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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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}
Journal of Gynecologic SurgeryAhead of Print Vaginal Natural Orifice Endoscopic Surgery: How It Can Be the Return of Vaginal SurgeryJerry Matkins Jr.Jerry Matkins Jr.Address correspondence to: Jerry Matkins, Jr., MD, Atrium Health, Eastover OB/GYN, 1025 Morehead Medical Drive, Charlotte, NC 28204, USA E-mail Address: [email protected]Atrium Health, Eastover OB/GYN, Charlotte, NC, USA.Search for more papers by this authorPublished Online:25 Sep 2023https://doi.org/10.1089/gyn.2023.0085AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View articleFiguresReferencesRelatedDetails Volume 0Issue 0 InformationCopyright 2023, Mary Ann Liebert, Inc., publishersTo cite this article:Jerry Matkins Jr..Vaginal Natural Orifice Endoscopic Surgery: How It Can Be the Return of Vaginal Surgery.Journal of Gynecologic Surgery.ahead of printhttp://doi.org/10.1089/gyn.2023.0085Online Ahead of Print:September 25, 2023PDF download
{"title":"Vaginal Natural Orifice Endoscopic Surgery: How It Can Be the Return of Vaginal Surgery","authors":"Jerry Matkins","doi":"10.1089/gyn.2023.0085","DOIUrl":"https://doi.org/10.1089/gyn.2023.0085","url":null,"abstract":"Journal of Gynecologic SurgeryAhead of Print Vaginal Natural Orifice Endoscopic Surgery: How It Can Be the Return of Vaginal SurgeryJerry Matkins Jr.Jerry Matkins Jr.Address correspondence to: Jerry Matkins, Jr., MD, Atrium Health, Eastover OB/GYN, 1025 Morehead Medical Drive, Charlotte, NC 28204, USA E-mail Address: [email protected]Atrium Health, Eastover OB/GYN, Charlotte, NC, USA.Search for more papers by this authorPublished Online:25 Sep 2023https://doi.org/10.1089/gyn.2023.0085AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View articleFiguresReferencesRelatedDetails Volume 0Issue 0 InformationCopyright 2023, Mary Ann Liebert, Inc., publishersTo cite this article:Jerry Matkins Jr..Vaginal Natural Orifice Endoscopic Surgery: How It Can Be the Return of Vaginal Surgery.Journal of Gynecologic Surgery.ahead of printhttp://doi.org/10.1089/gyn.2023.0085Online Ahead of Print:September 25, 2023PDF download","PeriodicalId":44791,"journal":{"name":"JOURNAL OF GYNECOLOGIC SURGERY","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135769641","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}
Background: Cervical ectopic pregnancy (CEP) is a rare diagnosis with few reported cases, making establishment of a standardized treatment challenging. CEPs often require multiple therapeutic modalities and curative surgical management. Case: A patient in her late 40s presented with a persistent CEP after in-vitro fertilization (IVF). Initially, the ectopic pregnancy was treated with ultrasound-guided needle aspiration and multiple doses of methotrexate, but further approaches were necessary to resolve the case. Results: This patient had a CEP with a heartbeat and she had a very high β–human chorionic gonadotropin (β-hCG level). She initially responded appropriately to repeat doses of methotrexate and needle aspiration, but her β-hCG levels eventually plateaued. Eventually, definitive suction curettage, vasopressin injection, and an intracervical Foley balloon tamponade provided a successful resolution. Conclusions: This case highlights further how multimodal treatment methods are valuable for safe resolution of CEPs. The patient at first responded appropriately to multiple doses of methotrexate, which decreased her surgical risks and morbidity significantly. (J GYNECOL SURG 20XX:000)
{"title":"Optimizing Outcomes Using Multimodal Therapy: Persistent Cervical Ectopic Pregnancy with Cardiac Motion","authors":"Andrew Claffey, Kevin Doody, Kathy Doody","doi":"10.1089/gyn.2023.0062","DOIUrl":"https://doi.org/10.1089/gyn.2023.0062","url":null,"abstract":"Background: Cervical ectopic pregnancy (CEP) is a rare diagnosis with few reported cases, making establishment of a standardized treatment challenging. CEPs often require multiple therapeutic modalities and curative surgical management. Case: A patient in her late 40s presented with a persistent CEP after in-vitro fertilization (IVF). Initially, the ectopic pregnancy was treated with ultrasound-guided needle aspiration and multiple doses of methotrexate, but further approaches were necessary to resolve the case. Results: This patient had a CEP with a heartbeat and she had a very high β–human chorionic gonadotropin (β-hCG level). She initially responded appropriately to repeat doses of methotrexate and needle aspiration, but her β-hCG levels eventually plateaued. Eventually, definitive suction curettage, vasopressin injection, and an intracervical Foley balloon tamponade provided a successful resolution. Conclusions: This case highlights further how multimodal treatment methods are valuable for safe resolution of CEPs. The patient at first responded appropriately to multiple doses of methotrexate, which decreased her surgical risks and morbidity significantly. (J GYNECOL SURG 20XX:000)","PeriodicalId":44791,"journal":{"name":"JOURNAL OF GYNECOLOGIC SURGERY","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136308460","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}
Danielle Mor-Hadar, Eyal Mor, Netanel Nagar, Oliana Vazhgovsky, Olga Saukhat, Shira Felder, David Hochstein, Tima Davidson, Shai Tejman-Yarden, Limor Helpman, Jacob Korach
Objectives: Identifying and resecting gynecologic lymph-node metastases can be challenging. Augmented reality (AR) may improve localization of such lesions and adjacent structures. Materials and Methods: For this prospective case series of women who had lymphadenectomy for gynecologic malignancies at a tertiary-care center, a 3-dimensional targeted lesions model was created. It was based on preoperative axial imaging (computed tomography [CT] or positron emission tomography [PET]) of the lesions, which were evaluated by the surgical team preoperatively. The surgeon wore an AR wireless headset, enabling real-time use of the model to assist lymph-node resection. Results: This pilot study included 7 patients: 4 had lymphadenectomy with hysterectomy and bilateral salpingo-oophorectomy; 2 had lymphadenectomy; and 1 had lymphadenectomy during pelvic exenteration. Median age was 53 (34–70) and mean body mass index was 28.3 (± 6.5). Mean operating room time was 223 (± 130.9) minutes, mean blood loss was 398.5 (± 600.1) mL, and 1 patient needed a blood transfusion. Overall, there were no significant differences between the preoperative assessments of the sizes and locations of the lesions with AR, compared to axial imaging. Surgeons' evaluations of the model revealed that 7 (50%) indicated that the AR model was superior to axial imaging; 4 (28.6%) noted that the AR model prompted them to change their surgical approaches. AR modeling changed the surgical approaches in 2 cases and improved surgical accuracy, disease characteristics, or intra- and postoperative outcomes. Conclusions: Preoperative evaluation with AR was meaningful, compared to conventional methods in 25%–50% of cases. The effect of AR should be investigated further in a larger study. (J GYNECOL SURG 20XX:000)
{"title":"Augmented Reality to Guide Lymph-Node Resection in Gynecologic Malignancies: A Pilot Study","authors":"Danielle Mor-Hadar, Eyal Mor, Netanel Nagar, Oliana Vazhgovsky, Olga Saukhat, Shira Felder, David Hochstein, Tima Davidson, Shai Tejman-Yarden, Limor Helpman, Jacob Korach","doi":"10.1089/gyn.2023.0057","DOIUrl":"https://doi.org/10.1089/gyn.2023.0057","url":null,"abstract":"Objectives: Identifying and resecting gynecologic lymph-node metastases can be challenging. Augmented reality (AR) may improve localization of such lesions and adjacent structures. Materials and Methods: For this prospective case series of women who had lymphadenectomy for gynecologic malignancies at a tertiary-care center, a 3-dimensional targeted lesions model was created. It was based on preoperative axial imaging (computed tomography [CT] or positron emission tomography [PET]) of the lesions, which were evaluated by the surgical team preoperatively. The surgeon wore an AR wireless headset, enabling real-time use of the model to assist lymph-node resection. Results: This pilot study included 7 patients: 4 had lymphadenectomy with hysterectomy and bilateral salpingo-oophorectomy; 2 had lymphadenectomy; and 1 had lymphadenectomy during pelvic exenteration. Median age was 53 (34–70) and mean body mass index was 28.3 (± 6.5). Mean operating room time was 223 (± 130.9) minutes, mean blood loss was 398.5 (± 600.1) mL, and 1 patient needed a blood transfusion. Overall, there were no significant differences between the preoperative assessments of the sizes and locations of the lesions with AR, compared to axial imaging. Surgeons' evaluations of the model revealed that 7 (50%) indicated that the AR model was superior to axial imaging; 4 (28.6%) noted that the AR model prompted them to change their surgical approaches. AR modeling changed the surgical approaches in 2 cases and improved surgical accuracy, disease characteristics, or intra- and postoperative outcomes. Conclusions: Preoperative evaluation with AR was meaningful, compared to conventional methods in 25%–50% of cases. The effect of AR should be investigated further in a larger study. (J GYNECOL SURG 20XX:000)","PeriodicalId":44791,"journal":{"name":"JOURNAL OF GYNECOLOGIC SURGERY","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135785119","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}
Alessandro Libretti, Beatrice Bracci, A. De Pedrini, Daniela Surico, Libera Troìa, Valentino Remorgida
{"title":"The Dermabond Prineo Skin Closure System: Benefits and Complications","authors":"Alessandro Libretti, Beatrice Bracci, A. De Pedrini, Daniela Surico, Libera Troìa, Valentino Remorgida","doi":"10.1089/gyn.2023.0038","DOIUrl":"https://doi.org/10.1089/gyn.2023.0038","url":null,"abstract":"","PeriodicalId":44791,"journal":{"name":"JOURNAL OF GYNECOLOGIC SURGERY","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2023-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45528511","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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