Gynecology and Minimally Invasive Therapy-GMIT最新文献

Objectives: The objectives of this study were to determine if radical laparoscopic excision of endometriosis (RLEE) improves long-term outcomes in the quality of life (QOL) and symptomatology experienced by women with the disease. Secondary objectives include recurrence and reoperation rates and impact on fertility.

Materials and methods: Prospective observational cohort study Patients who underwent surgical management of histologically confirmed endometriosis completed pre- and postoperative QOL questionnaires.

Results: Baseline preoperative scores on QOL questionnaires were lower than the population norms. Overall, 63.0% of patients improved their global health scores, and 57.5% of patients improved their health state scores from baseline to the most recent follow-up. On the Short Form-12 questionnaire, 63% of patients improved their physical and/or mental scores. Overall improvement was shown in Visual Analog Scale pain scores in menstrual pain (79.2% improved, median improvement 3, P < 0.001, n = 72), noncyclical pelvic pain (64.4% improved, median improvement 2, P < 0.001, n = 73), dyschezia (63.9% improved, median improvement 2, P < 0.001, n = 72), and dyspareunia (65.6% improved, median improvement 1, P = 0.002, n = 64 pairs). There was a significant reduction in discomfort 1-2 years after primary surgery among sexually active patients (n = 23, pre- vs. postmedian score 4 vs. 2, P = 0.005). Repeat surgery was required in 36% of patients and 77.1% of those wishing to, achieved a successful pregnancy.

Conclusion: RLEE significantly improves global health scores, with this improvement lasting up to 10 years following index surgery. It is also suggested that this management option has the capability of improving fertility outcomes in women with endometriosis.

Intrauterine adhesions (IUAs) and Asherman's syndrome (AS) have been recognized medical conditions since the late 19^th and mid-20^th centuries. Multiple classification systems have been proposed to better understand their severity and implications. This article aims to provide a comprehensive overview of the existing classifications for IUAs and introduces the Loddo scoring system, a novel approach for classifying these conditions. The Loddo scoring system is unique in amalgamating the strengths of previous classifications while emphasizing the importance of ultrasonographic endometrial thickness. This new system integrates various clinical parameters, offering a holistic representation of IUAs in clinical presentation and underlying structural changes. The Loddo scoring system presents a refined approach to understand and manage IUAs, providing a precise prognosis evaluation. Bridging the diagnostic and therapeutic divide seen in past systems, it offers promise for reshaping the landscape of diagnosis and treatment in women's health. Further research and validation are essential to assess its broad clinical applicability.

Objectives: This study aims to determine the impact of oxidized regenerated cellulose (ORC) during cystectomy and drainage on recurrence and ovarian reserve.

Materials and methods: Women aged 18-45 years with endometrioma (pathologically confirmed) who underwent conservative laparoscopy surgery (cystectomy and drainage) using ORC at Fatmawati General Hospital Jakarta, Indonesia, were included in this study. All surgeries were done by complete excision of all endometriosis lesions (especially for excision of deep infiltrating endometriosis and adenomyosis resection). All patients were followed up for 1 year, and the recurrence rate and postoperative anti-Mullerian Hormone (AMH) were evaluated.

Results: Twenty patients were included in the cystectomy group and 19 in the drainage group. The researchers found the result was not significant (P = 0.622) in recurrence rate. AMH was decreased from 3.0 ± 1.8 to 2.1 ± 1.5 in cystectomy with ORC group. Conversely, AMH decreased from 1.4 ± 1.25 to 1.1 ± 0.9 in the drainage with ORC group. The reduction of AMH level was more significant in the cystectomy group (P = 0.002) than in the drainage group (P = 0.124).

Conclusion: Cystectomy with ORC significantly reduces ovarian reserve. Drainage followed by insertion of ORC to the cyst cavity can be an option to maintain ovarian reserve with a risk of recurrence that is not significantly different from cystectomy.

Objectives: The initial learning curve is a barrier to introducing robotic surgery. Evidence regarding appropriate simulation programs that allow for a smooth introduction of gynecological robotic surgery remains limited.

Materials and methods: We retrospectively analyzed 149 patients who underwent robotic surgery for gynecologic diseases. Before their first procedure, the surgeons completed a robotic surgery training program. Assistant surgeons also completed simulation programs, including setup procedures and manipulation of the robotic arm.

Results: The mean (± standard deviation) operative, setup, and console times were 170 ± 54 min, 22 ± 8 min, and 126 ± 51 min, respectively. No patient required blood transfusion or conversion to laparoscopy or laparotomy. Patients undergoing surgery by the same surgeon were divided into three groups (first-third, middle-third, and last-third of patients undergoing surgery) to assess chronological changes. No statistically significant differences were found between the operative and console times among these groups. The setup times for the middle and last third of patients were 20 ± 7 min and 18 ± 7 min, respectively, which were statistically significantly shorter than those for the first third of patients. No significant differences in the operative and console times done by five physicians who completed programs were observed between the first 75 and the latter 74 procedures; however, the setup times of the latter 74 procedures were significantly shorter than those of the first 74 procedures (25 ± 9 min vs. 19 ± 6 min; P < 0.001).

Conclusion: The setup time was influenced by clinical experience. An appropriate simulation program allowed a safe implementation of robotic surgery.

Objectives: Allowing surgeons the option of individually sized laparoscopic instruments can potentially improve the ergonomics of laparoscopic surgery. We investigate interest in individually sized laparoscopic instruments among minimally invasive trained surgeons.

Materials and methods: Cross-sectional survey of 166 surgeons performing laparoscopic surgery in the disciplines of obstetrics/gynecology, general surgery, and urology. Items investigated surgeon knowledge, attitudes, potential usefulness, and interest regarding dissemination and implementation of individually sized laparoscopic instruments.

Results: Overall mean knowledge of individually sized laparoscopic instruments ranged from strongly disagree to disagree and did not differ by glove size. Overall mean attitudes, dissemination, and implementation for individually sized laparoscopic instruments were between neutral and agree. Overall mean usefulness for individually sized laparoscopic instruments was neutral. There was a general pattern of small glove size having greater mean values than medium glove size for individually sized laparoscopic instruments for the topics of attitudes, usefulness, dissemination, and implementation.

Conclusion: We found that those with small glove sizes are interested in individually sized laparoscopic instruments. We recommend that as surgeon demographics continue to diversify, especially with a larger number of women typically with smaller glove sizes becoming surgeons, there is a potential benefit for individually sized laparoscopic instruments. Hospitals, surgical centers, and clinical practices should consider making such individually sized laparoscopic instruments available to surgeons. This can potentially address the ergonomic concerns of surgeons and also improve surgical practice.

Objectives: On the first line of polycystic ovary syndrome (PCOS) treatment, ovulation with clomiphene citrate (CC) is induced. However, 25% of patients need alternative therapy. Laparoscopic ovarian drilling (LOD) can result in successive ovulations and is not linked to ovarian hyperstimulation. In this systematic review and meta-analysis, we aimed to consider the efficacy of unilateral LOD (ULOD) versus bilateral LOD (BLOD) for enhancing fertility and improving fertility outcomes in women with CC-resistant.

Materials and methods: A comprehensive literature search was conducted up to July 15, 2023, to identify relevant randomized controlled trials in PubMed, Scopus, Google Scholar, and Cochrane Library databases. Thirteen articles were included in the meta-analysis. After data extraction, we performed a meta-analysis.

Results: As the main unit of analysis for each variable, the standardized mean difference was used between the two groups. The random effects model was used for analysis and heterogeneity was assessed by I ² statistics. Publication bias was inspected through funnel plots and Begg's and Egger's regression tests. The included studies were divided into two general categories. In the first category, surgical treatment of LOD was compared with other treatments. Whereas, in the other category, ULOD was compared with BLOD.

Conclusion: In summary, this meta-analysis did not find a significant difference in the rate of ovulation, pregnancy, miscarriage, and live birth between the two groups. However, LOD could cause damage to the ovarian reserve, but it has long-term effects on improving the menstrual cycle and reproduction. In general, LOD is a significant method for the treatment of infertility in PCOS, which needs further investigation.

Objectives: The objective is to evaluate the feasibility and safety of ArtiSential for performing minimally invasive surgeries for gynecological cancers.

Materials and methods: We conducted a prospective observational study at 10 Tertiary Institutional Hospitals in Korea between November 2021 and April 2022. Eligible patients were 18 years or older and planned to undergo minimally invasive surgery for gynecologic cancer. We collected baseline characteristics, surgical information, and postoperative outcomes. The primary endpoint was to compare the operation time required for gynecologic cancer surgery using ArtiSential with the reported operation time for surgery using conventional laparoscopic instruments or robots. The secondary endpoints were to evaluate the surgical outcomes of gynecologic cancer surgery using ArtiSential compared to conventional laparoscopic instruments or robots and collect operator feedback on equipment improvements during surgery.

Results: Forty patients were enrolled in this study, including 19 with endometrial cancer, 15 with cervical cancer, and 6 with ovarian cancer. The average operation time was 187.0 ± 49.2 min, with no complications encountered during surgery. Pelvic lymph nodes were assessed in 34 patients, with the ArtiSential device utilized in 22 (64.7%) of these patients, at an average assessment time of 40.3 ± 19.4 min. Most surgeons using the ArtiSential device reported that it performed slightly better than conventional laparoscopic instruments.

Conclusion: The use of the ArtiSential device in minimally invasive surgery has been demonstrated to be both feasible and safe for the treatment of early-stage gynecologic cancer.

Objectives: The objective of this study was to quantify the time to diagnosis of endometriosis by laparoscopy for patients of varying body mass index (BMI), as well as the safety of laparoscopy for endometriosis by BMI.

Materials and methods: We performed a retrospective cohort study of reproductive-age women receiving a primary laparoscopic diagnosis of endometriosis at an academic tertiary hospital from January 2017 to December 2020. Patients excluded were those undergoing repeat laparoscopy, with previously histologically diagnosed endometriosis, asymptomatic endometriosis, an unknown first gynecologic encounter, or an unknown initial BMI. Our primary outcome was time to surgical diagnosis of endometriosis by BMI class. Our secondary outcome was the evaluation of peri/postoperative risk of laparoscopy for endometriosis.

Results: A total of 152 patients received a primary surgical diagnosis of endometriosis, including 44% normal or underweight patients, 29% overweight patients, and 27% obese patients. Obese patients experienced a delay from gynecologic presentation to diagnostic laparoscopy (18.4 months, interquartile range [IQR] 3.1-42.8) compared to overweight patients (9.0 months, IQR 2.5-23.2) and normal and underweight patients (3.8 months, IQR 1.1-17.0) (P = 0.02). Although a higher percentage of overweight and obese patients was Hispanic and non-Hispanic Black, multiple linear regression maintained a significant relationship between time to surgery and BMI (P = 0.03). Perioperative and postoperative complications did not differ by BMI class. There were no differences in repeat laparoscopy for endometriosis within 3 years by BMI (P = 0.99).

Conclusion: BMI is independently associated with time to surgical diagnosis of endometriosis in our retrospective study. Diagnostic laparoscopy appears safe in obese patients, without significant perioperative morbidity.

Objectives: Laparoscopic myomectomy (LM) is a procedure with a high rate of postoperative adhesions, which can lead to complications such as bowel obstruction and subsequent surgical problems, making anti-adhesion measures important. Various anti-adhesion materials are already on the market and have shown efficacy, but dextrin hydrogel spray (AdSpray™), an anti-adhesion material launched in 2017, has not yet been reported in the field of gynecology, although there are papers showing its usefulness in the surgical field such as repeat hepatectomy and ileostomy closure. Thereby, we investigated the postoperative status of AdSpray™ in LM.

Materials and methods: We report 24 cases in which AdSpray™ was used at Teine Keijinkai Hospital from 2018 to 2021 for LM, followed by cesarean section (CS) from 2019 to 2022. Adverse effects related to AdSpray™ and the presence of uterine adhesions in CS were examined.

Results: Adhesions were observed in 4 (16.7%) cases, none of which resulted in significant adverse effects of AdSpray™.

Conclusion: AdSpray™ was effective in preventing adhesion and may be an option as an anti-adhesion material in LM.