Gynecology and Minimally Invasive Therapy-GMIT最新文献

Objectives: Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is a novel surgical approach that confers on surgeons the dual advantages of vaginal and laparoscopic surgeries. There is a lack of literature comparing the vNOTES hysterectomy in obese and nonobese patients, especially in the Asian population. We aim to compare the surgical outcomes of vNOTES in patients with body mass index (BMI) <25 kg/m² and ≥25 kg/m².

Materials and methods: This study involved a retrospective comparative study of 159 overweight and nonoverweight women who underwent vNOTES hysterectomy in a single tertiary care center between April 2021 and January 2024. Patients were stratified based on their BMI (<25 kg/m² or ≥25 kg/m²). Demographics, preoperative findings, intraoperative findings, and postoperative outcomes between the two groups were then compared.

Results: Ninety-four women had normal BMI and 65 were overweight. No conversion to laparoscopic surgery or open surgery was needed. The mean age and parity were 52.3 (±10.1) and 1.9 (±1.1), respectively. Operative time was significantly shorter in the nonoverweight group compared to the overweight group (99.1 ± 37.8 min vs. 115.2 ± 46.8 min, P < 0.01). There was significantly higher estimated blood loss (189.2 ± 207.5 mL vs. 129.6 ± 146.5 mL, P = 0.02) and longer hospitalization stay (1.75 ± 0.90 days vs. 1.46 ± 0.60 days, P < 0.01) for overweight patients compared to nonoverweight patients. There was no significant difference in pain scores using a numeric rating scale (P = 0.27).

Conclusion: This study contributes valuable insights into the outcomes of vNOTES in Asian patients and demonstrates that vNOTES is a safe and effective surgical technique for overweight or obese patients. Overweight or obese patients scheduled for vNOTES procedures must be informed about the increased risk of blood loss and expected longer postoperative hospitalization as compared to nonobese patients.

Pregnancy in a noncommunicating uterine horn (NCUH) is extremely rare and torsion of the pregnant horn is even rarer. Only a few cases have been reported so far. Diagnosis of such extraordinary pathologies can be challenging, and this often leads to misdiagnosis and delay in appropriate treatment. We present the case of a NCUH pregnancy which was initially misdiagnosed on ultrasound and treated with standard miscarriage management regimen. Ongoing symptoms and suspicion of sepsis prompted surgical treatment, and laparoscopy revealed a torted NCUH pregnancy, completely distinct from the unicornuate uterus. The rarity in our case was not only conception in a noncommunicating horn but also the complete torsion of the gravid horn and ipsilateral adnexa. This shows the complexities of dealing with rare uterine abnormalities and highlights the importance of a high degree of clinical suspicion and consideration of atypical presentations of an anomalous uterus, especially if medical treatment fails.

This study evaluates the effectiveness of hysteroscopy in managing persistent pregnancy of unknown location (PUL) as an alternative to traditional curettage. Six patients diagnosed with PUL underwent hysteroscopy, four of them by the vaginoscopic approach and without anesthesia, and two under general anesthesia. The objective of the procedure was to locate the pregnancy, treat it, or take a tissue sample in cases of PUL where imaging studies were nonconclusive. Results showed that in five patients, hysteroscopy successfully identified and removed a gestational mass, leading to complete resolution of beta-human chorionic gonadotropin (ß-hCG) levels within 24 days. One patient was diagnosed with extrauterine pregnancy due to the absence of intrauterine gestational mass in hysteroscopy and a plateauing level of ß-hCG a day after the procedure. The findings indicate that hysteroscopy may offer a safe and more precise alternative to traditional blind curettage.

Objectives: To offer or not to offer hysteroscopy has remained an important question among clinicians treating infertility. With this question, we studied the impact of hysteroscopic diagnosis and treatment of pathologies in terms of improvement in implantation rates in patients requiring in vitro fertilization (IVF) treatment at our center.

Materials and methods: We performed a retrospective analysis of 432 infertile patients who underwent hysteroscopy prior to embryo transfer (ET) between January 2016 and December 2023: Group 1: patients with previous IVF failure and Group 2: patients without previous IVF failure. Chi-square test of independence was used to check if the relationship found in the contingency table is significant or not as 5% level of significance.

Results: A significant number of participants in Group 1 and Group 2, 70.5% (n = 98 of 139) and 79.9% (n = 234 of 293), respectively (P < 0.0031), were diagnosed and treated for some intrauterine pathology, suggesting their significant role in causing infertility. 51.1% (n = 71 of 139) and 63.1% (n = 185 of 293) patients in Group 1 and Group 2, respectively, were diagnosed with endometritis, showing that there is a significant role of performing hysteroscopy even without an obvious indication of intrauterine pathology diagnosed on ultrasound (P < 0.017).

Conclusion: Although Cochrane review suggests a low level of evidence to support screening hysteroscopy prior to IVF, the results of our study direct us to offer hysteroscopy, preferably to all women planned for IVF-ET cycle irrespective of the ultrasound findings and especially to the patients who have experienced IVF Failure in previous cycles.

Objectives: Obesity poses major perioperative challenges in gynecologic malignancies, particularly endometrial cancer, and increases surgical complexity and risk. Although robot-assisted hysterectomy (RAH) and bilateral salpingo-oophorectomy are preferred for early-stage cases, the obese patients make it limit their feasibility. Preoperative weight loss may improve outcomes; however, the pharmacological options remain understudied. This study explored the feasibility of a preoperative mazindol-based weight-loss program in severely obese patients.

Materials and methods: A retrospective case series study was conducted on four women (body mass index [BMI] ≥35 kg/m²) who were suspected of having stage 1A endometrial cancer based on preoperative magnetic resonance imaging between January 2021 and July 2024. The patients received nutritional counseling and mazindol (1.0 mg/day) before undergoing surgery. The effect of mazindol was indexed by each patient's weight loss before surgery, and surgery-related parameters included the time of surgery, the amount of blood loss, and the presence of surgical complications.

Results: Patients experienced a median weight reduction of 13.7 kg (range, 9.1-17.4 kg), with a corresponding decrease in BMI. Operative time was 247.5 min, with a console time of 214 min and blood loss of 75 g. The Trendelenburg angle was 18°-19°, which facilitated adequate surgical visualization. No adverse effects or postoperative complications were observed.

Conclusion: Preoperative administration of mazindol resulted in significant weight loss, enabling safer RAH with reduced surgical complexity. This suggests that mazindol may be a viable option for weight reduction in obese patients absolutely requiring gynecologic surgery for malignant diseases.