Facts Views and Vision in ObGyn最新文献

Background: The rate of kidney transplantation has been steadily increasing worldwide, accompanied by significant improvements in post-transplant survival rates. However, transplant recipients have a higher incidence of malignancies compared with the general population, and their oncological management often poses unique challenges. In recent years, major advances in the treatment of ovarian cancer (OC) have expanded the therapeutic options available for recurrent disease. Two randomised trials have underscored the role of surgery in platinum-sensitive recurrent OC while minimally invasive approaches have demonstrated reduced morbidity without compromising oncologic outcomes in carefully selected patients. For frail and immunosuppressed individuals, the minimally invasive approach may offer substantial advantages- including fewer wound complications, shorter hospitalisation, and earlier resumption of oral intake and immunosuppressive therapy. Despite these potential benefits, evidence regarding the feasibility and safety of minimally invasive secondary cytoreduction in kidney-transplanted patients remains limited.

Objectives: To demonstrate the feasibility and outcomes of robotic surgery in a platinum-sensitive OC recurrence in a frail, kidney-transplant patient.

Participant: A woman in her 50s with a history of kidney transplantation presented with isolated pelvic high-grade serous OC recurrence. Positron emission tomography scan revealed a 15 mm solid lesion with increased uptake infiltrating the rectum.

Intervention: A robot-assisted rectal resection was performed using the Da Vinci Xi Surgical System. The approach included four 8 mm robotic trocars: trans umbilical optical port, right and left iliac fossa, suprapubic region, and one 10 mm laparoscopic port at the left Palmer's point. Colorectal anastomosis was completed using the Ethicon Endo-Surgery 60 mm stapler by a specialised peritoneal and retroperitoneal team.

Conclusions: R0 resection was achieved with no complications or delays in immunosuppressive therapy resumption; final histology confirmed rectal involvement, and adjuvant chemotherapy was promptly initiated. At the two-year follow-up, the patient was disease-free.

What is new?: This case supports minimally invasive surgery as a valid approach in selected, frail, immunosuppressed patients with isolated OC recurrence.

Background: Retained intrauterine foreign bodies are rare but may cause abnormal uterine bleeding (AUB) and pelvic pain. Hysteroscopy is the preferred approach for diagnosis and management.

Objectives: This video describes a step-by-step hysteroscopic technique for intrauterine foreign body removal.

Participant: A 60-year-old woman presented with pelvic pain and AUB. She underwent resectoscopic polypectomy three years before. A computed tomography scan revealed a cylindrical foreign body (12x8 millimetres) in the uterine cavity. The patient was referred to the Digital Hysteroscopic Clinic CLASS Hysteroscopy in Fondazione Policlinico Universitario A. Gemelli IRCCS in Rome, where she was scheduled for a minimally invasive hysteroscopic procedure.

Intervention: Hysteroscopic evaluation identified a tubular foreign body firmly adherent to the posterior uterine wall. Removal was performed using a hysteroscopic approach combined with a traction suture technique. First, 5 Fr scissors were used to detach the foreign body from the posterior uterine wall. Then, a Collins electrode of a 15 Fr bipolar miniresectoscope was employed to incise the lateral isthmic walls to facilitate extraction. Finally, a 0 Vicryl traction suture loop, inserted through the foreign body using 5 Fr grasping forceps, enabled controlled removal under hysteroscopic guidance. The foreign body was successfully extracted.

Conclusions: This video demonstrates a step-by-step hysteroscopic technique for intrauterine foreign body removal, highlighting the safety and precision of this minimally invasive approach.

What is new?: This is the first reported case of hysteroscopic removal of a retained intrauterine foreign body, using a traction suture technique under hysteroscopic guidance for a controlled extraction.

Minimally invasive sacrocolpopexy is considered the reference procedure for pelvic organ prolapse (POP). This study reports the first series of robotic sacrocolpopexy (RSCP) performed with the Versius^® Robotic Surgical System (CMR Surgical, Cambridge, UK). Twenty women with symptomatic multicompartment POP underwent nerve-sparing RSCP. All procedures were completed successfully with no complications or conversions. Surgical and functional outcomes were consistent with those reported for other minimally invasive techniques. At three-month follow-up, complete anatomical correction was achieved in 90% of patients, with improvement in patient-reported outcomes. Our experience indicates that the Versius^® system is a safe and practical option for RSCP.

Background: Minimally invasive hysterectomy is increasingly performed robotically as new systems expand options and address limitations of traditional platforms, including financial, infrastructure, and workflow demands. The DEXTER^® Robotic Surgery System was designed to address some of these challenges.

Objectives: To confirm perioperative and early postoperative safety, and evaluate the clinical performance of DEXTER in hysterectomy.

Methods: This prospective multicentre study included 34 patients who underwent robotic-assisted hysterectomy for benign or low-risk malignant diseases between November 2022 and November 2023. DEXTER was integrated into the surgical workflows of the four participating centres, which used their existing laparoscopic towers.

Main outcome measures: Primary outcomes were procedural conversions and Clavien-Dindo grade III-V events up to 30 days post-surgery.

Results: Median patient age was 45.5 years; median body mass index was 26.0 kg/m². There were no conversions to laparotomy, intraoperative complications or transfusions, with a median estimated blood loss of 100 mL. Median skin-to-skin operative time was 125.5 min, including a median docking time of 5 minutes. Median length of hospitalisation was 2 days. Two Clavien-Dindo grade IIIb adverse events were recorded, neither of which was device-related. In 3 cases, the surgeons decided to finish the procedure laparoscopically.

Conclusions: Hysterectomy assisted with DEXTER can be safely performed even in the early learning phase. DEXTER facilitated an adaptable OR workflow allowing greater flexibility in procedural approaches. Further investigation with a larger cohort and a longer follow-up is required to evaluate long-term outcomes.

What is new?: First prospective multicentre study to confirm robotic-assisted hysterectomy using DEXTER is a feasible and safe approach for treating benign and low-risk malignant conditions.

Background: Chronic pelvic pain (CPP) is a complex, prevalent condition that significantly impacts quality of life, work, relationships, and healthcare resources. Management remains challenging, with variation in practice and no national consensus. Evidence supports a multidisciplinary approach to treatment.

Objectives: To describe the design, implementation, and outcomes of a multidisciplinary Pelvic Pain Management Programme (PPMP), reporting results from four programme cycles.

Methods: The PPMP was developed using behaviour-change principles and delivered over 12 weekly sessions. Participants completed validated psychometric questionnaires at baseline, programme completion, and 3-month follow-up. Change was analysed using repeated-measures ANOVA and clinical significance assessed using the Minimal Clinically Important Difference or the Reliable Change Index.

Main outcome measures: Psychometric questionnaires assessed the following outcome measures: pain intensity, pain self-efficacy, kinesiophobia, anxiety, depression, patient activation, health-related quality of life, pain acceptance, and catastrophising.

Results: Thirty-three participants completed the programme, with 19 full datasets. A statistically significant improvement was recorded across all measures, except for anxiety. At the 3-month follow-up, 79% of participants reported a clinically significant improvement in several areas. Notably, 82% of participants showed clinically significant improvement in pain self-efficacy, 74% in depression, and 81% in pain catastrophising at programme completion.

Conclusions: A PPMP is feasible, acceptable, and associated with significant and sustained improvements across biopsychosocial outcomes. Tailored PMPs may address gaps in CPP care and support long-term recovery.

What is new?: This represents the largest published dataset evaluating a PPMP. These results highlight the potential of PPMPs to achieve pain reduction and sustainable improvement in quality of life for individuals with CPP.

Background: TikTok is a popular platform for sharing health experiences, including those related to endometriosis. However, the quality and tone of the surgical information shared remain unclear.

Objectives: To characterise TikTok content regarding perceptions of surgical management for endometriosis and analyse content for information quality and differences between healthcare professionals and patients.

Methods: A cross-sectional analysis of the top 100 most-viewed TikTok videos under the search term "endometriosis surgery" was conducted on September 22, 2024. Videos were included if in English, referenced "endometriosis," and mentioned "surgery," "operation," or "laparoscopy." Two independent reviewers assessed creator identity, tone, and content. The brief DISCERN tool evaluated information quality.

Main outcome measures: Primary outcomes included the perceived benefits and drawbacks of surgery, tone towards surgical intervention, and thematic content. Secondary outcomes included DISCERN scores and comparison of content across creator identities.

Results: Of the included videos (2021-2024), 80% were created by patients. Most conveyed a neutral tone (41%) towards surgery. Perceived benefits included therapeutic effects (68%) and diagnostic clarity (61%). Reported drawbacks were postoperative recovery (58%) and symptom persistence (22%). Common themes among patients included barriers to surgery (35%), medical gaslighting (30%), delayed diagnosis/misdiagnosis (25%), and inadequate presurgical counselling (20%). Median DISCERN scores were significantly lower for patient videos (1.00) vs. healthcare professionals (1.96; P<0.001).

Conclusions: TikTok content on endometriosis surgery is largely driven by patient narratives that highlight both hope and frustration. The low quality of information underscores the need for accessible, evidence-based educational content. Our findings represent a cross-sectional snapshot subject to algorithmic ranking and platform dynamics.

What is new?: This is the first study to systematically evaluate TikTok content focused on surgical management of endometriosis, demonstrating that patient-generated videos overwhelmingly drive the conversation. While patients frequently describe benefits such as diagnostic clarity and symptom relief, they also highlight barriers to surgery, postoperative challenges, recurrent symptoms, and experiences of medical gaslighting. Patient-created videos had significantly lower information quality than provider-generated content, underscoring a critical gap in evidence-based surgical education on social media and an opportunity for clinician engagement.