Pub Date : 2024-11-01DOI: 10.1016/j.jmig.2024.09.077
F Heredia , JR Escalona , D Sanabria , M Arévalo , I Arévalo
Study Objective
To present a surgical observation while using NIR-ICG technology. And furtherly, how this observation translates in a potential application for Endometriosis surgery.
Design
Descriptive observational study.
Setting
Tertiary private clinic.
Patients or Participants
Two patients with Deep Infiltrating Endometriosis (DIE) nodules affecting the bladder.
Interventions
Bladder shaving aided by ICG staining after ureteral catheterization for parametrial and posterior compartment endometriosis. After retrieving catheters, Bladder urothelium stains and helps identifying urothelial limits facilitating bladder shaving without entering the bladder's lumen.
Measurements and Main Results
This is a proof of concept, a feasibility study.
Conclusion
As DIE nodules of the bladder come from the peritoneal side of the bladder, in the same way as deep rectal nodules, shaving is a surgical gesture with less potential complications compared to full thickness bladder resections. ICG-stained bladder mucosa is clearly visible making it possible to avoid entering the bladder´s lumen which can potentially decrease the need for post-operatory use of bladder catheter.
研究目的介绍使用近红外成像技术的手术观察结果。患者或参与者两名患有影响膀胱的深部浸润性子宫内膜异位症（DIE）结节的患者。干预措施输尿管导管术治疗宫旁和后室子宫内膜异位症后，在 ICG 染色的帮助下进行膀胱切除术。结论由于膀胱 DIE 结节来自膀胱腹膜侧，与直肠深部结节相同，与全层膀胱切除术相比，膀胱刮除是一种潜在并发症较少的手术方式。ICG 染色的膀胱粘膜清晰可见，可避免进入膀胱腔，从而减少术后使用膀胱导尿管的需要。
{"title":"Real-Time Near-Infrared ICG Fluorescence to Aid in Deep Infiltrating Endometriosis Bladder Nodule Shaving","authors":"F Heredia , JR Escalona , D Sanabria , M Arévalo , I Arévalo","doi":"10.1016/j.jmig.2024.09.077","DOIUrl":"10.1016/j.jmig.2024.09.077","url":null,"abstract":"<div><h3>Study Objective</h3><div>To present a surgical observation while using NIR-ICG technology. And furtherly, how this observation translates in a potential application for Endometriosis surgery.</div></div><div><h3>Design</h3><div>Descriptive observational study.</div></div><div><h3>Setting</h3><div>Tertiary private clinic.</div></div><div><h3>Patients or Participants</h3><div>Two patients with Deep Infiltrating Endometriosis (DIE) nodules affecting the bladder.</div></div><div><h3>Interventions</h3><div>Bladder shaving aided by ICG staining after ureteral catheterization for parametrial and posterior compartment endometriosis. After retrieving catheters, Bladder urothelium stains and helps identifying urothelial limits facilitating bladder shaving without entering the bladder's lumen.</div></div><div><h3>Measurements and Main Results</h3><div>This is a proof of concept, a feasibility study.</div></div><div><h3>Conclusion</h3><div>As DIE nodules of the bladder come from the peritoneal side of the bladder, in the same way as deep rectal nodules, shaving is a surgical gesture with less potential complications compared to full thickness bladder resections. ICG-stained bladder mucosa is clearly visible making it possible to avoid entering the bladder´s lumen which can potentially decrease the need for post-operatory use of bladder catheter.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"31 11","pages":"Page S16"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658002","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 : 2024-11-01DOI: 10.1016/j.jmig.2024.09.034
KA Stewart , A Famuyide
Study Objective
Review a minimally invasive hysteroscopic approach to large submucosal delivering fibroids with a video demonstration.
Design
Case series.
Setting
Tertiary referral center.
Patients or Participants
Two patients with significant fibroid burden experiencing delivery of submucosal fibroids after an inciting event.
Interventions
Hysteroscopic myomectomy with resectoscope.
Measurements and Main Results
The first patient was a 30 yo G1P0010 who presented to the emergency room with pelvic pain, recent spontaneous abortion at 12w5d, and vaginal discharge. Evaluation was notable for 12cm degenerated submucosal fibroid with superimposed infection consistent with pyomyoma. She failed a course of conservative treatment with IV antibiotics and underwent urgent myomectomy with vaginal debulking of delivering pyomyoma and hysteroscopic myomectomy with the resectoscope utilizing dilute vasopressin and temporary cervical cerclage to maintain fluid pressure. She underwent Lupron administration and interval myomectomy at 6 weeks with repeat hysteroscopic resection of the remaining 3.5cm myoma with 95% success. The second patient was a 46 yo G7P1142 who presented to clinic with leukorrhea, delivery of fibroid at home, and pelvic pain 6 months after uterine artery embolization. Preoperative imaging demonstrated 15cm uterus and a conglomeration of five 4-6cm FIGO type 0-2 fibroids. She underwent hysteroscopic myomectomy of the two most inferior fibroids with plans for postoperative Lupron and additional staged myomectomy. Benefits of the hysteroscopic approach include easy accessibility, avoidance of abdominal incisions, and utilizing the already dilated cervix to a surgical advantage. Disadvantages include requiring a multi-stage procedure for completion.
Conclusion
Hysteroscopic myomectomy can be utilized in cases of delivering fibroids in the setting of extreme submucosal fibroid burden, this offers a less invasive alternative to myomectomy but may require staged procedures. Preoperative imaging and examination are key to planning and can change rapidly. Pregnancy and uterine artery embolization can incite fibroid degeneration with delivery of submucosal fibroids, and rarely subsequent infection.
{"title":"Extreme Hysteroscopic Myomectomy for Delivering Fibroids","authors":"KA Stewart , A Famuyide","doi":"10.1016/j.jmig.2024.09.034","DOIUrl":"10.1016/j.jmig.2024.09.034","url":null,"abstract":"<div><h3>Study Objective</h3><div>Review a minimally invasive hysteroscopic approach to large submucosal delivering fibroids with a video demonstration.</div></div><div><h3>Design</h3><div>Case series.</div></div><div><h3>Setting</h3><div>Tertiary referral center.</div></div><div><h3>Patients or Participants</h3><div>Two patients with significant fibroid burden experiencing delivery of submucosal fibroids after an inciting event.</div></div><div><h3>Interventions</h3><div>Hysteroscopic myomectomy with resectoscope.</div></div><div><h3>Measurements and Main Results</h3><div>The first patient was a 30 yo G1P0010 who presented to the emergency room with pelvic pain, recent spontaneous abortion at 12w5d, and vaginal discharge. Evaluation was notable for 12cm degenerated submucosal fibroid with superimposed infection consistent with pyomyoma. She failed a course of conservative treatment with IV antibiotics and underwent urgent myomectomy with vaginal debulking of delivering pyomyoma and hysteroscopic myomectomy with the resectoscope utilizing dilute vasopressin and temporary cervical cerclage to maintain fluid pressure. She underwent Lupron administration and interval myomectomy at 6 weeks with repeat hysteroscopic resection of the remaining 3.5cm myoma with 95% success. The second patient was a 46 yo G7P1142 who presented to clinic with leukorrhea, delivery of fibroid at home, and pelvic pain 6 months after uterine artery embolization. Preoperative imaging demonstrated 15cm uterus and a conglomeration of five 4-6cm FIGO type 0-2 fibroids. She underwent hysteroscopic myomectomy of the two most inferior fibroids with plans for postoperative Lupron and additional staged myomectomy. Benefits of the hysteroscopic approach include easy accessibility, avoidance of abdominal incisions, and utilizing the already dilated cervix to a surgical advantage. Disadvantages include requiring a multi-stage procedure for completion.</div></div><div><h3>Conclusion</h3><div>Hysteroscopic myomectomy can be utilized in cases of delivering fibroids in the setting of extreme submucosal fibroid burden, this offers a less invasive alternative to myomectomy but may require staged procedures. Preoperative imaging and examination are key to planning and can change rapidly. Pregnancy and uterine artery embolization can incite fibroid degeneration with delivery of submucosal fibroids, and rarely subsequent infection.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"31 11","pages":"Pages S15-S16"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658000","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 : 2024-11-01DOI: 10.1016/j.jmig.2024.09.082
T Gallant , L Bar-El , CR King
Study Objective
Describe how our team utilizes a specific MRI endometriosis protocol to surgically optimize patients with extra pelvic endometriosis.
Design
We present the preoperative imaging along with the intraoperative findings in a series of patients with endometriosis. These patients have either bladder, abdominal wall, or diaphragmatic endometriosis.
Setting
Preoperative examination and MRI were completed at an endometriosis center. Surgery took place in a large academic center.
Patients or Participants
Patients in this study were seen by the surgeons at the endometriosis center at the Cleveland Clinic and underwent an endometriosis specific MRI given their history and physical exam findings. They subsequently had surgical excision of their endometriosis.
Interventions
MRI for evaluation of endometriosis followed by laparoscopic or robot assisted excision of endometriosis.
Measurements and Main Results
Surgical video revealing MRI utilization for extra pelvic endometriosis surgery.
Conclusion
An endometriosis specific MRI protocol can be utilized to aid in surgical optimization for patients presenting with symptoms concerning for extra pelvic endometriosis.
{"title":"Utilization of MRI for Extra Pelvic Endometriosis","authors":"T Gallant , L Bar-El , CR King","doi":"10.1016/j.jmig.2024.09.082","DOIUrl":"10.1016/j.jmig.2024.09.082","url":null,"abstract":"<div><h3>Study Objective</h3><div>Describe how our team utilizes a specific MRI endometriosis protocol to surgically optimize patients with extra pelvic endometriosis.</div></div><div><h3>Design</h3><div>We present the preoperative imaging along with the intraoperative findings in a series of patients with endometriosis. These patients have either bladder, abdominal wall, or diaphragmatic endometriosis.</div></div><div><h3>Setting</h3><div>Preoperative examination and MRI were completed at an endometriosis center. Surgery took place in a large academic center.</div></div><div><h3>Patients or Participants</h3><div>Patients in this study were seen by the surgeons at the endometriosis center at the Cleveland Clinic and underwent an endometriosis specific MRI given their history and physical exam findings. They subsequently had surgical excision of their endometriosis.</div></div><div><h3>Interventions</h3><div>MRI for evaluation of endometriosis followed by laparoscopic or robot assisted excision of endometriosis.</div></div><div><h3>Measurements and Main Results</h3><div>Surgical video revealing MRI utilization for extra pelvic endometriosis surgery.</div></div><div><h3>Conclusion</h3><div>An endometriosis specific MRI protocol can be utilized to aid in surgical optimization for patients presenting with symptoms concerning for extra pelvic endometriosis.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"31 11","pages":"Page S18"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658008","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 : 2024-11-01DOI: 10.1016/j.jmig.2024.09.129
J Caron, MD Truong, MT Siedhoff
Study Objective
To study the association between BMI and short-term postoperative complications of patients undergoing minimally invasive (MIS) hysterectomy.
Design
A cohort study of prospectively collected data.
Setting
American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2012 – 2020.
Patients or Participants
Patients requiring MIS hysterectomy for benign conditions.
Interventions
MIS hysterectomy.
Measurements and Main Results
We categorized patients who had undergone MIS hysterectomy into body mass index (BMI) subgroups according to World Health Organization classification and compared rates of 30-day postoperative major and minor complications, defined according to the Clavien-Dindo classification, across BMI groups.
A total of 206,944 patients met the inclusion criteria. In multivariable regression analysis, when comparing those with low and high BMI there was a statistically significant increase in any complications [aOR 95%CI 1.06(1.01-1.10)] and minor complications [aOR 95%CI 1.13(1.07-1.19)] in the high BMI group but no differences in major complications across the two groups [aOR 95%CI 0.96(0.88-1.04)].
When comparing classes of obesity to the normal BMI group, Class I, II, and III categories had a lower likelihood of major complications [aOR 95%CI 0.87(0.80-0.93), 0.84(0.77-0.91), 0.82(0.75-0.90), and 0.83(0.75-0.91), respectively] when compared to normal weight individuals. However, patients in the Class II and III categories had a higher likelihood of minor complications [aOR 95%CI 1.12(1.03-1.21), and 1.17(1.08-1.28), respectively] when compared to normal weight individuals.
The mean operative time was significantly longer for each BMI group compared to lower BMI groups (range 115.2-144.5 minutes, p<0.05).
Conclusion
Higher BMI was associated with a higher risk of all complications and minor complications than low BMI in patients undergoing MIS hysterectomy, as well as increased operative time. However, when comparing across specific BMI categories, overweight and obesity categories were associated with lower risks of major complications compared to the normal BMI category. These findings can help in preoperative patient counseling.
研究目的研究接受微创（MIS）子宫切除术的患者的体重指数与术后短期并发症之间的关系.设计对前瞻性收集的数据进行队列研究.设置美国外科学院国家外科质量改进计划（NSQIP）数据库（2012-2020年）.患者或参与者因良性疾病需要接受MIS子宫切除术的患者.干预措施MIS子宫切除术.测量和主要结果我们根据世界卫生组织的分类将接受MIS子宫切除术的患者分为体重指数（BMI）亚组，并比较了不同BMI组的术后30天主要和次要并发症发生率（根据Clavien-Dindo分类法定义）.共有206944名患者符合纳入标准.在多变量回归分析中，当比较低体重指数组和高体重指数组时，高体重指数组的任何并发症[aOR 95%CI 1.06(1.01-1.10)]和轻微并发症[aOR 95%CI 1.13(1.07-1.19)]显著增加，但两组的主要并发症没有差异[aOR 95%CI 0.将肥胖等级与正常体重指数组进行比较时，与正常体重者相比，I、II和III级肥胖者发生主要并发症的可能性较低[aOR 95%CI 分别为0.87(0.80-0.93)、0.84(0.77-0.91)、0.82(0.75-0.90)和0.83(0.75-0.91)]。然而，与正常体重者相比，II 级和 III 级患者发生轻微并发症的可能性更高[aOR 95%CI 分别为 1.12（1.03-1.21）和 1.17（1.08-1.28）]。与较低体重指数组相比，各体重指数组的平均手术时间明显更长（范围为 115.结论在接受 MIS 子宫切除术的患者中，较高的体重指数与较低的体重指数相比，所有并发症和轻微并发症的风险更高，手术时间也更长。然而，在对特定体重指数类别进行比较时，超重和肥胖类别与正常体重指数类别相比，主要并发症的风险较低。这些发现有助于对患者进行术前咨询。
{"title":"Association of Body Mass Index With Surgical Complications After Laparoscopic Hysterectomy","authors":"J Caron, MD Truong, MT Siedhoff","doi":"10.1016/j.jmig.2024.09.129","DOIUrl":"10.1016/j.jmig.2024.09.129","url":null,"abstract":"<div><h3>Study Objective</h3><div>To study the association between BMI and short-term postoperative complications of patients undergoing minimally invasive (MIS) hysterectomy.</div></div><div><h3>Design</h3><div>A cohort study of prospectively collected data.</div></div><div><h3>Setting</h3><div>American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2012 – 2020.</div></div><div><h3>Patients or Participants</h3><div>Patients requiring MIS hysterectomy for benign conditions.</div></div><div><h3>Interventions</h3><div>MIS hysterectomy.</div></div><div><h3>Measurements and Main Results</h3><div>We categorized patients who had undergone MIS hysterectomy into body mass index (BMI) subgroups according to World Health Organization classification and compared rates of 30-day postoperative major and minor complications, defined according to the Clavien-Dindo classification, across BMI groups.</div><div>A total of 206,944 patients met the inclusion criteria. In multivariable regression analysis, when comparing those with low and high BMI there was a statistically significant increase in any complications [aOR 95%CI 1.06(1.01-1.10)] and minor complications [aOR 95%CI 1.13(1.07-1.19)] in the high BMI group but no differences in major complications across the two groups [aOR 95%CI 0.96(0.88-1.04)].</div><div>When comparing classes of obesity to the normal BMI group, Class I, II, and III categories had a lower likelihood of major complications [aOR 95%CI 0.87(0.80-0.93), 0.84(0.77-0.91), 0.82(0.75-0.90), and 0.83(0.75-0.91), respectively] when compared to normal weight individuals. However, patients in the Class II and III categories had a higher likelihood of minor complications [aOR 95%CI 1.12(1.03-1.21), and 1.17(1.08-1.28), respectively] when compared to normal weight individuals.</div><div>The mean operative time was significantly longer for each BMI group compared to lower BMI groups (range 115.2-144.5 minutes, p<0.05).</div></div><div><h3>Conclusion</h3><div>Higher BMI was associated with a higher risk of all complications and minor complications than low BMI in patients undergoing MIS hysterectomy, as well as increased operative time. However, when comparing across specific BMI categories, overweight and obesity categories were associated with lower risks of major complications compared to the normal BMI category. These findings can help in preoperative patient counseling.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"31 11","pages":"Page S32"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658016","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 : 2024-11-01DOI: 10.1016/j.jmig.2024.09.128
KO Dykstal , J Coté , R Coté , R Walters
Study Objective
To compare medical students’ performance on LapMentorTM skills tests with and without the use of a video game warmup with different controllers and to determine the effect of a video game on the frequency of simulator use in OB/GYN residents.
Design
Prospective RCT combined with a QI project.
Setting
Department of OB/GYN at Creighton University School of Medicine.
Patients or Participants
Medical students and OB/GYN residents.
Interventions
First, students were randomized into groups: Group 1 (warm-up with UndergroundTM game using standard WiiUTM video game controller), Group 2 (warm-up with UndergroundTM game using custom-made laparoscopic controller), and Group 3 (no warm-up). Students completed a pretest and posttest on a validated laparoscopic simulator (LapMentorTM) according to their assigned group. Next, a pre-test questionnaire on the use of simulators for laparoscopic skills was given to OB/GYN residents. They completed a post-test questionnaire after being provided with a WiiUTM videogame system that included a custom controller and UndergroundTM video game.
Measurements and Main Results
Two analyses were performed for the first part of the project: ANCOVA, which used data from the pretest and posttest, and the mixed model, which included participants who did not return for the posttest. Subgroup analysis was conducted on all participants and only those who completed every LapMentorTM task. A statistically significant (p<0.001) decrease from pretest to posttest was constant across groups, regardless of analysis, with no between-group differences at time of pretest and posttest. For the second part of the project, there was a statistically significant increase in laparoscopic simulator use after providing residents with a WiiUTM video game system as compared to prior (p=0.027).
Conclusion
The use of a video game warm-up is associated with faster completion of laparoscopic skills tests in medical students regardless of controller type. Additionally, providing OB/GYN residents with access to the UndergroundTM video game is associated with increased use of the laparoscopic simulator.
{"title":"The Effect of Video Games on Laparoscopic Skills: A Prospective Randomized Controlled Trial and Quality Improvement Project","authors":"KO Dykstal , J Coté , R Coté , R Walters","doi":"10.1016/j.jmig.2024.09.128","DOIUrl":"10.1016/j.jmig.2024.09.128","url":null,"abstract":"<div><h3>Study Objective</h3><div>To compare medical students’ performance on LapMentor<sup>TM</sup> skills tests with and without the use of a video game warmup with different controllers and to determine the effect of a video game on the frequency of simulator use in OB/GYN residents.</div></div><div><h3>Design</h3><div>Prospective RCT combined with a QI project.</div></div><div><h3>Setting</h3><div>Department of OB/GYN at Creighton University School of Medicine.</div></div><div><h3>Patients or Participants</h3><div>Medical students and OB/GYN residents.</div></div><div><h3>Interventions</h3><div>First, students were randomized into groups: Group 1 (warm-up with Underground<sup>TM</sup> game using standard WiiU<sup>TM</sup> video game controller), Group 2 (warm-up with Underground<sup>TM</sup> game using custom-made laparoscopic controller), and Group 3 (no warm-up). Students completed a pretest and posttest on a validated laparoscopic simulator (LapMentor<sup>TM</sup>) according to their assigned group. Next, a pre-test questionnaire on the use of simulators for laparoscopic skills was given to OB/GYN residents. They completed a post-test questionnaire after being provided with a WiiU<sup>TM</sup> videogame system that included a custom controller and Underground<sup>TM</sup> video game.</div></div><div><h3>Measurements and Main Results</h3><div>Two analyses were performed for the first part of the project: ANCOVA, which used data from the pretest and posttest, and the mixed model, which included participants who did not return for the posttest. Subgroup analysis was conducted on all participants and only those who completed every LapMentor<sup>TM</sup> task. A statistically significant (<em>p</em><0.001) decrease from pretest to posttest was constant across groups, regardless of analysis, with no between-group differences at time of pretest and posttest. For the second part of the project, there was a statistically significant increase in laparoscopic simulator use after providing residents with a WiiU<sup>TM</sup> video game system as compared to prior (<em>p</em>=0.027).</div></div><div><h3>Conclusion</h3><div>The use of a video game warm-up is associated with faster completion of laparoscopic skills tests in medical students regardless of controller type. Additionally, providing OB/GYN residents with access to the Underground<sup>TM</sup> video game is associated with increased use of the laparoscopic simulator.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"31 11","pages":"Page S32"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658066","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}
Patient underwent a robotic cervical myomectomy without complications. Estimated blood loss was 100 cc. The postoperative course was uncomplicated and the patient was discharged home in stable condition on postoperative day 1.
Conclusion
Complications of robotic cervical myomectomy can be minimized with the utilization of techniques such as ureteral stenting with indocyanine green injection, injection of the myoma with vasopressin, use of a tenaculum for myoma manipulation, and multi-layer myometrial closure.
{"title":"Robotic Cervical Myomectomy: How to Prevent Pitfalls","authors":"K Ha , Soto D Encalada , E Mikhail","doi":"10.1016/j.jmig.2024.09.065","DOIUrl":"10.1016/j.jmig.2024.09.065","url":null,"abstract":"<div><h3>Study Objective</h3><div>The objective of this video is to present a simplified approach for robotic-assisted laparoscopic removal of cervical fibroids.</div></div><div><h3>Design</h3><div>Surgical video.</div></div><div><h3>Setting</h3><div>Tertiary care academic center.</div></div><div><h3>Patients or Participants</h3><div>32-year-old G0 with an 8 cm cervical fibroid.</div></div><div><h3>Interventions</h3><div>Robotic-assisted laparoscopic cervical myomectomy.</div></div><div><h3>Measurements and Main Results</h3><div>Patient underwent a robotic cervical myomectomy without complications. Estimated blood loss was 100 cc. The postoperative course was uncomplicated and the patient was discharged home in stable condition on postoperative day 1.</div></div><div><h3>Conclusion</h3><div>Complications of robotic cervical myomectomy can be minimized with the utilization of techniques such as ureteral stenting with indocyanine green injection, injection of the myoma with vasopressin, use of a tenaculum for myoma manipulation, and multi-layer myometrial closure.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"31 11","pages":"Page S7"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658213","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 : 2024-11-01DOI: 10.1016/j.jmig.2024.09.097
AN Valdez-Sinon , AM Madison , ME Gornet
Study Objective
This study compared adverse event reports (AEs) amongst commonly used operative hysteroscopy devices.
Design
A secondary analysis of the Manufacturer and User Facility Device Experience (MAUDE)-a voluntary reporting system by the Food and Drug Administration. Search terms included “resectoscope,” “hysteroscopic reciprocating morcellator”, "MyoSure,” and “TruClear.” Statistical analysis utilized Chi-squared tests.
Setting
N/A.
Patients or Participants
Between 2014-present, 1872 AEs were identified for hysteroscopes: 664 for resectoscopes and 1208 for morcellation devices (MyoSure, N=645 and TruClear, N=563).
Interventions
N/A.
Measurements and Main Results
MyoSure and TruClear device AEs were combined into a “morcellation device” composite group and compared to resectoscope AEs. There were significant differences in patient complications: morcellation devices had higher rates of infection (p=0.0019), hemorrhage (p<0.00001), burns (p<0.00001), uterine perforation (p<0.00001), and bowel perforation (p<0.00001). Morcellation device AEs more often reported surgical intervention: hysterectomy (0.2 vs 3.0%, p<0.001), laparoscopy/laparotomy (0.9 vs 8.5%, p<0.001). Subgroup analysis comparing morcellation devices showed the majority (73.18%) of TruClear AEs reported no direct patient impact or harm, while only 21.2% of MyoSure AEs reported no patient impact. Compared to TruClear devices, MyoSure devices reported more infections (p=0.0012), hemorrhage (<0.00001), uterine perforations (<0.00001), and bowel perforations (p<0.00001). Additionally, MyoSure AEs reported more surgical intervention, including hysterectomy (4.8 vs 0.9%, p=0.00007) and laparoscopy/laparotomy (13.5 vs 2.8%, p<0.0001), comparatively. Though death is a rare complication of hysteroscopy, of 21 deaths reported, 17 were associated with MyoSure devices.
Conclusion
Significant differences in AEs exist among operative hysteroscopy instruments. Morcellation AEs comprised significant and substantial patient impact and surgical interventions compared to resectoscopes. When comparing Myosure and Truclear, MyoSure had significantly more serious patient complications (uterine/bowel perforation, infection, hemorrhage) compared to TruClear device AEs. It is vital for physicians to recognize associated risks and understand that devices with similar functions may differ significantly in safety profiles.
研究目的本研究比较了常用宫腔镜手术设备的不良事件报告（AEs）。设计对制造商和用户设施设备经验（MAUDE）进行二次分析--MAUDE是美国食品和药物管理局的自愿报告系统。搜索关键词包括 "切除镜"、"宫腔镜往复式切除器"、"MyoSure "和 "TruClear"。干预措施N/A.测量和主要结果将MyoSure和TruClear装置的AE合并为 "切除装置 "综合组，并与切除镜AE进行比较。患者并发症存在明显差异：Morcellation 设备的感染率（p=0.0019）、出血率（p<0.00001）、烧伤率（p<0.00001）、子宫穿孔率（p<0.00001）和肠穿孔率（p<0.00001）均较高。Morcellation设备的AE更常报告手术干预：子宫切除术（0.2 vs 3.0%，p<0.001）、腹腔镜/腹膜切开术（0.9 vs 8.5%，p<0.001）。比较胃切除术器械的分组分析表明，大多数（73.18%）TruClear AE 报告没有对患者造成直接影响或伤害，而只有 21.2% 的 MyoSure AE 报告没有对患者造成影响。与 TruClear 设备相比，MyoSure 设备报告的感染（p=0.0012）、出血（<0.00001）、子宫穿孔（<0.00001）和肠穿孔（p<0.00001）更多。此外，MyoSure AE 报告的手术干预较多，包括子宫切除术（4.8% vs 0.9%，p=0.00007）和腹腔镜/腹膜切开术（13.5% vs 2.8%，p<0.0001）。尽管死亡是宫腔镜手术的罕见并发症，但在报告的21例死亡病例中，17例与MyoSure设备有关。与切除镜相比，Morcellation AEs 对患者和手术干预造成了重大影响。在比较 Myosure 和 Truclear 时，MyoSure 的严重患者并发症（子宫/肠穿孔、感染、出血）明显多于 TruClear 装置的 AEs。医生必须认识到相关风险，了解功能相似的器械在安全性方面可能存在很大差异。
{"title":"Food and Drug Administration Database Secondary Analysis: Difference in Operative Hysteroscopy Device Safety Profiles","authors":"AN Valdez-Sinon , AM Madison , ME Gornet","doi":"10.1016/j.jmig.2024.09.097","DOIUrl":"10.1016/j.jmig.2024.09.097","url":null,"abstract":"<div><h3>Study Objective</h3><div>This study compared adverse event reports (AEs) amongst commonly used operative hysteroscopy devices.</div></div><div><h3>Design</h3><div>A secondary analysis of the Manufacturer and User Facility Device Experience (MAUDE)-a voluntary reporting system by the Food and Drug Administration. Search terms included “resectoscope,” “hysteroscopic reciprocating morcellator”, \"MyoSure,” and “TruClear.” Statistical analysis utilized Chi-squared tests.</div></div><div><h3>Setting</h3><div>N/A.</div></div><div><h3>Patients or Participants</h3><div>Between 2014-present, 1872 AEs were identified for hysteroscopes: 664 for resectoscopes and 1208 for morcellation devices (MyoSure, N=645 and TruClear, N=563).</div></div><div><h3>Interventions</h3><div>N/A.</div></div><div><h3>Measurements and Main Results</h3><div>MyoSure and TruClear device AEs were combined into a “morcellation device” composite group and compared to resectoscope AEs. There were significant differences in patient complications: morcellation devices had higher rates of infection (p=0.0019), hemorrhage (p<0.00001), burns (p<0.00001), uterine perforation (p<0.00001), and bowel perforation (p<0.00001). Morcellation device AEs more often reported surgical intervention: hysterectomy (0.2 vs 3.0%, p<0.001), laparoscopy/laparotomy (0.9 vs 8.5%, p<0.001). Subgroup analysis comparing morcellation devices showed the majority (73.18%) of TruClear AEs reported no direct patient impact or harm, while only 21.2% of MyoSure AEs reported no patient impact. Compared to TruClear devices, MyoSure devices reported more infections (p=0.0012), hemorrhage (<0.00001), uterine perforations (<0.00001), and bowel perforations (p<0.00001). Additionally, MyoSure AEs reported more surgical intervention, including hysterectomy (4.8 vs 0.9%, p=0.00007) and laparoscopy/laparotomy (13.5 vs 2.8%, p<0.0001), comparatively. Though death is a rare complication of hysteroscopy, of 21 deaths reported, 17 were associated with MyoSure devices.</div></div><div><h3>Conclusion</h3><div>Significant differences in AEs exist among operative hysteroscopy instruments. Morcellation AEs comprised significant and substantial patient impact and surgical interventions compared to resectoscopes. When comparing Myosure and Truclear, MyoSure had significantly more serious patient complications (uterine/bowel perforation, infection, hemorrhage) compared to TruClear device AEs. It is vital for physicians to recognize associated risks and understand that devices with similar functions may differ significantly in safety profiles.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"31 11","pages":"Page S22"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658399","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 : 2024-11-01DOI: 10.1016/j.jmig.2024.09.142
van Reesema LL Siewertsz , L Nehme , JJ Woo
Study Objective
To demonstrate a methodology for laparoscopic en-bloc resection of a cervical ectopic pregnancy using eight reproducible steps, focusing on minimizing potential blood loss and preserving fertility.
Design
Surgical video outlining the steps of laparoscopic en-bloc resection of a cervical ectopic pregnancy using examples from a single case.
Setting
The highlighted surgery was performed at a tertiary referral center by a single surgeon specialized in minimally invasive gynecological surgery and robotics.
Patients or Participants
A 27-year-old patient, gravida two, para one, presented with vaginal bleeding and a positive home pregnancy test. She had a history of one prior cesarean section via a low transverse uterine incision. On transvaginal ultrasound, she was found to have an abnormally implanted pregnancy within the proximal cervical canal. The pregnancy measured approximately 6 weeks gestational age, and cardiac activity was present.
Interventions
After discussion of various management options, the patient was consented for robotic-assisted laparoscopic en-bloc resection of the cervical ectopic pregnancy with a plan for possible repair of isthmocele. The surgical approach highlights eight reproducible steps, including: 1) utilization of pelvic retroperitoneal spaces to delineate the borders of the ectopic pregnancy; 2) identification of ureters; 3) skeletonization of uterine arteries; 4) ensuring hemostasis with the use of laparoscopic bulldog clamps and dilute vasopressin; 5) identification of the cervicovaginal junction; 6) removal of the ectopic pregnancy en-bloc; 7) identification of the cervical canal; 8) reapproximation of the cervix in multiple layers.
Measurements and Main Results
Laparoscopic en-bloc resection of a cervical ectopic pregnancy was completed successfully without intraoperative complications and minimal blood loss.
Conclusion
Cervical ectopic pregnancy can be treated surgically through a systematic minimally invasive approach. Timely intervention and the surgical techniques as demonstrated are essential for ensuring hemostasis, optimizing outcomes, and preserving fertility in these rare cases.
{"title":"Cervical Ectopic Pregnancy: Tips and Tricks for Laparoscopic Management","authors":"van Reesema LL Siewertsz , L Nehme , JJ Woo","doi":"10.1016/j.jmig.2024.09.142","DOIUrl":"10.1016/j.jmig.2024.09.142","url":null,"abstract":"<div><h3>Study Objective</h3><div>To demonstrate a methodology for laparoscopic en-bloc resection of a cervical ectopic pregnancy using eight reproducible steps, focusing on minimizing potential blood loss and preserving fertility.</div></div><div><h3>Design</h3><div>Surgical video outlining the steps of laparoscopic en-bloc resection of a cervical ectopic pregnancy using examples from a single case.</div></div><div><h3>Setting</h3><div>The highlighted surgery was performed at a tertiary referral center by a single surgeon specialized in minimally invasive gynecological surgery and robotics.</div></div><div><h3>Patients or Participants</h3><div>A 27-year-old patient, gravida two, para one, presented with vaginal bleeding and a positive home pregnancy test. She had a history of one prior cesarean section via a low transverse uterine incision. On transvaginal ultrasound, she was found to have an abnormally implanted pregnancy within the proximal cervical canal. The pregnancy measured approximately 6 weeks gestational age, and cardiac activity was present.</div></div><div><h3>Interventions</h3><div>After discussion of various management options, the patient was consented for robotic-assisted laparoscopic en-bloc resection of the cervical ectopic pregnancy with a plan for possible repair of isthmocele. The surgical approach highlights eight reproducible steps, including: 1) utilization of pelvic retroperitoneal spaces to delineate the borders of the ectopic pregnancy; 2) identification of ureters; 3) skeletonization of uterine arteries; 4) ensuring hemostasis with the use of laparoscopic bulldog clamps and dilute vasopressin; 5) identification of the cervicovaginal junction; 6) removal of the ectopic pregnancy en-bloc; 7) identification of the cervical canal; 8) reapproximation of the cervix in multiple layers.</div></div><div><h3>Measurements and Main Results</h3><div>Laparoscopic en-bloc resection of a cervical ectopic pregnancy was completed successfully without intraoperative complications and minimal blood loss.</div></div><div><h3>Conclusion</h3><div>Cervical ectopic pregnancy can be treated surgically through a systematic minimally invasive approach. Timely intervention and the surgical techniques as demonstrated are essential for ensuring hemostasis, optimizing outcomes, and preserving fertility in these rare cases.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"31 11","pages":"Pages S36-S37"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658015","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 : 2024-11-01DOI: 10.1016/j.jmig.2024.09.122
ACE Dadrat , ARR Borovich , N Goncalves , J To
Study Objective
In this video we aim to present the diagnostic work up for 3 different types of ectopic pregnancies (angular, interstitial, and intramural) that all occurred within the uterine cornua and the subtle ultrasonographic and surgical differences identified between them in their work ups that led to their correct diagnoses.
Design
Surgical Video.
Setting
Tertiary care center.
Patients or Participants
Three patients with differing pregnancies all implanted within the uterine cornea.
Interventions
Patients underwent diagnostic imaging (ultrasound/MRI) and surgical management if appropriate (laparoscopy/hysteroscopy) for 3 different ectopic pregnancies.
Measurements and Main Results
The angular pregnancy was identified on ultrasound as eccentrically located intrauterine pregnancy within the uterine cornea with < 5mm surrounding myometrium. Our patient did not undergo laparoscopy, however, if she had, uterine distention medial to the round ligament would have been visualized. The interstitial pregnancy was identified on ultrasound with interstitial line and a <5mm myometrial thickness surrounding trophoblastic tissue. On laparoscopy the ectopic was found distending the uterine body laterally to the round ligament. The intramural pregnancy was identified on MRI without evidence of clear uterine distention on laparoscopy and no clear evidence of intrauterine-pregnancy on hysteroscopy.
Conclusion
The use of imaging and minimally invasive surgical procedures are useful in diagnosing ectopic pregnancies presenting at the uterine cornea. Furthermore, accurate terminology is important when describing ectopic pregnancies, as each of these might have incorrectly been called cornual ectopics, however, workup and management plans are different. The term interstitial pregnancy is preferred to the term cornual pregnancy for pregnancies located within the intrauterine portion of the proximal fallopian tube.
{"title":"“Cornual” Ectopic Pregnancies: Diagnostic Approach to Pregnancies Presenting Within the Uterine Cornua","authors":"ACE Dadrat , ARR Borovich , N Goncalves , J To","doi":"10.1016/j.jmig.2024.09.122","DOIUrl":"10.1016/j.jmig.2024.09.122","url":null,"abstract":"<div><h3>Study Objective</h3><div>In this video we aim to present the diagnostic work up for 3 different types of ectopic pregnancies (angular, interstitial, and intramural) that all occurred within the uterine cornua and the subtle ultrasonographic and surgical differences identified between them in their work ups that led to their correct diagnoses.</div></div><div><h3>Design</h3><div>Surgical Video.</div></div><div><h3>Setting</h3><div>Tertiary care center.</div></div><div><h3>Patients or Participants</h3><div>Three patients with differing pregnancies all implanted within the uterine cornea.</div></div><div><h3>Interventions</h3><div>Patients underwent diagnostic imaging (ultrasound/MRI) and surgical management if appropriate (laparoscopy/hysteroscopy) for 3 different ectopic pregnancies.</div></div><div><h3>Measurements and Main Results</h3><div>The angular pregnancy was identified on ultrasound as eccentrically located intrauterine pregnancy within the uterine cornea with < 5mm surrounding myometrium. Our patient did not undergo laparoscopy, however, if she had, uterine distention medial to the round ligament would have been visualized. The interstitial pregnancy was identified on ultrasound with interstitial line and a <5mm myometrial thickness surrounding trophoblastic tissue. On laparoscopy the ectopic was found distending the uterine body laterally to the round ligament. The intramural pregnancy was identified on MRI without evidence of clear uterine distention on laparoscopy and no clear evidence of intrauterine-pregnancy on hysteroscopy.</div></div><div><h3>Conclusion</h3><div>The use of imaging and minimally invasive surgical procedures are useful in diagnosing ectopic pregnancies presenting at the uterine cornea. Furthermore, accurate terminology is important when describing ectopic pregnancies, as each of these might have incorrectly been called cornual ectopics, however, workup and management plans are different. The term interstitial pregnancy is preferred to the term cornual pregnancy for pregnancies located within the intrauterine portion of the proximal fallopian tube.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"31 11","pages":"Pages S29-S30"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658071","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 : 2024-11-01DOI: 10.1016/j.jmig.2024.09.058
S Rubenstein, T Mupombwa
Study Objective
Demonstrate the surgical technique of laparoscopic hysterectomy and bilateral salpingectomy with abnormal ureteral anatomy after prior ureteral surgery.
Design
Stepwise narrated video footage of laparoscopic surgery.
Setting
Tertiary care hospital affiliated with an academic institution.
Patients or Participants
This case describes a 33-year-old gravida 0 cisgender woman with a history of left ureteral reimplantation with dysmenorrhea desiring definitive surgical management.
Interventions
A laparoscopic survey of the abdomen and pelvis demonstrated an ectopic left ureter that entered the peritoneum at the level of the infundibulopelvic ligament, traversed along the ovarian vasculature, crossed over the fallopian tube and round ligament, then coursed lateral and anterior to the cervix to insert into the bladder in the normal anatomic location. The laparoscopic hysterectomy and bilateral salpingectomy were then performed with meticulous dissection of the left ureter to prevent ureteral injury. Routine cystoscopy demonstrated normal bilateral ureteral orificies.
Measurements and Main Results
The patient's surgery was uncomplicated with no immediate or delayed ureteral injury. Ureteral anatomy and techniques to avoid ureteral injury were reviewed including routine identification and re-identification of the ureters, identification of preoperative risk factors, and consideration of intraoperative urology consultation if suspicion of injury.
Conclusion
In this video, we demonstrate a step-wise laparoscopic hysterectomy and bilateral salpingectomy in a patient with abnormal left ureteral anatomy.
{"title":"Laparoscopic Hysterectomy After Childhood Ureteral Reimplantation","authors":"S Rubenstein, T Mupombwa","doi":"10.1016/j.jmig.2024.09.058","DOIUrl":"10.1016/j.jmig.2024.09.058","url":null,"abstract":"<div><h3>Study Objective</h3><div>Demonstrate the surgical technique of laparoscopic hysterectomy and bilateral salpingectomy with abnormal ureteral anatomy after prior ureteral surgery.</div></div><div><h3>Design</h3><div>Stepwise narrated video footage of laparoscopic surgery.</div></div><div><h3>Setting</h3><div>Tertiary care hospital affiliated with an academic institution.</div></div><div><h3>Patients or Participants</h3><div>This case describes a 33-year-old gravida 0 cisgender woman with a history of left ureteral reimplantation with dysmenorrhea desiring definitive surgical management.</div></div><div><h3>Interventions</h3><div>A laparoscopic survey of the abdomen and pelvis demonstrated an ectopic left ureter that entered the peritoneum at the level of the infundibulopelvic ligament, traversed along the ovarian vasculature, crossed over the fallopian tube and round ligament, then coursed lateral and anterior to the cervix to insert into the bladder in the normal anatomic location. The laparoscopic hysterectomy and bilateral salpingectomy were then performed with meticulous dissection of the left ureter to prevent ureteral injury. Routine cystoscopy demonstrated normal bilateral ureteral orificies.</div></div><div><h3>Measurements and Main Results</h3><div>The patient's surgery was uncomplicated with no immediate or delayed ureteral injury. Ureteral anatomy and techniques to avoid ureteral injury were reviewed including routine identification and re-identification of the ureters, identification of preoperative risk factors, and consideration of intraoperative urology consultation if suspicion of injury.</div></div><div><h3>Conclusion</h3><div>In this video, we demonstrate a step-wise laparoscopic hysterectomy and bilateral salpingectomy in a patient with abnormal left ureteral anatomy.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"31 11","pages":"Page S9"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658137","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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