Objective: This study compared the outcomes of the bulking agent polyacrylamide hydrogel (PAHG) with a single-incision sling (SIS) for treating occult stress urinary incontinence (SUI) in association with vaginal prolapse surgery. Methods: This was a retrospective study of patients who underwent transvaginal surgical correction of pelvic organ prolapse and received either SIS or urethral bulking with PAHG for occult SUI. Demographic and perioperative data were extracted from the charts. The primary outcomes were Urinary Distress Inventory–6 (UDI-6) scores, Incontinence Impact Questionnaire–7 (IIQ-7) scores, and incontinence episodes documented by 3-day bladder diaries collected 24 months after surgery. Secondary outcomes included complications such as adverse events, rates of urine retention with prolonged catheterization, and urinary-tract infections. Results: Thirty patients had the bulking agent using PAHG with the prolapse surgery for occult incontinence and 23 patients has SIS. Twenty-two patients from each group completed the postoperative questionnaires. UDI-6 scores were low in both groups with bulking versus SIS value (19 versus 11; p = 0.096). The stress subscale median value for bulking versus SIS was 33 versus 0; p = 0.009. IIQ-7 median value was 0 for both groups. The median Foley catheter duration for the bulking group versus the SIS group was 1 versus 5 days (p = 0.015). Conclusions: SIS and PAHG were equally satisfactory for treating occult SUI with similar total UDI-6 and IIQ-7 scores; yet, the UDI-6 stress subscale was significantly better for the SIS group, but with more short-term voiding dysfunction. (J GYNECOL SURG 20XX:000)
{"title":"Single-Incision Sling Versus Polyacrylamide Hydrogel During Transvaginal Prolapse Surgery for Occult Stress Urinary Incontinence: A Retrospective Cohort Study","authors":"Ahmed Abdelaziz, Mark Walters, Mickey Karram","doi":"10.1089/gyn.2023.0092","DOIUrl":"https://doi.org/10.1089/gyn.2023.0092","url":null,"abstract":"Objective: This study compared the outcomes of the bulking agent polyacrylamide hydrogel (PAHG) with a single-incision sling (SIS) for treating occult stress urinary incontinence (SUI) in association with vaginal prolapse surgery. Methods: This was a retrospective study of patients who underwent transvaginal surgical correction of pelvic organ prolapse and received either SIS or urethral bulking with PAHG for occult SUI. Demographic and perioperative data were extracted from the charts. The primary outcomes were Urinary Distress Inventory–6 (UDI-6) scores, Incontinence Impact Questionnaire–7 (IIQ-7) scores, and incontinence episodes documented by 3-day bladder diaries collected 24 months after surgery. Secondary outcomes included complications such as adverse events, rates of urine retention with prolonged catheterization, and urinary-tract infections. Results: Thirty patients had the bulking agent using PAHG with the prolapse surgery for occult incontinence and 23 patients has SIS. Twenty-two patients from each group completed the postoperative questionnaires. UDI-6 scores were low in both groups with bulking versus SIS value (19 versus 11; p = 0.096). The stress subscale median value for bulking versus SIS was 33 versus 0; p = 0.009. IIQ-7 median value was 0 for both groups. The median Foley catheter duration for the bulking group versus the SIS group was 1 versus 5 days (p = 0.015). Conclusions: SIS and PAHG were equally satisfactory for treating occult SUI with similar total UDI-6 and IIQ-7 scores; yet, the UDI-6 stress subscale was significantly better for the SIS group, but with more short-term voiding dysfunction. (J GYNECOL SURG 20XX:000)","PeriodicalId":44791,"journal":{"name":"JOURNAL OF GYNECOLOGIC SURGERY","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135932896","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}
Alexandra Snyder, Yael Baumfeld, S. Abbas Shobeiri
Objective: This study evaluated trends and efficiency of robotic surgeons per surgical volume, procedure type, and subspecialty. As robotic surgery is more popular in gynecologic subspecialties, studies comparing surgical volume suggest that robotic gynecologic surgery is advantageous when performed by high-volume surgeons and used for complex surgeries. Materials and Methods: During 2017–2021, evaluations were made of 3914 robotic gynecologic surgery cases performed at the Inova Fairfax Women's Hospital, Fairfax, VA, USA. All patients having robotic gynecologic surgery during the study were included. Surgeons were divided into high-, medium-, and low-volume groups. Statistical analysis evaluated changes in procedure types, surgeon subspecialties, operating times, and surgeon volumes. Results: Over the 5 years, there was a significant increase in adnexal surgery, surgery for pelvic organ prolapse, and myomectomy. High-volume surgeons performed more-complex surgeries overall. Operating room (OR) and surgery times were significantly lower for high-volume surgeons than for other groups. Conclusions: There was an increased variety of procedure types performed on the Da Vinci® robot over the 5 years. The data showed that high-volume surgeons had shorter OR and surgery times while performing more-complicated surgeries. This supports that high-volume gynecologic surgeons perform robotic cases more efficiently. With the increased interest in robotic surgery among surgeons and patients, an ongoing analysis of robotic surgery trends is essential to optimize availability, usage, and outcomes of these surgeries. (J GYNECOL SURG 20XX:000)
{"title":"Robotic Surgery Trends and Efficiency in a High-Volume Gynecologic Surgery Center","authors":"Alexandra Snyder, Yael Baumfeld, S. Abbas Shobeiri","doi":"10.1089/gyn.2023.0020","DOIUrl":"https://doi.org/10.1089/gyn.2023.0020","url":null,"abstract":"Objective: This study evaluated trends and efficiency of robotic surgeons per surgical volume, procedure type, and subspecialty. As robotic surgery is more popular in gynecologic subspecialties, studies comparing surgical volume suggest that robotic gynecologic surgery is advantageous when performed by high-volume surgeons and used for complex surgeries. Materials and Methods: During 2017–2021, evaluations were made of 3914 robotic gynecologic surgery cases performed at the Inova Fairfax Women's Hospital, Fairfax, VA, USA. All patients having robotic gynecologic surgery during the study were included. Surgeons were divided into high-, medium-, and low-volume groups. Statistical analysis evaluated changes in procedure types, surgeon subspecialties, operating times, and surgeon volumes. Results: Over the 5 years, there was a significant increase in adnexal surgery, surgery for pelvic organ prolapse, and myomectomy. High-volume surgeons performed more-complex surgeries overall. Operating room (OR) and surgery times were significantly lower for high-volume surgeons than for other groups. Conclusions: There was an increased variety of procedure types performed on the Da Vinci® robot over the 5 years. The data showed that high-volume surgeons had shorter OR and surgery times while performing more-complicated surgeries. This supports that high-volume gynecologic surgeons perform robotic cases more efficiently. With the increased interest in robotic surgery among surgeons and patients, an ongoing analysis of robotic surgery trends is essential to optimize availability, usage, and outcomes of these surgeries. (J GYNECOL SURG 20XX:000)","PeriodicalId":44791,"journal":{"name":"JOURNAL OF GYNECOLOGIC SURGERY","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135932915","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}
Marcos Izquierdo, Michael Platten, Luis Tollinche, Anastasia Jones, Cindy Yeoh
Gynecologic surgeries are often complex interventions that require extensive communication and planning to ensure favorable patient outcomes. Many gynecologic surgery patients present with a vast range of systemic comorbidities that need adequate workups and plans for care prior to undergoing anesthesia. Enhanced recovery after surgery (ERAS) protocols are vital for organizing patient-centered discussions preoperatively, allowing the patient, anesthesia, and surgical teams to address all clinical concerns directly to minimize perioperative risks. A multidisciplinary approach in preoperative patient-management decisions helps optimize the care of each patient's comorbidities and medications and is essential to ensure best patient outcomes. (J GYNECOL SURG 2023:XXX>
{"title":"Preoperative Evaluation and Optimization for Gynecologic Surgery Patients","authors":"Marcos Izquierdo, Michael Platten, Luis Tollinche, Anastasia Jones, Cindy Yeoh","doi":"10.1089/gyn.2023.0068","DOIUrl":"https://doi.org/10.1089/gyn.2023.0068","url":null,"abstract":"Gynecologic surgeries are often complex interventions that require extensive communication and planning to ensure favorable patient outcomes. Many gynecologic surgery patients present with a vast range of systemic comorbidities that need adequate workups and plans for care prior to undergoing anesthesia. Enhanced recovery after surgery (ERAS) protocols are vital for organizing patient-centered discussions preoperatively, allowing the patient, anesthesia, and surgical teams to address all clinical concerns directly to minimize perioperative risks. A multidisciplinary approach in preoperative patient-management decisions helps optimize the care of each patient's comorbidities and medications and is essential to ensure best patient outcomes. (J GYNECOL SURG 2023:XXX>","PeriodicalId":44791,"journal":{"name":"JOURNAL OF GYNECOLOGIC SURGERY","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135271164","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}
Uterine fibroids may impact fertility and the outcomes of infertility treatments negatively, depending on the fibroids' positions in the uterine wall, their sizes, and their numbers. This article reviews the available data on managing uterine fibroids in infertile patients. Subserosal fibroids do not affect fertility negatively and generally do not require treatment. It is advisable to remove submucosal fibroids before infertility treatment or in patients who have recurrent miscarriages. It is challenging to counsel infertile women with intramural fibroids because of the lack of a consensus about what should be done. The choice of treating intramural fibroids depends on the characteristics of the fibroids (such as numbers, sizes, and distances from the endometrial cavity), the reproductive history of the patient, and her willingness to wait until the appropriate time for myometrial healing before receiving infertility treatments. (J GYNECOL SURG 20XX:000)
{"title":"Surgery for Fibroids in Infertility Women: The How, the When, and the When Not","authors":"Simone Ferrero, Fabio Barra, Giulio Evangelisti, Michele Paudice, Valerio Gaetano Vellone","doi":"10.1089/gyn.2023.0080","DOIUrl":"https://doi.org/10.1089/gyn.2023.0080","url":null,"abstract":"Uterine fibroids may impact fertility and the outcomes of infertility treatments negatively, depending on the fibroids' positions in the uterine wall, their sizes, and their numbers. This article reviews the available data on managing uterine fibroids in infertile patients. Subserosal fibroids do not affect fertility negatively and generally do not require treatment. It is advisable to remove submucosal fibroids before infertility treatment or in patients who have recurrent miscarriages. It is challenging to counsel infertile women with intramural fibroids because of the lack of a consensus about what should be done. The choice of treating intramural fibroids depends on the characteristics of the fibroids (such as numbers, sizes, and distances from the endometrial cavity), the reproductive history of the patient, and her willingness to wait until the appropriate time for myometrial healing before receiving infertility treatments. (J GYNECOL SURG 20XX:000)","PeriodicalId":44791,"journal":{"name":"JOURNAL OF GYNECOLOGIC SURGERY","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135270770","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 : 2023-10-31DOI: 10.1089/gyn.2022.0127.correx
Journal of Gynecologic SurgeryAhead of Print CorrectionOpen AccessCorrection to: Myomectomy Benefits, Risks, Long-Term Outcomes, and Effects on Fertility and Pregnancy Outcomes: A Literature Review by Gnanachandran et al. Journal of Gynecologic Surgery 2023;39(4):151–157; doi: 10.1089/gyn.2022.0217is erratum ofMyomectomy Benefits, Risks, Long-Term Outcomes, and Effects on Fertility and Pregnancy Outcomes: A Literature ReviewPublished Online:31 Oct 2023https://doi.org/10.1089/gyn.2022.0127.correxAboutSectionsPDF/EPUB Permissions & CitationsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail In the August 2023 issue of Journal of Gynecologic Surgery (vol. 39, no. 4; pp. 151–157) the article entitled “Myomectomy Benefits, Risks, Long-Term Outcomes, and Effects on Fertility and Pregnancy Outcomes: A Literature Review” by Gnanachandran et al. requires correction.This article was originally published under the copyright of Mary Ann Liebert, Inc. publishers. It has now been updated to reflect Open Access, with copyright transferring to the author(s), and a Creative Commons License (CC-BY) added (http://creativecommons.org/licenses/by/4.0). The CC-BY license goes into effect October 31, 2023.The online version of this article has been corrected to reflect this.FiguresReferencesRelatedDetailsRelated articlesMyomectomy Benefits, Risks, Long-Term Outcomes, and Effects on Fertility and Pregnancy Outcomes: A Literature Review26 Jul 2023Journal of Gynecologic Surgery Volume 0Issue 0 InformationCopyright 2023, Mary Ann Liebert, Inc., publishersTo cite this article:Correction to: Myomectomy Benefits, Risks, Long-Term Outcomes, and Effects on Fertility and Pregnancy Outcomes: A Literature Review by Gnanachandran et al. Journal of Gynecologic Surgery 2023;39(4):151–157; doi: 10.1089/gyn.2022.0217.Journal of Gynecologic Surgery.ahead of printhttp://doi.org/10.1089/gyn.2022.0127.correxcreative commons licenseOnline Ahead of Print:October 31, 2023PDF download
子宫肌瘤切除术的益处、风险、长期结局以及对生育和妊娠结局的影响:Gnanachandran等人的文献综述。妇科外科杂志2023;39(4):151-157;doi: 10.1089/gyn.2022.0217is子宫肌瘤切除术的好处，风险，长期结果，以及对生育和妊娠结果的影响:文献综述在线发表:2023年10月31日https://doi.org/10.1089/gyn.2022.0127.correxAboutSectionsPDF/EPUB权限和引文下载引文strack引文添加到收藏夹返回出版分享分享在facebook上推特链接在redditemail在2023年8月号的妇科外科杂志(卷39,no. 17)。4;Gnanachandran等人发表的题为“子宫肌瘤切除术的益处、风险、长期结果以及对生育和妊娠结局的影响:文献综述”的文章需要更正。本文最初由Mary Ann Liebert, Inc.出版社版权所有。它现在已经更新，以反映开放获取，版权转让给作者，并添加了创作共用许可证(CC-BY) (http://creativecommons.org/licenses/by/4.0)。CC-BY许可证将于2023年10月31日生效。为了反映这一点，本文的在线版本已经进行了更正。相关文章子宫肌瘤切除术的益处、风险、长期结果以及对生育能力和妊娠结果的影响:文献综述2023年7月26日《妇科外科杂志》第0卷第0期信息版权所有2023,Mary Ann Liebert, Inc.，出版商引用这篇文章:更正:子宫肌瘤切除术的益处、风险、长期结果以及对生育能力和妊娠结果的影响:Gnanachandran等人的文献综述。妇科外科杂志2023;39(4):151-157;doi: 10.1089 / gyn.2022.0217。妇科外科杂志。提前打印://doi.org/10.1089/gyn.2022.0127.correxcreative commons licenseOnline提前打印:2023年10月31日pdf下载
{"title":"<i>Correction to</i>: Myomectomy Benefits, Risks, Long-Term Outcomes, and Effects on Fertility and Pregnancy Outcomes: A Literature Review by Gnanachandran et al. <i>Journal of Gynecologic Surgery 2023;39(4):151–157</i>; doi: 10.1089/gyn.2022.0217","authors":"","doi":"10.1089/gyn.2022.0127.correx","DOIUrl":"https://doi.org/10.1089/gyn.2022.0127.correx","url":null,"abstract":"Journal of Gynecologic SurgeryAhead of Print CorrectionOpen AccessCorrection to: Myomectomy Benefits, Risks, Long-Term Outcomes, and Effects on Fertility and Pregnancy Outcomes: A Literature Review by Gnanachandran et al. Journal of Gynecologic Surgery 2023;39(4):151–157; doi: 10.1089/gyn.2022.0217is erratum ofMyomectomy Benefits, Risks, Long-Term Outcomes, and Effects on Fertility and Pregnancy Outcomes: A Literature ReviewPublished Online:31 Oct 2023https://doi.org/10.1089/gyn.2022.0127.correxAboutSectionsPDF/EPUB Permissions & CitationsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail In the August 2023 issue of Journal of Gynecologic Surgery (vol. 39, no. 4; pp. 151–157) the article entitled “Myomectomy Benefits, Risks, Long-Term Outcomes, and Effects on Fertility and Pregnancy Outcomes: A Literature Review” by Gnanachandran et al. requires correction.This article was originally published under the copyright of Mary Ann Liebert, Inc. publishers. It has now been updated to reflect Open Access, with copyright transferring to the author(s), and a Creative Commons License (CC-BY) added (http://creativecommons.org/licenses/by/4.0). The CC-BY license goes into effect October 31, 2023.The online version of this article has been corrected to reflect this.FiguresReferencesRelatedDetailsRelated articlesMyomectomy Benefits, Risks, Long-Term Outcomes, and Effects on Fertility and Pregnancy Outcomes: A Literature Review26 Jul 2023Journal of Gynecologic Surgery Volume 0Issue 0 InformationCopyright 2023, Mary Ann Liebert, Inc., publishersTo cite this article:Correction to: Myomectomy Benefits, Risks, Long-Term Outcomes, and Effects on Fertility and Pregnancy Outcomes: A Literature Review by Gnanachandran et al. Journal of Gynecologic Surgery 2023;39(4):151–157; doi: 10.1089/gyn.2022.0217.Journal of Gynecologic Surgery.ahead of printhttp://doi.org/10.1089/gyn.2022.0127.correxcreative commons licenseOnline Ahead of Print:October 31, 2023PDF download","PeriodicalId":44791,"journal":{"name":"JOURNAL OF GYNECOLOGIC SURGERY","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135813801","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}
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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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}
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