Facts Views and Vision in ObGyn最新文献

Background: In 2022, OpenAI launched ChatGPT 3.5, which is now widely used in medical education, training, and research. Despite its valuable use for the generation of information, concerns persist about its authenticity and accuracy. Its undisclosed information source and outdated dataset pose risks of misinformation. Although it is widely used, AI-generated text inaccuracies raise doubts about its reliability. The ethical use of such technologies is crucial to uphold scientific accuracy in research.

Objective: This study aimed to assess the accuracy of ChatGPT in doing GESEA tests 1 and 2.

Materials and methods: The 100 multiple-choice theoretical questions from GESEA certifications 1 and 2 were presented to ChatGPT, requesting the selection of the correct answer along with an explanation. Expert gynaecologists evaluated and graded the explanations for accuracy.

Main outcome measures: ChatGPT showed a 59% accuracy in responses, with 64% providing comprehensive explanations. It performed better in GESEA Level 1 (64% accuracy) than in GESEA Level 2 (54% accuracy) questions.

Conclusions: ChatGPT is a versatile tool in medicine and research, offering knowledge, information, and promoting evidence-based practice. Despite its widespread use, its accuracy has not been validated yet. This study found a 59% correct response rate, highlighting the need for accuracy validation and ethical use considerations. Future research should investigate ChatGPT's truthfulness in subspecialty fields such as gynaecologic oncology and compare different versions of chatbot for continuous improvement.

What is new?: Artificial intelligence (AI) has a great potential in scientific research. However, the validity of outputs remains unverified. This study aims to evaluate the accuracy of responses generated by ChatGPT to enhance the critical use of this tool.

This is the case of a 30-year-old nulliparous patient with a complete uterine septum, double cervix and non- obstructive longitudinal vaginal septum (Class U2bC2V1 according to the ESHRE/ESGE classification). The patient presented with severe dyspareunia and dysmenorrhea. Imaging revealed a complex Müllerian anomaly and hysteroscopic treatment was agreed. We present an approach of hysteroscopic metroplasty after insertion of a Foley catheter balloon in one uterine hemi-cavity, which serves as a guide for septum resection using a resectoscope in the contralateral hemi-cavity. No complications were encountered. The patient was discharged after a short period of observation. A post-operative evaluation revealed complete resection of the vaginal septum and the formation of a single, normal uterine cavity.

Background: Complete bicorporeal uterus, double cervix and obstructive longitudinal vaginal septum (classified as U3bC2V2 according to ESHRE/ESGE classification) is a rare congenital anomaly of the genital tract. This condition is typically associated with ipsilateral renal agenesis and is known as Herlyn-Werner-Wunderlich syndrome or OHVIRA (Obstructed HemiVagina and Ipsilateral Renal Anomaly) syndrome. The primary symptoms include dysmenorrhea and pelvic pain, which usually manifest after menarche due to haematocolpos in the obstructed hemivagina. Diagnosis is often challenging and frequently delayed. Early detection and surgical drainage of the haematocolpos are essential for symptom relief and prevention of complications. Various surgical approaches have been described, with vaginoplasty and septal resection being the recommended treatment.

Objective: To propose a step-by-step demonstration with narrated video footage of an integrated approach for one-stop diagnosis and ultrasound-guided endoscopic hymen-sparing treatment in a patient with OHVIRA syndrome.

Materials and methods: We present the case of a 17-year-old virgo-intacta female who was referred to our institution due to dysmenorrhea, abnormal uterine bleeding and a right presumed ovarian endometrioma. A preoperative evaluation, including pelvic ultrasound and MRI, suspected a U3bC2V2 malformation, associated to a right haematocolpos and ipsilateral renal agenesis. The patient underwent a complete minimally invasive vaginoscopic resection of the obstructive longitudinal vaginal septum under transabdominal ultrasound guidance, using a 15Fr bipolar mini-resectoscope. The procedure successfully drained the haematocolpos and allowed visualisation of the right cervix, confirming the preoperative diagnosis.

Results: The procedure was performed in our Digital Hysteroscopic Clinic (DHC) - CLASS Hysteroscopy -under general anaesthesia (with laryngeal mask), according to an ambulatory model of care. No complications occurred and the patient was discharged three hours after the procedure.

Main outcomes: After 40 days, hysteroscopic office control revealed a normal vagina with double cervix and complete bicorporeal uterus (classified as U3bC2V0 according to ESHRE/ESGE classification), and the patient had complete relief of symptoms.

Conclusion: The combined approach of one-stop diagnosis and ultrasound-guided minimally invasive vaginoscopic resection of the obstructive longitudinal vaginal septum, using a 15Fr bipolar mini-resectoscope, has proven to be an effective strategy. This approach leads to optimal surgical results without complications.

Submucosal uterine fibroids are the rarest type of fibroids. They can lead to abnormal uterine bleeding and may play a role in infertility and miscarriage. Hysteroscopic myomectomy is the preferred treatment to relieve bleeding caused by these fibroids and to restore the normal structure of the uterine cavity. The European Society for Gynaecological Endoscopy Uterine Fibroids Working Group developed recommendations based on the best available evidence and expert opinion for the surgical treatment of uterine fibroids. In this second part of the recommendations, hysteroscopic approaches are described. This review explores the techniques related to hysteroscopic myomectomy, focusing on narrower scopes, fluid management and advances in tissue removal systems and electrosurgery.

Background: The quality of gynaecological surgical training has faced mounting criticism internationally with multiple countries publishing potential remedies for improvement. Simulation has the indisputable ability to mitigate against training deficiencies, however, access to and the quality of simulation varies across regions, never mind nations.

Objectives: To assess the effect on surgical skills by the introduction of a structured and integrated simulation programme with the unique aspect of being completely free of cost with the provision of a take-home laparoscopy box trainer (LBT).

Materials and methods: The course was mandatory in attendance and was divided into basic, intermediate and advanced streams. Each stream had a bespoke curriculum based on RCOG training. It was delivered through a combination of lectures and a mixture of dry/wet lab training sessions with the LBT provided for home use.

Main outcome measures: All participants completed a pre- and post-course questionnaire with objective laparoscopic skill metrics assessed using the Inovus LapAR system at the beginning and end of the course.

Results: 100% of trainees demonstrated a statistically significant (p=<0.05) improvement in smoothness, time and speed. Furthermore, 100% reported the course improved their surgical skills which were further developed by LBT practice.

Conclusion: This demonstrated improvement in surgical skills and confidence solidifies the hope that such a programme could be implemented as an international gynaecological standard. If implemented from the initial specialist years of training, a strong foundation can be instilled to ensure that each future gynaecologist has strong surgical skills built from a high level of laparoscopic simulation.

What is new?: Our study is the first of its kind to describe an equitable and fair approach to laparoscopic surgery training; for the many rather than the select few.

Background: Stress urinary incontinence is a frequent condition in female patients. Surgical treatment with tension-free vaginal tape (TVT) insertion is a minimally invasive option with immediate improvement of symptoms. Different possible complications have been described in the literature. Obturator nerve entrapment is a very rare complication of retropubic (rp) TVT insertion.

Objectives: To show the feasibility of robotic-assisted laparoscopic mesh removal in a case of rpTVT-related entrapment of the left obturator nerve.

Materials and methods: We present the case of a 55-year-old patient who suffered from left obturator nerve dysfunction with adductor muscle atony and neuralgia after insertion of rpTVT five years earlier in an external hospital for urinary stress incontinence. We show the safety and feasibility of robotic-assisted nerve-sparing mesh removal.

Main outcome measures: Post-interventional pain release and nerve and muscle function recovery.

Results: Immediately after the surgical removal of the mesh and release of the left obturator nerve, the patient reported pain release and improvement of motoric function.

Conclusions: Robotic-assisted surgery is a feasible minimally invasive alternative in the treatment of rpTVT-related obturator nerve entrapment.

Background: Electrosurgery is widely used in all surgical specialities. There is evidence that surgeons in different disciplines and with different experience levels have an inadequate understanding of the basics of electrosurgery and its complications. This can increase the risk of electrosurgical complications. Despite its improved safety technology, electrosurgery is still associated with serious morbidity and mortality. In addition, such adverse outcomes will incur financial losses to our health system due to the costs of repeated operations, prolonged hospital stays, and litigation.

Objectives: To identify the various mechanisms of electrosurgical complications and to highlight the recommended actions to prevent such complications.

Materials and methods: Narrative review based on a literature search of the Medline database using the following search terms: "electrosurgery", "complications", "risks", and "adverse effects", with further citation searching for related articles.

Main outcome measures and results: The paper does not address specific research questions but addresses common knowledge gaps in the mechanisms of electrosurgical complications among surgeons.

Conclusions: Electrosurgical devices can cause severe complications such as unintended tissue burns, surgical fires, smoke hazards, and interference with implantable devices. Although such energy devices are designed with increasingly improving safety features, an adequate understanding of the circumstances, mechanisms, and prevention of these complications by the surgical team is the cornerstone in mitigating such risks.

Objectives: To enhance evidence-based knowledge about sexual function and the prevalence of sexual dysfunction after surgical therapy for congenital anomalies with menstrual outflow obstruction.

Materials and methods: In this long-term case-control study, all patients underwent surgical correction of an obstructive Müllerian anomaly between 1980 and 2013. At the start of the case-control study, patients were at least 18 years old and were two years post their initial operation. The control group were women without current gynaecological problems. 38 patients (response rate 48.7%) and 54 controls were included. Chi-square test linear-by-linear Association, Fisher's Exact Test, Mann-Whitney U test and the unpaired sample t-test were used for statistical analysis.

Main outcome measures: The following questionnaires were used: the Female Sexual Function Index (FSFI), the Body Exposure during Sexual Activities Questionnaire (BESAQ), and the Endometriosis Health Profile Questionnaire (EHP-30).

Results: The mean FSFI score in patients was 27.8 (SD5.4) versus 27.4 (SD6.8) in controls (p=0.858). A total FSFI score ≥26.55, indicating no sexual dysfunction was present in 70.6% of patients and 69.2% of controls (p=1.000). The mean BESAQ score in patients was 30.4 (18.5), compared to 38.3 (SD21.4) in controls (p=0.261), where lower scores denote better body image during intimate sessions. In the EHP-30, a statistically significant difference between patients and controls was found in all items on sexual intercourse. The subscale score of patients was 31.1 (SD26.2) versus 7.0 (SD11.1) in controls (p=<0.001), indicating better sexual functioning in controls.

What is new?: The study showed that a history of menstrual outflow obstruction had a negative influence on several domains of sexual function, yet the patients total scores on sexual function remained in the normal range. The FSFI score of patients' post-surgical treatment of obstructive congenital anomalies is similar to the control group.

Background: Several endometriosis classification systems have been proposed and published but the search for a universal language that communicates the complexity, laterality and severity of this disease continues. The authors introduce the Visual-Numeric Endometriosis Scoring System. VNESS is a novel system for describing surgical findings in each compartment of the pelvis in a way that is simple to use, visually intuitive and mirrors a laparoscopic image of the pelvis.

Objective: The aim of this study was to assess inter-rater reliability for components of VNESS.

Materials and methods: The project took the format of a validation study using short surgical laparoscopic video clips. Anonymised video clips of endometriosis procedures were scored by 50 Gynaecologists of varying levels of experience from 12 different countries. The clips were collated from a series of procedures performed between 2012 and 2022. Each participant scored 93 short surgical clips using VNESS. 4650 scores were compared against a reference score and analysis was performed to assess inter-rater reliability.

Main outcome measures: The outcome measures were percentage agreement between given and reference scores, as well as intra-class correlation coefficients (ICC), Cohen Kappa and Quadratic Weighted Kappa Coefficients calculated to evaluate inter-rater reliability.

Results: The highest and lowest percentage agreement with the reference score was seen in VNESS 4 (full thickness disease, 97% perfect agreement) and VNESS 1 (superficial disease, 53% perfect agreement) respectively. The intraclass correlation coefficient showed strong inter-rater reliability for all VNESS compartments except the vagina.

Conclusions: This study suggests that VNESS has excellent reliability between observers. Correlation is stronger with more severe disease.