Gynecology and Minimally Invasive Therapy-GMIT最新文献

Objectives: To evaluate factors associated with malignancy in patients with endometrial polyps.

Materials and methods: We conducted electronic database research on PubMed, MEDLINE, EMBASE, COCHRANE, and Google Scholar from inception for all studies on endometrial polyp. After removing duplicates, and title and abstract screening, we had a total of 121 articles and 151 others from screening the reference list. Inclusion criteria included peri and postmenopausal women > 45 years diagnosed histopathologically with endometrial polyp(s). We excluded women with a history of endometrial cancer or hysterectomy.

Results: Twenty studies were analyzed. Of 11204 patients with endometrial polyp, 287 had malignant polyps (2.75%), 182 (1.8%) had concomitant endometrial hyperplasia with atypia, and 520 (5.2%) had hyperplasia without atypia within the polyp. Menopausal women had a higher risk of pre-malignancy/malignancy than non-menopausal women (OR 5.63 (95CI 3.87, 8.20, I ² = 0%, P < 0.001). Endometrial thickness on ultrasound in pre-malignancy/malignancy cases was significantly thicker than in the benign polyp (mean difference 4.2 mm, 95% CI 0.8 to 7.6 mm, I ² = 18%, P = 0.02). Women who used tamoxifen or hormone replacement therapy (HRT) had a lower likelihood of endometrial pre-malignancy/malignancy, while women with abnormal uterine bleeding (AUB) had a higher probability of pre-malignancy/malignancy. The odd ratio of having pre-malignancy/malignancy among those who used tamoxifen was 0.50 (95% CI 0.26-0.94: I ² 12%, p = 0.03).

Conclusion: In women with endometrial polyp, menopausal age and thickened endometrium might increase the probability while tamoxifen or HRT use might lower the likelihood of endometrial pre-malignancy/malignancy; and the presence of AUB might signal endometrial pre-malignancy/malignancy.

[This corrects the article on p. 243 in vol. 12, PMID: 38034103.].

Objectives: To establish the expert opinions and consensus recommendations from the Taiwanese Endometriosis Society on managing adenomyosis.

Materials and methods: This study employed a two-round modified Delphi method incorporating a national panel of expert gynecologists to form the consensus on managing adenomyosis. The first round of the Delphi procedure involved an expert panel from the board members to evaluate the relevance of each item. In the subsequent round of votes, gynecologists affiliated with the Taiwan Endometriosis Society participated and used a 5-point Likert scale to cast votes and approve each statement. The rating scales for each item of the key recommendations were analyzed for the distribution of degrees of agreement.

Results: The consensus for managing adenomyosis was developed, encompassing various aspects including imaging diagnosis, hormonal treatment, surgical treatment, noninvasive/minimally invasive treatment, infertility concerns, and obstetric considerations. In the first round of voting, all 25 recommendations received approval from the board members, advancing them to the second round. During the second round of voting, the majority of recommendations received either a "strongly agree" or "agree" response. There was divergence regarding the similarity of effectiveness in alleviating adenomyosis-related pain by either laparotomic or laparoscopic approaches (55% strongly agree or agree vs. 21% disagree or strongly disagree).

Conclusion: The Taiwan Endometriosis Society expert panel has established a set of consensus guidelines for the management of adenomyosis. There are diverging opinions among experts regarding the optimal surgical approaches for resection of adenomyosis.

Objectives: Minimally invasive surgery (MIS) is a limited treatment option for early-stage ovarian cancer. The National Comprehensive Cancer Network^® guidelines that salpingo-oophorectomy should be performed with every effort to keep an encapsulated mass intact during removal. We aimed to investigate whether, if tumor rupture was controlled, patients' oncological outcomes for Stage I ovarian cancer would not be worse in MIS. An endobag was prepared and used to prevent the ovarian cancer cells from spilling into the peritoneal cavity. We report a recent 10-year clinical outcome of MIS for ovarian cancer by oncological endoscopists in gynecology.

Materials and methods: We retrospectively collected clinical data from an electric chart. Collective clinical data included age, body mass index (BMI), operative time (OT), estimated blood loss (EBL), intraoperative rupture (IR), duration of hospital stay (HS), time from the operation date to the first infusion of chemotherapy (TOFC), disease-free survival (DFS), and overall survival (OS) at 5 years. The data were statistically analyzed using EZR.

Results: The median age, BMI, OT, EBL, IR, HS, TOFC, and DFS were 50 years, 23.9 kg/m², 363 min, 100 mL, 65 (98%) patients, 7 days, 15 days, and 43.4 months, respectively. The OS was 98%. The data were consistent with those from the past 10 years, except for a tendency toward an increasing trend in the proportion of ruptured tumors during surgery.

Conclusion: Tumor rupture within the prepared endobag during MIS did not affect the oncological outcomes of early-stage ovarian cancer.

The occurrence of metachronous multiple primary malignancies remains relatively rare; however, its incidence is notably rising. We present the case of a 25-year-old woman who underwent fertility-sparing surgery, followed by chemotherapy for ovarian yolk sac tumor. Three years later, the patient was diagnosed with a large B-cell lymphoma in the cecum. She underwent bowel surgery and received chemotherapy postoperatively. Despite her condition, she was able to conceive spontaneously and had a successful pregnancy after treatment. This report highlights the importance of considering fertility-preserving treatment strategies in young patients and the possibility of spontaneous conception and successful pregnancy even in patients diagnosed with metachronous multiple primary malignancies who underwent extensive surgical procedures and heavily treated with chemotherapy.

Objectives: The aim of this study was to assess the clinical outcomes of ultrasound (US)-guided high-intensity focused ultrasound (HIFU) in patients with breast fibroadenoma (FA) of different sizes.

Materials and methods: A total of 88 patients with 245 lesions diagnosed with FA by core needle biopsy from January 2021 to November 2023 were included in this study. US-guided HIFU was performed under local anesthesia. Baseline and treatment characteristics were recorded and analyzed. FAs were divided into three groups according to the longest diameter for further analysis. After the treatment, follow-up with volume evaluation and physical examination was performed at 3, 6, and 12 months.

Results: There were 56 FAs ≤10 mm (group 1), 144 FAs with a diameter of 10-20 mm (Group 2), and 45 FAs of 20-30 mm (Group 3). The sonication time of the three groups was 22.5 s, 45.0 s, and 83.0 s (P < 0.05). Based on contrast-enhanced ultrasound evaluation, the median nonperfused volume ratio of the three groups was 74.1%, 87.6%, and 79.2% (P > 0.05), respectively. The volume reduction rates (VRR) of the three groups were 47.3%, 77.0%, and 82.0% at 12 months after HIFU, showing statistical differences. All patients were tolerated well and there were no adverse events after HIFU.

Conclusion: The current evidence indicated HIFU was effective and safe in treating breast FA of different sizes, and the VRR of FA >1 cm at 12 months post-HIFU was greater than that of FA <1 cm.

Robotic hysterectomy has emerged as a superior surgical approach for patients with obesity, providing significant benefits including reduced incidence of myocardial infarction, peripheral nerve injury, wound infections, and urinary tract infections. However, these unique considerations require careful attention when managing such cases. Therefore, this study aimed to propose several key strategies for achieving optimal outcomes, including maintaining a mild Trendelenburg position (12°), ensuring the patient's secure positioning, avoiding the lithotomy position, considering a slightly higher pneumoperitoneum insufflation pressure (12 mmHg), and using a 30° endoscope for improved visualization rather than a 0° endoscope. We present three cases of stage IA atypical endometrial hyperplasia and carcinoma. All three patients underwent robotic hysterectomy and bilateral salpingo-oophorectomy, with body mass indices of 53.3, 43.8, and 43.7 kg/m².