Growing interest in minimally invasive uterine-sparing conservative surgery for managing uterine fibroids has made radiofrequency ablation (RFA) a popular procedure. The two most common approaches are a laparoscopic RFA (LAP-RFA) technique—the Acessa ProVu® System (Acessa Health Inc., Austin, TX, USA)—and transcervical fibroid ablation (TFA)—the Sonata® System (Gynesonics, Redwood City, CA, USA). Positive impacts on decreasing uterine size, improving patients' quality of life, and inducing uncomplicated pregnancy outcomes, support RFA as an option to manage fibroids in the right patients. However, although these procedures are promising, they are not yet approved by the U.S. Food and Drug Administration for patients seeking treatment for infertility. This article briefly addresses updates in the current literature on these 2 procedures . (J GYNECOL SURG 20XX:000)
越来越多的人对保留子宫的微创保守手术治疗子宫肌瘤的兴趣使得射频消融(RFA)成为一种流行的手术。两种最常见的方法是腹腔镜RFA (LAP-RFA)技术- Acessa ProVu®系统(Acessa Health Inc.， Austin, TX, USA)和经宫颈肌瘤消融(TFA) - Sonata®系统(genesonics, Redwood City, CA, USA)。在减小子宫大小、改善患者生活质量和诱导无并发症妊娠结局方面的积极影响，支持RFA作为治疗子宫肌瘤的一种选择。然而，尽管这些方法很有希望，但它们尚未被美国食品和药物管理局批准用于寻求不孕症治疗的患者。本文简要介绍了关于这两种方法的最新文献。(j妇科外科200xx:000)
{"title":"Update on Conservative Surgery for Fibroids: Laparoscopic Radiofrequency and Transcervical Fibroid Ablation","authors":"Ghadear Shukr","doi":"10.1089/gyn.2023.0064","DOIUrl":"https://doi.org/10.1089/gyn.2023.0064","url":null,"abstract":"Growing interest in minimally invasive uterine-sparing conservative surgery for managing uterine fibroids has made radiofrequency ablation (RFA) a popular procedure. The two most common approaches are a laparoscopic RFA (LAP-RFA) technique—the Acessa ProVu® System (Acessa Health Inc., Austin, TX, USA)—and transcervical fibroid ablation (TFA)—the Sonata® System (Gynesonics, Redwood City, CA, USA). Positive impacts on decreasing uterine size, improving patients' quality of life, and inducing uncomplicated pregnancy outcomes, support RFA as an option to manage fibroids in the right patients. However, although these procedures are promising, they are not yet approved by the U.S. Food and Drug Administration for patients seeking treatment for infertility. This article briefly addresses updates in the current literature on these 2 procedures . (J GYNECOL SURG 20XX:000)","PeriodicalId":44791,"journal":{"name":"JOURNAL OF GYNECOLOGIC SURGERY","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136264163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: Uterine leiomyomas are the commonest benign tumors in women. Myomectomy is preferred for symptomatic uterine leiomyomas when a patient wants to stay fertile. Abdominal myomectomy can be complex and lead to complications. This study examined the usefulness of preoperative ultrasound (US) scans prior to myomectomy to enhance outcomes. Materials and Methods: This retrospective, hospital-based case-control review evaluated surgical outcomes after myomectomies when surgeons themselves performed preoperative US scans in a cases group. The study was at the University of Cape Coast Hospital, Cape Coast, Ghana, from January1, 2018, to December 31, 2020. Data were extracted from the hospital records and analyzed with a Statistical Package for Social Sciences (SPSS version 21.0). Results: The mean ages were 34.5 years and 33.2 years for cases and controls, respectively. abnormal uterine bleeding and infertility associated with uterine fibroids were the commonest indications for myomectomy (88.5% and 70.8%, respectively). The mean duration of surgery was 98.63 minutes for the cases, which was statistically lower than for the controls (115.41 minutes). The number of incisions on the uterus and the frequency of blood transfusion was higher in the controls. There were no significant differences in postoperative complications and durations of hospital stays between the cases and controls. Conclusions: Preoperative US helps reduce surgery duration, incisions on uteri, blood transfusions (which can be correlated to blood loss); yet, there are no proven reduced hospital stays and postoperative complications. Surgeons should perform US scans before surgery.
{"title":"Preoperative Ultrasound Scanning Reduces Surgery Duration and Improves Myomectomy Outcomes in Cape Coast, Ghana, West Africa","authors":"Abdoul Azize Diallo, Albright Nana Afua Amesua Brookman, Sebastian Ken-Amoah, Evans Ekanem","doi":"10.1089/gyn.2023.0018","DOIUrl":"https://doi.org/10.1089/gyn.2023.0018","url":null,"abstract":"Objectives: Uterine leiomyomas are the commonest benign tumors in women. Myomectomy is preferred for symptomatic uterine leiomyomas when a patient wants to stay fertile. Abdominal myomectomy can be complex and lead to complications. This study examined the usefulness of preoperative ultrasound (US) scans prior to myomectomy to enhance outcomes. Materials and Methods: This retrospective, hospital-based case-control review evaluated surgical outcomes after myomectomies when surgeons themselves performed preoperative US scans in a cases group. The study was at the University of Cape Coast Hospital, Cape Coast, Ghana, from January1, 2018, to December 31, 2020. Data were extracted from the hospital records and analyzed with a Statistical Package for Social Sciences (SPSS version 21.0). Results: The mean ages were 34.5 years and 33.2 years for cases and controls, respectively. abnormal uterine bleeding and infertility associated with uterine fibroids were the commonest indications for myomectomy (88.5% and 70.8%, respectively). The mean duration of surgery was 98.63 minutes for the cases, which was statistically lower than for the controls (115.41 minutes). The number of incisions on the uterus and the frequency of blood transfusion was higher in the controls. There were no significant differences in postoperative complications and durations of hospital stays between the cases and controls. Conclusions: Preoperative US helps reduce surgery duration, incisions on uteri, blood transfusions (which can be correlated to blood loss); yet, there are no proven reduced hospital stays and postoperative complications. Surgeons should perform US scans before surgery.","PeriodicalId":44791,"journal":{"name":"JOURNAL OF GYNECOLOGIC SURGERY","volume":"434 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135112590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nawsin Baset, Sirai Ramirez, Nafis Deen, Larry Segars, Tony Olinger, Melanie Meister
Objective: Retropubic midurethral sling placement (MUS) is a surgical procedure for treating stress urinary incontinence (SUI) in females that uses mesh to support the urethra to prevent leakage during episodes of increased abdominal pressure. Hematoma is a documented risk of MUS placement. The location of relevant pelvic vasculature was compared to pelvic bony dimensions with the aim of measuring these anatomic relationships in order to prevent hematomas during MUS placement. Materials and Methods: The superficial epigastric, inferior epigastric, external iliac, and obturator arteries were dissected bilaterally from 13 formalin-embalmed cadavers. Distance was measured to a retropubic trocar placed in the typical fashion. Anteroposterior pelvic (AP) diameter and ischial interspinous distance were recorded. SPSS was used for statistical analyses. Results: All arteries were identified lateral to the trocar site. Obturator arteries were the closest (30.60 ± 5.19 mm) and external iliac arteries were the furthest (48.08 ± 9.64 mm). There was a significant correlation between artery–trocar distance and AP diameter, but not interspinous distance. Conclusions: Major vascular structures lie in close proximity to the path of the trocar used in MUS placement for treating SUI. The female AP diameter is correlated with the distance between these vessels and the trocar—and may be a clinically useful measure to determine which patients are at increased risk for hematomas during MUS. (J GYNECOL SURG 20XX:000)
{"title":"Relationship Between Retropubic Vessels and Pelvic Bony Anatomy: Retropubic Midurethral-Sling Placement Considerations","authors":"Nawsin Baset, Sirai Ramirez, Nafis Deen, Larry Segars, Tony Olinger, Melanie Meister","doi":"10.1089/gyn.2023.0090","DOIUrl":"https://doi.org/10.1089/gyn.2023.0090","url":null,"abstract":"Objective: Retropubic midurethral sling placement (MUS) is a surgical procedure for treating stress urinary incontinence (SUI) in females that uses mesh to support the urethra to prevent leakage during episodes of increased abdominal pressure. Hematoma is a documented risk of MUS placement. The location of relevant pelvic vasculature was compared to pelvic bony dimensions with the aim of measuring these anatomic relationships in order to prevent hematomas during MUS placement. Materials and Methods: The superficial epigastric, inferior epigastric, external iliac, and obturator arteries were dissected bilaterally from 13 formalin-embalmed cadavers. Distance was measured to a retropubic trocar placed in the typical fashion. Anteroposterior pelvic (AP) diameter and ischial interspinous distance were recorded. SPSS was used for statistical analyses. Results: All arteries were identified lateral to the trocar site. Obturator arteries were the closest (30.60 ± 5.19 mm) and external iliac arteries were the furthest (48.08 ± 9.64 mm). There was a significant correlation between artery–trocar distance and AP diameter, but not interspinous distance. Conclusions: Major vascular structures lie in close proximity to the path of the trocar used in MUS placement for treating SUI. The female AP diameter is correlated with the distance between these vessels and the trocar—and may be a clinically useful measure to determine which patients are at increased risk for hematomas during MUS. (J GYNECOL SURG 20XX:000)","PeriodicalId":44791,"journal":{"name":"JOURNAL OF GYNECOLOGIC SURGERY","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135112591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alexander S. Wang, Andrew S. Bossick, Georgine M. Lamvu, Lisa Callegari, Jodie G. Katon
Objectives: This article describes the prevalence of preexisting gynecologic conditions associated with chronic pelvic pain (CPP) in veterans having hysterectomy for benign indications and explores whether preexisting CPP affects receipt of minimally invasive hysterectomy (MIH). Materials and Methods: This cross-sectional study used Veterans Health Administration (VHA) data to identify hysterectomies provided or paid for by the VHA between 2007 and 2014. Veterans were included if they had any type of hysterectomy—abdominal or MIH (vaginal, laparoscopic, or robotic). Veterans were categorized as having preexisting gynecologic conditions associated with CPP if they had an International Classification of Diseases, 9th Revision, Clinical Modification diagnosis of endometriosis/adenomyosis, dysmenorrhea, dyspareunia, or pelvic-congestion syndrome within 1 year prior to hysterectomy. Generalized linear models with a Poisson distribution were used to estimate the relative risks (RRs) and 95% confidence intervals (CIs) for preexisting CPP conditions and MIH. Results: The final sample had 6830 veterans who had hysterectomies. Of these, 66.5% (n = 4540) had preexisting CPP conditions. MIH was performed in 41.8% (n = 1897) of veterans who had preexisting CPP conditions. After adjustment, there was no association between preexisting CPP and MIH (unadjusted RR: 1.05; 95% CI: 0.97, 1.15; adjusted RR: 0.99; 95% CI: 0.90, 1.08). Conclusions: Veterans undergoing hysterectomy have a high prevalence of preexisting conditions associated with CPP. More hysterectomies were performed in veterans with preexisting CPP, compared to those without. However, the presence of preexisting CPP did not affect the likelihood of receiving MIH. (J GYNECOL SURG 20XX:000)
{"title":"Preexisting Gynecologic Conditions Associated with Chronic Pelvic Pain in Veterans Undergoing Hysterectomy for Benign Indications: Impact on Minimally Invasive Hysterectomy","authors":"Alexander S. Wang, Andrew S. Bossick, Georgine M. Lamvu, Lisa Callegari, Jodie G. Katon","doi":"10.1089/gyn.2023.0089","DOIUrl":"https://doi.org/10.1089/gyn.2023.0089","url":null,"abstract":"Objectives: This article describes the prevalence of preexisting gynecologic conditions associated with chronic pelvic pain (CPP) in veterans having hysterectomy for benign indications and explores whether preexisting CPP affects receipt of minimally invasive hysterectomy (MIH). Materials and Methods: This cross-sectional study used Veterans Health Administration (VHA) data to identify hysterectomies provided or paid for by the VHA between 2007 and 2014. Veterans were included if they had any type of hysterectomy—abdominal or MIH (vaginal, laparoscopic, or robotic). Veterans were categorized as having preexisting gynecologic conditions associated with CPP if they had an International Classification of Diseases, 9th Revision, Clinical Modification diagnosis of endometriosis/adenomyosis, dysmenorrhea, dyspareunia, or pelvic-congestion syndrome within 1 year prior to hysterectomy. Generalized linear models with a Poisson distribution were used to estimate the relative risks (RRs) and 95% confidence intervals (CIs) for preexisting CPP conditions and MIH. Results: The final sample had 6830 veterans who had hysterectomies. Of these, 66.5% (n = 4540) had preexisting CPP conditions. MIH was performed in 41.8% (n = 1897) of veterans who had preexisting CPP conditions. After adjustment, there was no association between preexisting CPP and MIH (unadjusted RR: 1.05; 95% CI: 0.97, 1.15; adjusted RR: 0.99; 95% CI: 0.90, 1.08). Conclusions: Veterans undergoing hysterectomy have a high prevalence of preexisting conditions associated with CPP. More hysterectomies were performed in veterans with preexisting CPP, compared to those without. However, the presence of preexisting CPP did not affect the likelihood of receiving MIH. (J GYNECOL SURG 20XX:000)","PeriodicalId":44791,"journal":{"name":"JOURNAL OF GYNECOLOGIC SURGERY","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135729776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Omar Abuzeid, Cassandra Heiselman, Anna Fuchs, Jenny LaChance, Kimberly Herrera, David Garry, Mostafa Abuzeid
Objective: The aim of this research was to determine the obstetric outcomes in patients who had singleton live birth after hysteroscopic septoplasty of complete uterine septum (CUS) that reached the internal or the external cervical os. Materials and Methods: This retrospective study included 112 patients, each with a history of reproductive failure between 2002 and 2019. Of these patients, 29 each had a singleton live birth after hysteroscopic septoplasty for CUS (group 1) and 83 each had a singleton live birth after hysteroscopy revealed a normal uterine cavity (group 2). In group 1 the septum reached the internal or the external cervical os in 16 and 13 patients, respectively. Subgroup analysis was performed of 24 patients: 8, in whom the septum reached the external cervical os (group 1a); and 16, in whom the septum reached the internal cervical os (group 1b). Results: There was no significant difference in incidence of premature birth (12.5% versus 12.2%) or other pregnancy complications, gestational age, or newborn birth weight between group 1 and group 2, respectively. Obstetric outcomes between the 2 subgroups were also similar. Conclusions: The study data suggest favorable obstetric outcomes for singleton gestation after hysteroscopic septoplasty of CUS reaching the internal or external cervical os. Division of cervical septum was not associated with cervical insufficiency. (J GYNECOL SURG 20XX:000)
目的:本研究的目的是确定宫腔镜下完全性子宫间隔成形术(CUS)到达宫颈内腔或宫颈外腔后单胎活产的产科结局。材料与方法:本回顾性研究包括112例患者，均有2002年至2019年期间的生殖失败史。其中宫腔镜下室间隔成形术治疗CUS后各有29例单胎活产(1组)，宫腔镜检查显示子宫腔正常后各有83例单胎活产(2组)。1组中室间隔到达宫颈内腔或宫颈外腔分别有16例和13例。对24例患者进行亚组分析:8例中隔到达颈外骨(1a组);16例中隔到达颈内OS (1b组)。结果:1组与2组在早产发生率(12.5% vs 12.2%)、其他妊娠并发症、胎龄、新生儿体重方面均无显著差异。两个亚组的产科结局也相似。结论:本研究数据提示宫腔镜下输卵管中隔成形术后到达颈内或颈外腔后单胎妊娠的产科预后良好。宫颈隔分裂与宫颈功能不全无关。(j妇科外科200xx:000)
{"title":"Obstetric Outcomes of Singleton Birth After Hysteroscopic Septoplasty of Complete Uterine Septum","authors":"Omar Abuzeid, Cassandra Heiselman, Anna Fuchs, Jenny LaChance, Kimberly Herrera, David Garry, Mostafa Abuzeid","doi":"10.1089/gyn.2023.0031","DOIUrl":"https://doi.org/10.1089/gyn.2023.0031","url":null,"abstract":"Objective: The aim of this research was to determine the obstetric outcomes in patients who had singleton live birth after hysteroscopic septoplasty of complete uterine septum (CUS) that reached the internal or the external cervical os. Materials and Methods: This retrospective study included 112 patients, each with a history of reproductive failure between 2002 and 2019. Of these patients, 29 each had a singleton live birth after hysteroscopic septoplasty for CUS (group 1) and 83 each had a singleton live birth after hysteroscopy revealed a normal uterine cavity (group 2). In group 1 the septum reached the internal or the external cervical os in 16 and 13 patients, respectively. Subgroup analysis was performed of 24 patients: 8, in whom the septum reached the external cervical os (group 1a); and 16, in whom the septum reached the internal cervical os (group 1b). Results: There was no significant difference in incidence of premature birth (12.5% versus 12.2%) or other pregnancy complications, gestational age, or newborn birth weight between group 1 and group 2, respectively. Obstetric outcomes between the 2 subgroups were also similar. Conclusions: The study data suggest favorable obstetric outcomes for singleton gestation after hysteroscopic septoplasty of CUS reaching the internal or external cervical os. Division of cervical septum was not associated with cervical insufficiency. (J GYNECOL SURG 20XX:000)","PeriodicalId":44791,"journal":{"name":"JOURNAL OF GYNECOLOGIC SURGERY","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135825414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Enhanced Recovery After Surgery (ERAS) protocols represent a new era in surgical care in many different surgical disciplines, including gynecologic surgery. ERAS focuses on optimizing patient health prior to surgery and decreasing the stress response during and after surgery. This leads to benefits such as shortened length of stay, decreased postsurgical complications, and decreased readmission rates for patients. This narrative article summarizes current ERAS protocols developed for gynecologic surgery from leading institutions—including the ERAS Society, in Stockholm, Sweden, the American Society of Enhanced Recovery and Perioperative Medicine, (ASER), in Glenview, IL, USA, Duke, the University of Virginia, and Beaumont Hospital–Troy—and compares them to the current authors' protocal at the H. Lee Moffitt Cancer Center and Research Institute, in Tampa, Florida, USA. The article also discusses patient benefits of ERAS in gynecologic surgery through a review of studied outcomes, such as medical outcomes for patients, postoperative pain control, patient satisfaction, and cost savings to hospital systems. (J GYNECOL SURG 20XX:000)
加强术后恢复(ERAS)协议代表了外科护理的新时代，在许多不同的外科学科，包括妇科手术。ERAS的重点是在手术前优化患者的健康状况，减少手术期间和手术后的应激反应。这样可以缩短住院时间，减少术后并发症，降低患者再入院率。这篇叙叙性文章总结了目前主要机构为妇科手术制定的ERAS方案，包括瑞典斯德哥尔摩的ERAS协会，美国伊利诺伊州格伦维尤的美国增强康复和围手术期医学协会(ASER)，杜克大学，弗吉尼亚大学和博蒙特医院-特洛伊，并将其与当前作者在美国佛罗里达州坦帕市的H. Lee Moffitt癌症中心和研究所的方案进行了比较。本文还通过对研究结果的回顾，讨论了在妇科手术中ERAS对患者的益处，例如患者的医疗结果、术后疼痛控制、患者满意度和医院系统的成本节约。(j妇科外科200xx:000)
{"title":"Enhanced Recovery Protocols in Gynecological Surgery","authors":"Ryan Tang, Katie Letchworth, Aaron Muncey","doi":"10.1089/gyn.2023.0079","DOIUrl":"https://doi.org/10.1089/gyn.2023.0079","url":null,"abstract":"Enhanced Recovery After Surgery (ERAS) protocols represent a new era in surgical care in many different surgical disciplines, including gynecologic surgery. ERAS focuses on optimizing patient health prior to surgery and decreasing the stress response during and after surgery. This leads to benefits such as shortened length of stay, decreased postsurgical complications, and decreased readmission rates for patients. This narrative article summarizes current ERAS protocols developed for gynecologic surgery from leading institutions—including the ERAS Society, in Stockholm, Sweden, the American Society of Enhanced Recovery and Perioperative Medicine, (ASER), in Glenview, IL, USA, Duke, the University of Virginia, and Beaumont Hospital–Troy—and compares them to the current authors' protocal at the H. Lee Moffitt Cancer Center and Research Institute, in Tampa, Florida, USA. The article also discusses patient benefits of ERAS in gynecologic surgery through a review of studied outcomes, such as medical outcomes for patients, postoperative pain control, patient satisfaction, and cost savings to hospital systems. (J GYNECOL SURG 20XX:000)","PeriodicalId":44791,"journal":{"name":"JOURNAL OF GYNECOLOGIC SURGERY","volume":"84 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135146790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-01Epub Date: 2023-10-03DOI: 10.1089/gyn.2023.0041
Tanushree Rao, Sandesh Kade
Objective: This article presents a 6-step laparoscopic technique for dissecting a central uterine band in a ventrofixed uterus, in order to minimize injury to adjacent structures during such procedures as repeat cesarean sections and hysterectomy.
Methods: The description of this laparoscopic surgical technique shows how the anatomically consistent avascular space beneath the uterine band was accessed via lateral dissection. An online video demonstrating the anatomy, anatomical free space, and secure dissection techniques is included.
Results: The proposed technique enables safe dissection of the uterine band and reduces the risk of bladder injury during uterine-preserving procedures. Accessing the anatomical free space via lateral dissection results in a safer operative field, decreased blood loss, and preserved myometrium during uterine-preserving procedures.
Conclusions: The anatomically consistent avascular space beneath the uterine band is accessible via lateral dissection, enabling secure dissection of the uterine band. This technique can be used in both laparoscopic and open procedures, such as repeat cesarean sections. Familiarity with the anatomy of the central uterine-adhesion band can ensure a safe operation and reduce the risk of bladder injury. (J GYNECOL SURG 39:220).
{"title":"Ventrofixed Uterus: Unfreezing the Uterus in 6 Standardized Steps.","authors":"Tanushree Rao, Sandesh Kade","doi":"10.1089/gyn.2023.0041","DOIUrl":"10.1089/gyn.2023.0041","url":null,"abstract":"<p><strong>Objective: </strong>This article presents a 6-step laparoscopic technique for dissecting a central uterine band in a ventrofixed uterus, in order to minimize injury to adjacent structures during such procedures as repeat cesarean sections and hysterectomy.</p><p><strong>Methods: </strong>The description of this laparoscopic surgical technique shows how the anatomically consistent avascular space beneath the uterine band was accessed via lateral dissection. An online video demonstrating the anatomy, anatomical free space, and secure dissection techniques is included.</p><p><strong>Results: </strong>The proposed technique enables safe dissection of the uterine band and reduces the risk of bladder injury during uterine-preserving procedures. Accessing the anatomical free space via lateral dissection results in a safer operative field, decreased blood loss, and preserved myometrium during uterine-preserving procedures.</p><p><strong>Conclusions: </strong>The anatomically consistent avascular space beneath the uterine band is accessible via lateral dissection, enabling secure dissection of the uterine band. This technique can be used in both laparoscopic and open procedures, such as repeat cesarean sections. Familiarity with the anatomy of the central uterine-adhesion band can ensure a safe operation and reduce the risk of bladder injury. (J GYNECOL SURG 39:220).</p>","PeriodicalId":44791,"journal":{"name":"JOURNAL OF GYNECOLOGIC SURGERY","volume":"39 5","pages":"220-221"},"PeriodicalIF":0.3,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10561766/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41215509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Journal of Gynecologic SurgeryVol. 39, No. 5 EditorialFree AccessLearning and Teaching SurgeryMitchel S. HoffmanMitchel S. Hoffman—Mitchel S. Hoffman, MD, Editor-in-Chief Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA.MCC GYN Program, Moffitt Cancer Center, Tampa, Florida, USA.Search for more papers by this authorPublished Online:3 Oct 2023https://doi.org/10.1089/gyn.2023.0087AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail A surgeon must select from among 3 routes for performing a hysterectomy: vaginal; open abdominal; or laparoscopic. In addition, there are variations of these approaches that include robotic and vNOTES [vaginal natural orifice transluminal endoscopic surgery].The first article of this issue has Drs. Kristin N. Taylor and Kenneth H. Kim (MD, MHPE) from the Samuel Oschin Cancer Center at Cedars–Sinai Medical Center (Los Angeles, CA) providing a historical perspective on the use of robotics in gynecologic surgery. Dr. Kim, an internationally renowned expert on the subject, adds thoughts on future directions that this evolving technology might take.As an introduction to this article, I would like to comment on surgical training in robotic surgery. During an open abdominal operation, the attending surgeon can readily demonstrate, observe, control, and correct surgical steps with a trainee. The same is true, although to a lesser extent, for vaginal and laparoscopic surgery. Robotic surgery is unique in this respect. The individual operating at the surgeon console has complete control, at least momentarily, of the operation. The attending surgeon can point, draw a line, control an assisting robotic instrument (dual console), and resume complete control very rapidly.The complete transfer of control of robotic surgery to a trainee highlights 2 important issues. First: Even with only momentary control, a catastrophic complication may occur (such as moving scissors that are out of the field of view and puncturing a major vessel). Second: How do we effectively teach complex gynecologic surgery without being able to continuously demonstrate or redirect the trainee should the need to do so arise during the case? There are no clear answers to these questions, although the development of the teaching console and the ability of the educator to control 1 of 3 instruments have been major advances with respect to teaching robotic surgery. Currently, the major focus of the Taylor and Kim article provides the best answer to balancing surgical safety and education in robotic surgery with the use of a priori simulation-based training.This article presents a very relevant point of view regarding how sophisticated data developed from the robotic simulator will push education beyond practice and basic feedback to practice, leading to very sophisticated feedback
妇科外科杂志卷。学习与教学外科mitchell S. Hoffman mitchell S. Hoffman - mitchell S. Hoffman医学博士，总编，南佛罗里达大学莫尔萨尼医学院妇产科，美国佛罗里达州坦帕市。MCC妇科项目，莫菲特癌症中心，坦帕，佛罗里达州，美国。搜索该作者的更多论文发表在线:2023年10月3日https://doi.org/10.1089/gyn.2023.0087AboutSectionsPDF/EPUB权限& CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites返回出版物ShareShare onFacebookTwitterLinked InRedditEmail外科医生必须从3种途径中选择进行子宫切除术:阴道;开放的腹部;或腹腔镜。此外，这些方法还包括机器人和vNOTES(阴道自然孔腔内窥镜手术)。这期的第一篇文章有dr。来自Cedars-Sinai医学中心Samuel Oschin癌症中心(洛杉矶，CA)的Kristin N. Taylor和Kenneth H. Kim(医学博士，MHPE)提供了机器人在妇科手术中使用的历史视角。金博士是国际知名的该领域专家，他对这项不断发展的技术可能采取的未来方向进行了思考。作为本文的介绍，我想谈谈机器人手术中的外科训练。在腹部开腹手术中，主治医生可以很容易地与受训者演示、观察、控制和纠正手术步骤。阴道和腹腔镜手术也是如此，尽管程度较轻。机器人手术在这方面是独一无二的。在外科手术台上进行手术的个体至少可以暂时完全控制手术。主治外科医生可以指出，画一条线，控制辅助机器人仪器(双控制台)，并非常迅速地恢复完全控制。将机器人手术的控制权完全移交给实习生凸显了两个重要问题。首先，即使只有短暂的控制，也可能发生灾难性的并发症(例如移动视野之外的剪刀并刺穿主要血管)。第二:我们如何有效地教授复杂的妇科手术，而不能够持续地向受训者演示或引导，如果在病例中需要这样做的话?这些问题没有明确的答案，尽管教学控制台的发展和教育工作者控制三种仪器中的一种的能力在机器人手术教学方面取得了重大进展。目前，Taylor和Kim文章的主要焦点是通过使用基于先验模拟的训练来平衡机器人手术的手术安全和教育。这篇文章提出了一个非常相关的观点，即从机器人模拟器开发的复杂数据将如何推动教育超越实践和基本反馈到实践，从而导致非常复杂的反馈，并最终达到熟练掌握机器人手术技术。作为一名专业人员，我们必须负责任地对待外科技术的进步，尤其是在培训方面。我邀请本杂志的读者通过向编辑投稿的方式与我交流他们关于外科教育和外科护理新技术的结合的想法。资料来源:Mary Ann Liebert, Inc.，出版者版权所有。学与教外科。妇科外科杂志。Oct 2023.203-203.http://doi.org/10.1089/gyn.2023.0087Published in Volume: 39 Issue 5: October 3, 2023PDF下载
{"title":"Learning and Teaching Surgery","authors":"Mitchel S. Hoffman","doi":"10.1089/gyn.2023.0087","DOIUrl":"https://doi.org/10.1089/gyn.2023.0087","url":null,"abstract":"Journal of Gynecologic SurgeryVol. 39, No. 5 EditorialFree AccessLearning and Teaching SurgeryMitchel S. HoffmanMitchel S. Hoffman—Mitchel S. Hoffman, MD, Editor-in-Chief Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA.MCC GYN Program, Moffitt Cancer Center, Tampa, Florida, USA.Search for more papers by this authorPublished Online:3 Oct 2023https://doi.org/10.1089/gyn.2023.0087AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail A surgeon must select from among 3 routes for performing a hysterectomy: vaginal; open abdominal; or laparoscopic. In addition, there are variations of these approaches that include robotic and vNOTES [vaginal natural orifice transluminal endoscopic surgery].The first article of this issue has Drs. Kristin N. Taylor and Kenneth H. Kim (MD, MHPE) from the Samuel Oschin Cancer Center at Cedars–Sinai Medical Center (Los Angeles, CA) providing a historical perspective on the use of robotics in gynecologic surgery. Dr. Kim, an internationally renowned expert on the subject, adds thoughts on future directions that this evolving technology might take.As an introduction to this article, I would like to comment on surgical training in robotic surgery. During an open abdominal operation, the attending surgeon can readily demonstrate, observe, control, and correct surgical steps with a trainee. The same is true, although to a lesser extent, for vaginal and laparoscopic surgery. Robotic surgery is unique in this respect. The individual operating at the surgeon console has complete control, at least momentarily, of the operation. The attending surgeon can point, draw a line, control an assisting robotic instrument (dual console), and resume complete control very rapidly.The complete transfer of control of robotic surgery to a trainee highlights 2 important issues. First: Even with only momentary control, a catastrophic complication may occur (such as moving scissors that are out of the field of view and puncturing a major vessel). Second: How do we effectively teach complex gynecologic surgery without being able to continuously demonstrate or redirect the trainee should the need to do so arise during the case? There are no clear answers to these questions, although the development of the teaching console and the ability of the educator to control 1 of 3 instruments have been major advances with respect to teaching robotic surgery. Currently, the major focus of the Taylor and Kim article provides the best answer to balancing surgical safety and education in robotic surgery with the use of a priori simulation-based training.This article presents a very relevant point of view regarding how sophisticated data developed from the robotic simulator will push education beyond practice and basic feedback to practice, leading to very sophisticated feedback","PeriodicalId":44791,"journal":{"name":"JOURNAL OF GYNECOLOGIC SURGERY","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134931112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dana C. McKee, Marlene E. Girardo, Megan N. Wasson
Objective: The aim of this research was to evaluate intraoperative visual detection of endometriosis compared to final histopathologic diagnosis based on lesion type. Materials and Methods: This prospective clinical study at a tertiary-care, academic medical center involved 77 patients who had surgery by high-volume endometriosis surgeons for suspected endometriosis. Pelvic peritonectomy was performed with documentation of visual presence or absence of endometriosis and lesion type. Powder burn lesions were defined as typical lesions. White scarring, clear vesicles, red flame, and peritoneal pockets were defined as atypical lesions. Results: Of 1069 peritoneal specimens, there was visual detection of endometriosis in 352 (32.93%). Endometriosis was confirmed on histopathologic evaluation of: powder-burn, 65.8%; white scarring, 51.6%; clear vesicles, 45.7%; red-flame, 39.1%; and peritoneal pockets, 28.9% (p = 0.003). Additionally, 11.3% of specimens with no visible endometriosis demonstrated a positive histopathologic diagnosis. Overall sensitivity was 68.36%; specificity was 78.15%; positive predictive value (PPV) was 49.72%; and negative predictive value was 88.66%. All lesions had high specificity (powder-burn, 96.20%; white scarring, 91.34%; clear vesicles; 92.54%; red-flame, 97.84%; and peritoneal pockets; 95.91%). PPV depended on lesion type (powder-burn, 65.75%; white scarring, 51.61 %; clear vesicles, 45.74%; red-flame, 39.13% peritoneal pockets, 28.95%). Conclusions: Visual detection of endometriosis during surgical evaluation is not reliable. The potential for atypical-lesion appearance and disease not macroscopically visible suggests a role for complete pelvic peritonectomy. (J GYNECOL SURG 39:235)
{"title":"Diagnosis of Endometriosis: The Surgeon's Eye Compared to Histopathology","authors":"Dana C. McKee, Marlene E. Girardo, Megan N. Wasson","doi":"10.1089/gyn.2023.0032","DOIUrl":"https://doi.org/10.1089/gyn.2023.0032","url":null,"abstract":"Objective: The aim of this research was to evaluate intraoperative visual detection of endometriosis compared to final histopathologic diagnosis based on lesion type. Materials and Methods: This prospective clinical study at a tertiary-care, academic medical center involved 77 patients who had surgery by high-volume endometriosis surgeons for suspected endometriosis. Pelvic peritonectomy was performed with documentation of visual presence or absence of endometriosis and lesion type. Powder burn lesions were defined as typical lesions. White scarring, clear vesicles, red flame, and peritoneal pockets were defined as atypical lesions. Results: Of 1069 peritoneal specimens, there was visual detection of endometriosis in 352 (32.93%). Endometriosis was confirmed on histopathologic evaluation of: powder-burn, 65.8%; white scarring, 51.6%; clear vesicles, 45.7%; red-flame, 39.1%; and peritoneal pockets, 28.9% (p = 0.003). Additionally, 11.3% of specimens with no visible endometriosis demonstrated a positive histopathologic diagnosis. Overall sensitivity was 68.36%; specificity was 78.15%; positive predictive value (PPV) was 49.72%; and negative predictive value was 88.66%. All lesions had high specificity (powder-burn, 96.20%; white scarring, 91.34%; clear vesicles; 92.54%; red-flame, 97.84%; and peritoneal pockets; 95.91%). PPV depended on lesion type (powder-burn, 65.75%; white scarring, 51.61 %; clear vesicles, 45.74%; red-flame, 39.13% peritoneal pockets, 28.95%). Conclusions: Visual detection of endometriosis during surgical evaluation is not reliable. The potential for atypical-lesion appearance and disease not macroscopically visible suggests a role for complete pelvic peritonectomy. (J GYNECOL SURG 39:235)","PeriodicalId":44791,"journal":{"name":"JOURNAL OF GYNECOLOGIC SURGERY","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136307254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chronic pelvic pain in the female patient is often debilitating and can arise from a variety of sources, often with multiple etiologies. Difficulties managing these disorders parallel the difficulties in establishing a specific diagnosis for them. A focused and detailed history and a physical examination are often most helpful, categorizing pain signs and symptoms and suggesting an organ system that is not in homeostasis. Diagnostic laboratory testing and imaging are often of limited value. Initial treatment focuses on identification of the specific causes or sources of this pelvic pain. Oral analgesics, physical and psychologic treatments, interventional procedures, and injections have the potential to be both diagnostic and therapeutic for patients. Surgical management is often maintained as a last-line treatment option and may not necessarily enhance diagnostic evaluation or add pain relief. (J GYNECOL SURG 20XX:000)
{"title":"Management of Chronic Female Pelvic Pain","authors":"Jessica Ibañez, Robert S. Ackerman","doi":"10.1089/gyn.2023.0066","DOIUrl":"https://doi.org/10.1089/gyn.2023.0066","url":null,"abstract":"Chronic pelvic pain in the female patient is often debilitating and can arise from a variety of sources, often with multiple etiologies. Difficulties managing these disorders parallel the difficulties in establishing a specific diagnosis for them. A focused and detailed history and a physical examination are often most helpful, categorizing pain signs and symptoms and suggesting an organ system that is not in homeostasis. Diagnostic laboratory testing and imaging are often of limited value. Initial treatment focuses on identification of the specific causes or sources of this pelvic pain. Oral analgesics, physical and psychologic treatments, interventional procedures, and injections have the potential to be both diagnostic and therapeutic for patients. Surgical management is often maintained as a last-line treatment option and may not necessarily enhance diagnostic evaluation or add pain relief. (J GYNECOL SURG 20XX:000)","PeriodicalId":44791,"journal":{"name":"JOURNAL OF GYNECOLOGIC SURGERY","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134885395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：