技巧和窍门，并演示这些技术在机器人辅助宫颈肌瘤剔除术中的应用。患者或参与者32岁的大型后位宫颈肌瘤患者.干预措施机器人辅助子宫肌瘤切除术.测量和主要结果N/A.结论在这段视频中，我们回顾了处理宫颈肌瘤的技巧，包括止血技术、亚甲蓝的使用、输尿管溶解、垂直子宫切除术和后方缝合。使用这些技术可以安全有效地完成宫颈肌瘤剔除术。

{"title":"Tips and Tricks for Cervical Myomectomy","authors":"C Liao , RJ Schneyer , K Hamilton , MD Truong","doi":"10.1016/j.jmig.2024.09.067","DOIUrl":"10.1016/j.jmig.2024.09.067","url":null,"abstract":"<div><h3>Study Objective</h3><div>Removal of large cervical fibroids is often surgically challenging. Their location can distort normal anatomy and make it difficult to visualize vital structures needed to safely remove these types of fibroids. In this video, we provide tips and tricks for successfully managing cervical fibroids. The objectives of this video are to review relevant anatomy that may be distorted by large cervical fibroids, to discuss tips and tricks for performing myomectomy for cervical fibroids, and to demonstrate the application of these techniques during a robotic-assisted cervical myomectomy.</div></div><div><h3>Design</h3><div>Surgical video.</div></div><div><h3>Setting</h3><div>Academic tertiary care hospital.</div></div><div><h3>Patients or Participants</h3><div>32-year-old patient with large posterior cervical fibroid.</div></div><div><h3>Interventions</h3><div>Robotic-assisted myomectomy.</div></div><div><h3>Measurements and Main Results</h3><div>N/A.</div></div><div><h3>Conclusion</h3><div>In this video, we review tips for approaching cervical fibroids including hemostasis techniques, use of methylene blue, ureterolysis, vertical hysterotomy, and posterior suturing. Cervical myomectomy can be done safely and efficiently using these techniques.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"31 11","pages":"Pages S7-S8"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658215","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

Robotic Excision of Morrison's Pouch and Full-Thickness Diaphragmatic Endometriosis 机器人切除莫里森氏囊和全厚横膈膜子宫内膜异位症

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.2024.09.103

E Olig , S Beamer , CC Stucky , M Wasson

Study Objective

The objective of this video is to display surgical technique for multidisciplinary management of endometriosis of Morrison's pouch and the diaphragm.

Design

N/A.

Setting

Academic medical center.

Patients or Participants

The patient is a 29-year-old G0 who initially presented for lifelong dysmenorrhea, infertility, and new onset debilitating right shoulder pain with menses. She had no previous surgical history and MRI of the abdomen and pelvis was negative for deep infiltrating endometriosis.

Interventions

Patient underwent robotic liver mobilization, peritonectomy of Morrison's pouch, and full thickness diaphragmatic excision followed by thoracoscopy and primary diaphragmatic repair. The case was performed in conjunction with general and cardiothoracic surgery.

Measurements and Main Results

The patient recovered without complication and had complete resolution of her right shoulder pain at her six week follow up.

Conclusion

Multidisciplinary management is essential for treatment of severe diaphragmatic and Morrison's pouch endometriosis. Liver mobilization and retraction allows for complete visualization of Morrison's pouch and resection of disease. Thoracoscopic evaluation ensures no other thoracic disease is present and allows for more straightforward closure of the diaphragm. MRI may not reliably identify diaphragmatic disease, and thorough visual evaluation is essential in the management of patients with symptoms concerning for diaphragmatic endometriosis.

研究目的本视频旨在展示多学科治疗莫里森氏囊和横膈膜子宫内膜异位症的手术技术。设计N/A.设置学术医疗中心。患者或参与者患者是一名29岁的G0患者，最初因终身痛经、不孕和新发右肩疼痛伴月经衰弱而就诊。患者接受了机器人肝脏移动术、莫里森氏囊腹膜切除术、全厚膈肌切除术，随后进行了胸腔镜检查和原发性膈肌修补术。该病例与普外科和心胸外科联合进行。测量和主要结果患者康复后无并发症，在六周的随访中右肩疼痛完全消失。肝脏移动和牵拉可使莫里森氏囊完全显露并切除病灶。胸腔镜评估可确保没有其他胸腔疾病，并能更直接地关闭横膈膜。核磁共振成像可能无法可靠地识别横膈膜疾病，因此在处理有横膈膜子宫内膜异位症相关症状的患者时，彻底的视觉评估至关重要。

{"title":"Robotic Excision of Morrison's Pouch and Full-Thickness Diaphragmatic Endometriosis","authors":"E Olig , S Beamer , CC Stucky , M Wasson","doi":"10.1016/j.jmig.2024.09.103","DOIUrl":"10.1016/j.jmig.2024.09.103","url":null,"abstract":"<div><h3>Study Objective</h3><div>The objective of this video is to display surgical technique for multidisciplinary management of endometriosis of Morrison's pouch and the diaphragm.</div></div><div><h3>Design</h3><div>N/A.</div></div><div><h3>Setting</h3><div>Academic medical center.</div></div><div><h3>Patients or Participants</h3><div>The patient is a 29-year-old G0 who initially presented for lifelong dysmenorrhea, infertility, and new onset debilitating right shoulder pain with menses. She had no previous surgical history and MRI of the abdomen and pelvis was negative for deep infiltrating endometriosis.</div></div><div><h3>Interventions</h3><div>Patient underwent robotic liver mobilization, peritonectomy of Morrison's pouch, and full thickness diaphragmatic excision followed by thoracoscopy and primary diaphragmatic repair. The case was performed in conjunction with general and cardiothoracic surgery.</div></div><div><h3>Measurements and Main Results</h3><div>The patient recovered without complication and had complete resolution of her right shoulder pain at her six week follow up.</div></div><div><h3>Conclusion</h3><div>Multidisciplinary management is essential for treatment of severe diaphragmatic and Morrison's pouch endometriosis. Liver mobilization and retraction allows for complete visualization of Morrison's pouch and resection of disease. Thoracoscopic evaluation ensures no other thoracic disease is present and allows for more straightforward closure of the diaphragm. MRI may not reliably identify diaphragmatic disease, and thorough visual evaluation is essential in the management of patients with symptoms concerning for diaphragmatic endometriosis.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"31 11","pages":"Page S24"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658396","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

Intraoperative Delineation of Bladder Deep Endometriosis: Optimizing Excision Margins for Postoperative Bladder Capacity Preservation 膀胱深部子宫内膜异位症的术中界定：优化切除边缘，术后保留膀胱容量

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.2024.09.102

D Encalada Soto , K Heinsimer , E Mikhail

Study Objective

To demonstrate the implementation of robotic integrated ultrasound alongside meticulous dissection and cystoscopic guidance in the surgical excision of deep endometriosis nodules, to prevent persistent or recurrent disease without sacrificing normal bladder wall, thereby optimizing postoperative bladder capacity.

Design

This study presents a case report detailing the proposed surgical technique.

Setting

Academic tertiary referral center.

Patients or Participants

A 45-yo-woman with a history of hysterectomy for fibroids presenting with persistent symptoms suggestive of urinary tract infection and hematuria.

Interventions

Surgical excision with robotic assistance, cystoscopic guidance and incorporation of robotic integrated ultrasound for precise delineation of lesion margins.

Measurements and Main Results

The patient had an uneventful postoperative course with symptom resolution. Pathology confirmed full thickness endometriosis lesion with free margins.

Conclusion

The integration of intraoperative ultrasound with meticulous dissection and cystoscopic guidance represents a reproducible approach for the precise delineation of bladder deep endometriosis nodules. This technique is an effective methodology for optimizing excision margins while concurrently preserving the integrity of the normal bladder wall.

研究目的展示在手术切除深部子宫内膜异位症结节时，如何利用机器人综合超声技术，配合精细解剖和膀胱镜引导，在不牺牲正常膀胱壁的情况下防止疾病持续或复发，从而优化术后膀胱容量。患者或参与者一名45岁女性，曾因子宫肌瘤行子宫切除术，并伴有尿路感染和血尿的持续症状。干预措施在机器人辅助下进行手术切除，膀胱镜引导，并结合机器人综合超声精确划定病灶边缘。病理证实为全厚度子宫内膜异位症病灶，边缘游离。结论术中超声与精细解剖和膀胱镜引导的整合是精确划分膀胱深部子宫内膜异位症结节的一种可重复方法。这项技术是优化切除边缘的有效方法，同时还能保护正常膀胱壁的完整性。

{"title":"Intraoperative Delineation of Bladder Deep Endometriosis: Optimizing Excision Margins for Postoperative Bladder Capacity Preservation","authors":"D Encalada Soto , K Heinsimer , E Mikhail","doi":"10.1016/j.jmig.2024.09.102","DOIUrl":"10.1016/j.jmig.2024.09.102","url":null,"abstract":"<div><h3>Study Objective</h3><div>To demonstrate the implementation of robotic integrated ultrasound alongside meticulous dissection and cystoscopic guidance in the surgical excision of deep endometriosis nodules, to prevent persistent or recurrent disease without sacrificing normal bladder wall, thereby optimizing postoperative bladder capacity.</div></div><div><h3>Design</h3><div>This study presents a case report detailing the proposed surgical technique.</div></div><div><h3>Setting</h3><div>Academic tertiary referral center.</div></div><div><h3>Patients or Participants</h3><div>A 45-yo-woman with a history of hysterectomy for fibroids presenting with persistent symptoms suggestive of urinary tract infection and hematuria.</div></div><div><h3>Interventions</h3><div>Surgical excision with robotic assistance, cystoscopic guidance and incorporation of robotic integrated ultrasound for precise delineation of lesion margins.</div></div><div><h3>Measurements and Main Results</h3><div>The patient had an uneventful postoperative course with symptom resolution. Pathology confirmed full thickness endometriosis lesion with free margins.</div></div><div><h3>Conclusion</h3><div>The integration of intraoperative ultrasound with meticulous dissection and cystoscopic guidance represents a reproducible approach for the precise delineation of bladder deep endometriosis nodules. This technique is an effective methodology for optimizing excision margins while concurrently preserving the integrity of the normal bladder wall.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"31 11","pages":"Page S24"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658397","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

Modified Wharton-Sheares-George Vaginoplasty With OASIS Graft: An Outpatient Surgical Procedure for Neovagina Creation 使用 OASIS 移植的改良 Wharton-Sheares-George 阴道成形术：新阴道创建的门诊手术程序

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.2024.09.118

D Elborno , J Geynisman-Tan , S Muttar , E Yerkes , J Grabowski

Study Objective

The objective of this video is to show how to perform a Wharton-Sheares-George vaginoplasty with a modification to use submucosal small intestine (SIS) graft for patients with Mayer-Rokitansky-Kuster-Hauser (MRKH) seeking surgical creation of neovagina. We aim to highlight the benefits of this approach for patients who either do not want to pursue primary dilation or who achieve a suboptimal result with primary dilation and aim to provide a step-by-step description for surgeons seeking to replicate this technique.

Design

N/A.

Setting

Tertiary care children's hospital operating room.

Patients or Participants

Patients with MRKH undergoing surgical creation of neovagina who have consented to photography/video for educational purposes.

Interventions

The creation of a neovagina according to Wharton-Sheares-George in patients with MRKH syndrome with a modification to use SIS graft for epithelial scaffolding.

Measurements and Main Results

Discussion of the surgical steps and review of the anatomic and functional results.

Conclusion

The creation of a neovagina using the Wharton-Sheares-George method does not require harvesting grafts, nor does it require an inpatient stay for prolonged traction. The procedure is efficient and offers a valuable alternative to primary dilation with low short- and long-term morbidity. By following our step-by-step description of this technique, surgeons can offer a minimally invasive surgical option that achieves a functional and anatomically result within 1 week.

研究目的本视频旨在展示如何为寻求手术创建新阴道的Mayer-Rokitansky-Kuster-Hauser（MRKH）患者实施Wharton-Sheares-George阴道成形术，并使用粘膜下小肠（SIS）移植进行改良。我们的目的是强调这种方法对那些不想进行初次扩张或初次扩张效果不理想的患者的益处，并为寻求复制这种技术的外科医生提供一步步的说明。干预措施根据Wharton-Sheares-George法为MRKH综合征患者创建新阴道，并改用SIS移植物作为上皮支架.测量和主要结果讨论手术步骤并回顾解剖和功能结果.结论使用Wharton-Sheares-George法创建新阴道不需要采集移植物，也不需要住院进行长时间牵引。该手术效率高，短期和长期发病率低，是原发性扩张术的重要替代方法。根据我们对该技术的逐步描述，外科医生可以提供一种微创手术方案，在一周内达到功能和解剖效果。

{"title":"Modified Wharton-Sheares-George Vaginoplasty With OASIS Graft: An Outpatient Surgical Procedure for Neovagina Creation","authors":"D Elborno , J Geynisman-Tan , S Muttar , E Yerkes , J Grabowski","doi":"10.1016/j.jmig.2024.09.118","DOIUrl":"10.1016/j.jmig.2024.09.118","url":null,"abstract":"<div><h3>Study Objective</h3><div>The objective of this video is to show how to perform a Wharton-Sheares-George vaginoplasty with a modification to use submucosal small intestine (SIS) graft for patients with Mayer-Rokitansky-Kuster-Hauser (MRKH) seeking surgical creation of neovagina. We aim to highlight the benefits of this approach for patients who either do not want to pursue primary dilation or who achieve a suboptimal result with primary dilation and aim to provide a step-by-step description for surgeons seeking to replicate this technique.</div></div><div><h3>Design</h3><div>N/A.</div></div><div><h3>Setting</h3><div>Tertiary care children's hospital operating room.</div></div><div><h3>Patients or Participants</h3><div>Patients with MRKH undergoing surgical creation of neovagina who have consented to photography/video for educational purposes.</div></div><div><h3>Interventions</h3><div>The creation of a neovagina according to Wharton-Sheares-George in patients with MRKH syndrome with a modification to use SIS graft for epithelial scaffolding.</div></div><div><h3>Measurements and Main Results</h3><div>Discussion of the surgical steps and review of the anatomic and functional results.</div></div><div><h3>Conclusion</h3><div>The creation of a neovagina using the Wharton-Sheares-George method does not require harvesting grafts, nor does it require an inpatient stay for prolonged traction. The procedure is efficient and offers a valuable alternative to primary dilation with low short- and long-term morbidity. By following our step-by-step description of this technique, surgeons can offer a minimally invasive surgical option that achieves a functional and anatomically result within 1 week.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"31 11","pages":"Page S28"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658065","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

Fluorescence-Image Guided Paraaortic Sentinel Lymph Node Sampling in Early Ovarian Cancer 荧光成像引导下的早期卵巢癌主动脉旁前哨淋巴结取样术

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.2024.09.085

KE Seon , SW Kim

Study Objective

To describe stepwise techniques for fluorescence image-guided paraaortic sentinel lymph node (SLN) sampling in early ovarian cancer.

Design

Single port laparoscopic ovarian lymphatic flow mapping technique with narrated video.

Setting

Tertiary referral hospital.

Patients or Participants

A 48-year-old female with an 8 cm sized right ovarian cystic tumor with internal solid nodules was transferred to Yonsei Cancer Center. Preoperative serum CA 125 and CA19-9 levels were 23.9 U/mL and 24.7 U/mL, respectively. The right ovarian mass was suspected to be a malignant ovarian epithelial tumor on pelvic MRI and PET-CT.

Interventions

Single port laparoscopy was performed. Right salpingo-oophorectomy with total laparoscopic hysterectomy was performed. The solid tumor component of right ovarian mass was submitted for frozen section and the pathologic finding was ovarian nonepithelial tumor (such as germ cell or sex cord/stromal cell origin). As ovarian malignancy could not be excluded in this patient, subsequent single port laparoscopic surgical staging with SLN sampling was planned. Through the single port, diluted indocyanine green (ICG, 1.25 mg/mL) was directly injected into the right infundibulopelvic (IP) ligament stump. Fluorescent lymphatic channels of right IP ligament were visualized using endoscopic fluorescence imaging system.

Measurements and Main Results

After 7 minutes, the ICG drained from the right IP ligament to the right aortocaval lymph nodes. The paraaortic lymphatic drainage of the ovary appeared to branch along the ovarian vessels. After 15 minutes, the ICG drained to inframesenteric interaortocaval lymph nodes (L3M) and supramesenteric interaortocaval lymph node (L4M). There were no detected fluorescent lymph nodes between the right IP ligament and the right paracaval area. In this patient, the right ovarian SLNs were detected at the L3M and L4M. The patient was diagnosed with stage 1A clear cell ovarian cancer in permanent section pathology.

Conclusion

This stepwise technique of paraaortic SLN sampling in early ovarian cancer allows further utilization of this surgical method.

研究目的描述荧光图像引导下早期卵巢癌主动脉旁前哨淋巴结（SLN）取样的分步技术.设计单孔腹腔镜卵巢淋巴流图示技术，并配有视频解说.设置三级转诊医院.患者或参与者一名48岁女性，患有8厘米大小的右卵巢囊性肿瘤，内部有实性结节，转入延世癌症中心。术前血清 CA 125 和 CA19-9 水平分别为 23.9 U/mL和 24.7 U/mL。经盆腔 MRI 和 PET-CT 检查，怀疑右侧卵巢肿块为卵巢上皮恶性肿瘤。进行了单孔腹腔镜手术，右侧输卵管切除术和全腹腔镜子宫切除术。右侧卵巢肿块的实体瘤成分被送去做冰冻切片，病理结果为卵巢非上皮性肿瘤（如生殖细胞或性索/间质细胞来源）。由于无法排除该患者的卵巢恶性肿瘤，因此计划随后进行单孔腹腔镜手术分期，并进行SLN取样。通过单孔，将稀释的吲哚菁绿（ICG，1.25 mg/mL）直接注入右侧盆底韧带（IP）残端。测量和主要结果7分钟后，ICG从右IP韧带引流至右主动脉淋巴结。卵巢主动脉旁淋巴引流似乎沿着卵巢血管分支。15 分钟后，ICG 引流至肠系膜下腹主动脉间淋巴结（L3M）和肠系膜上腹主动脉间淋巴结（L4M）。在右 IP 韧带和右腔旁区域之间没有检测到荧光淋巴结。该患者的右侧卵巢 SLN 位于 L3M 和 L4M。该患者在永久切片病理中被诊断为 1A 期透明细胞卵巢癌。

{"title":"Fluorescence-Image Guided Paraaortic Sentinel Lymph Node Sampling in Early Ovarian Cancer","authors":"KE Seon , SW Kim","doi":"10.1016/j.jmig.2024.09.085","DOIUrl":"10.1016/j.jmig.2024.09.085","url":null,"abstract":"<div><h3>Study Objective</h3><div>To describe stepwise techniques for fluorescence image-guided paraaortic sentinel lymph node (SLN) sampling in early ovarian cancer.</div></div><div><h3>Design</h3><div>Single port laparoscopic ovarian lymphatic flow mapping technique with narrated video.</div></div><div><h3>Setting</h3><div>Tertiary referral hospital.</div></div><div><h3>Patients or Participants</h3><div>A 48-year-old female with an 8 cm sized right ovarian cystic tumor with internal solid nodules was transferred to Yonsei Cancer Center. Preoperative serum CA 125 and CA19-9 levels were 23.9 U/mL and 24.7 U/mL, respectively. The right ovarian mass was suspected to be a malignant ovarian epithelial tumor on pelvic MRI and PET-CT.</div></div><div><h3>Interventions</h3><div>Single port laparoscopy was performed. Right salpingo-oophorectomy with total laparoscopic hysterectomy was performed. The solid tumor component of right ovarian mass was submitted for frozen section and the pathologic finding was ovarian nonepithelial tumor (such as germ cell or sex cord/stromal cell origin). As ovarian malignancy could not be excluded in this patient, subsequent single port laparoscopic surgical staging with SLN sampling was planned. Through the single port, diluted indocyanine green (ICG, 1.25 mg/mL) was directly injected into the right infundibulopelvic (IP) ligament stump. Fluorescent lymphatic channels of right IP ligament were visualized using endoscopic fluorescence imaging system.</div></div><div><h3>Measurements and Main Results</h3><div>After 7 minutes, the ICG drained from the right IP ligament to the right aortocaval lymph nodes. The paraaortic lymphatic drainage of the ovary appeared to branch along the ovarian vessels. After 15 minutes, the ICG drained to inframesenteric interaortocaval lymph nodes (L3M) and supramesenteric interaortocaval lymph node (L4M). There were no detected fluorescent lymph nodes between the right IP ligament and the right paracaval area. In this patient, the right ovarian SLNs were detected at the L3M and L4M. The patient was diagnosed with stage 1A clear cell ovarian cancer in permanent section pathology.</div></div><div><h3>Conclusion</h3><div>This stepwise technique of paraaortic SLN sampling in early ovarian cancer allows further utilization of this surgical method.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"31 11","pages":"Pages S18-S19"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658434","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

Fertility Sparing Management of a Large Broad Ligament Fibroid 大型阔韧带肌瘤的生育保护疗法

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.2024.09.062

KM Sankey-Thomas , J Travieso , CA Salazar , M Williams-Brown , MT Breen

Study Objective

Demonstrate the safety and feasibility of a robotic approach to fertility sparing management of large broad ligament fibroid.

Design

Case presentation.

Setting

Academic tertiary care center.

Patients or Participants

37 year-old G1P0 with a large uterine mass, suspected to be a fibroid, presented desiring fertility sparing surgical management after a failed exploratory laparotomy myomectomy. MRI showed a large 15 cm mass in the right broad ligament.

Interventions

Preoperative management with uterine artery embolization. Robotic assisted laparoscopic myomectomy.

Measurements and Main Results

The fibroid was removed robotically with EBL of <50cc. A postoperative hysterosalpingogram showing intact uterine cavity and patent fallopian tubes.

Conclusion

Minimally invasive surgery is feasible for large broad ligament fibroids. Consideration of preoperative interventions with a multidisciplinary team, like UAE with interventional radiology, may optimize surgical outcomes. A second opinion by minimally invasive gynecologic surgeons can provide the option for fertility sparing surgery when it is not initially offered.

患者或参与者37岁，G1P0，有一个巨大的子宫肿块，怀疑是子宫肌瘤，在探查性开腹子宫肌瘤切除术失败后，希望进行保留生育功能的手术治疗。核磁共振成像显示右侧阔韧带有一个15厘米大的肿块。机器人辅助腹腔镜子宫肌瘤剔除术。术后子宫输卵管造影显示子宫腔完整，输卵管通畅。考虑与多学科团队进行术前干预，如与介入放射科合作进行超短波手术，可优化手术效果。微创妇科外科医生的第二意见可为最初未提供的保留生育功能手术提供选择。

{"title":"Fertility Sparing Management of a Large Broad Ligament Fibroid","authors":"KM Sankey-Thomas , J Travieso , CA Salazar , M Williams-Brown , MT Breen","doi":"10.1016/j.jmig.2024.09.062","DOIUrl":"10.1016/j.jmig.2024.09.062","url":null,"abstract":"<div><h3>Study Objective</h3><div>Demonstrate the safety and feasibility of a robotic approach to fertility sparing management of large broad ligament fibroid.</div></div><div><h3>Design</h3><div>Case presentation.</div></div><div><h3>Setting</h3><div>Academic tertiary care center.</div></div><div><h3>Patients or Participants</h3><div>37 year-old G1P0 with a large uterine mass, suspected to be a fibroid, presented desiring fertility sparing surgical management after a failed exploratory laparotomy myomectomy. MRI showed a large 15 cm mass in the right broad ligament.</div></div><div><h3>Interventions</h3><div>Preoperative management with uterine artery embolization. Robotic assisted laparoscopic myomectomy.</div></div><div><h3>Measurements and Main Results</h3><div>The fibroid was removed robotically with EBL of <50cc. A postoperative hysterosalpingogram showing intact uterine cavity and patent fallopian tubes.</div></div><div><h3>Conclusion</h3><div>Minimally invasive surgery is feasible for large broad ligament fibroids. Consideration of preoperative interventions with a multidisciplinary team, like UAE with interventional radiology, may optimize surgical outcomes. A second opinion by minimally invasive gynecologic surgeons can provide the option for fertility sparing surgery when it is not initially offered.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"31 11","pages":"Page S6"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658210","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