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Devins KM, Young RH, Oliva E. Sex Cord-Stromal Tumors of the Ovary: An Update and Review. Part I - Pure Ovarian Stromal Tumors. Adv Anat Pathol 2024; 31:215-230. [PMID: 38369847 DOI: 10.1097/pap.0000000000000435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
In two separate reviews, we review the time-honored but still frequently challenging features of ovarian sex cord-stromal tumors, and also emphasize new developments including unusual morphologic appearances that, despite the relative rarity of many of the tumors, result in a disproportionate number of differential diagnostic problems, variant immunohistochemical profiles, and specific molecular and syndromic associations. These neoplasms are also of historical interest as current knowledge is still based in significant part on the contributions of 2 giants of gynecologic pathology, Dr Robert Meyer and Dr Robert E. Scully. In part I, we present the major clinical, pathologic, and genomic features of the pure ovarian stromal tumors including comments on differential diagnosis and briefly note significant historical contributions. In part II we will discuss pure sex cord and sex cord-stromal tumors.
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Affiliation(s)
- Kyle M Devins
- James Homer Wright Pathology Laboratories, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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202
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Huang KJ, Chang WC, Tsai TY, Sheu BC. Woman With Lower Abdominal Pain. Ann Emerg Med 2024; 84:82-83. [PMID: 38906629 DOI: 10.1016/j.annemergmed.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/01/2024] [Accepted: 01/10/2024] [Indexed: 06/23/2024]
Affiliation(s)
- Kuan-Ju Huang
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Yunlin Branch, Yunlin county, Taiwan
| | - Wen-Chun Chang
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tou-Yuan Tsai
- School of Medicine, Tzu Chi University, Hualien, Taiwan; Emergency Department, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Bor-Ching Sheu
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
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203
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Chan LE, Casiraghi E, Reese J, Harmon QE, Schaper K, Hegde H, Valentini G, Schmitt C, Motsinger-Reif A, Hall JE, Mungall CJ, Robinson PN, Haendel MA. Predicting nutrition and environmental factors associated with female reproductive disorders using a knowledge graph and random forests. Int J Med Inform 2024; 187:105461. [PMID: 38643701 PMCID: PMC11188727 DOI: 10.1016/j.ijmedinf.2024.105461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 04/09/2024] [Accepted: 04/16/2024] [Indexed: 04/23/2024]
Abstract
OBJECTIVE Female reproductive disorders (FRDs) are common health conditions that may present with significant symptoms. Diet and environment are potential areas for FRD interventions. We utilized a knowledge graph (KG) method to predict factors associated with common FRDs (for example, endometriosis, ovarian cyst, and uterine fibroids). MATERIALS AND METHODS We harmonized survey data from the Personalized Environment and Genes Study (PEGS) on internal and external environmental exposures and health conditions with biomedical ontology content. We merged the harmonized data and ontologies with supplemental nutrient and agricultural chemical data to create a KG. We analyzed the KG by embedding edges and applying a random forest for edge prediction to identify variables potentially associated with FRDs. We also conducted logistic regression analysis for comparison. RESULTS Across 9765 PEGS respondents, the KG analysis resulted in 8535 significant or suggestive predicted links between FRDs and chemicals, phenotypes, and diseases. Amongst these links, 32 were exact matches when compared with the logistic regression results, including comorbidities, medications, foods, and occupational exposures. DISCUSSION Mechanistic underpinnings of predicted links documented in the literature may support some of our findings. Our KG methods are useful for predicting possible associations in large, survey-based datasets with added information on directionality and magnitude of effect from logistic regression. These results should not be construed as causal but can support hypothesis generation. CONCLUSION This investigation enabled the generation of hypotheses on a variety of potential links between FRDs and exposures. Future investigations should prospectively evaluate the variables hypothesized to impact FRDs.
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Affiliation(s)
- Lauren E Chan
- Oregon State University, College of Public Health and Human Sciences, Corvallis, OR, USA.
| | - Elena Casiraghi
- AnacletoLab, Dipartimento di Informatica, Università degli Studi di Milano, Italy; Environmental Genomics and Systems Biology Division, Lawrence Berkeley National Laboratory, Berkeley, CA, USA; European Laboratory for Learning and Intelligent Systems, ELLIS
| | - Justin Reese
- Environmental Genomics and Systems Biology Division, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Quaker E Harmon
- National Institute of Environmental Health Sciences, Epidemiology Branch, Durham, NC, USA
| | - Kevin Schaper
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Harshad Hegde
- Environmental Genomics and Systems Biology Division, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Giorgio Valentini
- AnacletoLab, Dipartimento di Informatica, Università degli Studi di Milano, Italy; European Laboratory for Learning and Intelligent Systems, ELLIS
| | - Charles Schmitt
- National Institute of Environmental Health Sciences, Office of Data Science, Durham, NC, USA
| | - Alison Motsinger-Reif
- National Institute of Environmental Health Sciences, Biostatistics & Computational Biology Branch, Durham, NC, USA
| | - Janet E Hall
- National Institute of Environmental Health Sciences, Clinical Research Branch, Durham, NC, USA
| | - Christopher J Mungall
- Environmental Genomics and Systems Biology Division, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Peter N Robinson
- European Laboratory for Learning and Intelligent Systems, ELLIS; The Jackson Laboratory for Genomic Medicine, 10 Discovery Drive, Farmington, CT, USA
| | - Melissa A Haendel
- University of North Carolina, Dept. of Genetics, Chapel Hill, NC, USA
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204
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Hamilton KM, Liao C, Levin G, Barnajian M, Nasseri Y, Bresee C, Truong MD, Wright KN, Siedhoff MT, Meyer R. Characteristics associated with blood transfusion among women undergoing laparoscopic myomectomy: a National Surgical Quality Improvement Program study. Am J Obstet Gynecol 2024; 231:109.e1-109.e9. [PMID: 38365098 DOI: 10.1016/j.ajog.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 01/25/2024] [Accepted: 02/12/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Uterine fibroids are the most common benign tumors that affect females. A laparoscopic myomectomy is the standard surgical treatment for most women who wish to retain their uterus. The most common complication of a myomectomy is excessive bleeding. However, risk factors for hemorrhage during a laparoscopic myomectomy are not well studied and no risk stratification tool specific for identifying the need for a blood transfusion during a laparoscopic myomectomy currently exists in the literature. OBJECTIVE This study aimed to identify risk factors for intraoperative and postoperative blood transfusion during laparoscopic myomectomies and to develop a risk stratification tool to determine the risk for requiring a blood transfusion. STUDY DESIGN This was a retrospective cohort study of the American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2020. Women who underwent a laparoscopic (conventional or robotic) myomectomy were included. Women who received 1 or more blood transfusions within 72 hours after the start time of a laparoscopic myomectomy were compared with those who did not require a blood transfusion. A multivariable analysis was performed to identify risk factors independently associated with the risk for transfusion. Two risk stratification tools to determine the need for a blood transfusion were developed based on the multivariable results, namely (1) based on preoperative factors and (2) based on preoperative and intraoperative factors. RESULTS During the study period, 11,498 women underwent a laparoscopic myomectomy. Of these, 331(2.9%) required a transfusion. In a multivariable regression analysis of the preoperative factors, Black or African American and Asian races, Hispanic ethnicity, bleeding disorders, American Society of Anesthesiologists class III or IV classification, and a preoperative hematocrit value ≤35.0% were independently associated with the risk for transfusion. Identified intraoperative factors included specimen weight >250 g or ≥5 intramural myomas and an operation time of ≥197 minutes. A risk stratification tool was developed in which points are assigned based on the identified risk factors. The mean probability of transfusion can be calculated based on the sum of the points. CONCLUSION We identified preoperative and intraoperative independent risk factors for a blood transfusion among women who underwent a laparoscopic myomectomy. A risk stratification tool to determine the risk for requiring a blood transfusion was developed based on the identified risk factors. Further studies are needed to validate this tool.
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Affiliation(s)
- Kacey M Hamilton
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA.
| | - Connie Liao
- Department of Obstetrics and Gynecology, Abington Hospital - Jefferson Health, Abington, PA
| | - Gabriel Levin
- Lady Davis Institute for Cancer Research, Jewish General Hospital, McGill University, Quebec, Canada
| | - Moshe Barnajian
- Division of Colorectal Surgery, Department of General Surgery, Cedars Sinai Medical Center, Los Angeles, CA
| | - Yosef Nasseri
- Division of Colorectal Surgery, Department of General Surgery, Cedars Sinai Medical Center, Los Angeles, CA
| | - Catherine Bresee
- Biostatistics Shared Resources, Cedars Sinai Medical Center, Los Angeles, CA
| | - Mireille D Truong
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA
| | - Kelly N Wright
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA
| | - Matthew T Siedhoff
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA
| | - Raanan Meyer
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA
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205
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Aydın Doğan R, Yazıcı S. Use and Effectiveness of Innovative Virtual Reality Application in Teaching Fetal Development: A Randomized Controlled Trial. Comput Inform Nurs 2024; 42:515-521. [PMID: 38453431 DOI: 10.1097/cin.0000000000001036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Virtual reality-based training is effective. It is increasingly used by multiple disciplines to develop observation and critical skills, including engineering, education, arts, and health. This study was conducted to determine the effectiveness of the application created with Fetal Development Application Created by Virtual Reality Technology, which was developed to teach fetal development. The study was conducted in a single-blind, randomized fashion. Undergraduate midwifery students who took normal pregnancy lessons and learned fetal development were included. Eighty-four students were included in the experimental (n = 42) and control (n = 42) groups. Before the training, a personal information form and a pretest were applied to both groups. After the pretest, the experimental group received Fetal Development Application Created by Virtual Reality Technology, and the control group received 2 hours of theory training. Posttest was applied to both groups 6 weeks after the application. Preintervention scores were similar for the two groups. The posttest score of the experimental group was statistically significant compared with that of the control group ( P < .05). The mean cognitive load score of the experimental group was 1.09 ± 0.29, and the application did not create a cognitive load. The innovative application of Fetal Development Application Created by Virtual Reality Technology is an effective and applicable method in teaching fetal development in midwifery education.
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Affiliation(s)
- Reyhan Aydın Doğan
- Author Affiliations : Faculty of Health Sciences, Department of Midwifery, Karabuk University (Dr Aydın Doğan); and Faculty of Health Sciences, Department of Nursing, Istanbul Health and Technology University (Prof Dr Yazıcı), Istanbul, Turkey
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206
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Lee YL, Bai YS, Yu MH, Chang FW, Wang YC, Chiang KJ, Wu GJ, Yin CS. Effectiveness of high-intensity focused ultrasound combined with gonadotropin-releasing hormone agonist or combined with levonorgestrel-releasing intrauterine system for adenomyosis: A systematic review and meta-analysis. Taiwan J Obstet Gynecol 2024; 63:492-499. [PMID: 39004475 DOI: 10.1016/j.tjog.2024.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 07/16/2024] Open
Abstract
Gonadotropin-Releasing Hormone Agonist (GnRH-a) and levonorgestrel releasing intrauterine system (LNG-IUS) are conventional conservative treatments for adenomyosis, and high-intensity focused ultrasound (HIFU) is a novel ablation technique. This study aimed to investigate the effectiveness of HIFU combined with GnRH-a or LNG-IUS for adenomyosis patients. In this systematic review and meta-analysis, Pubmed, Embase, Cochrane Library and Scopus databases were searched up to December 2021. Published studies comparing HIFU plus GnRH-a with HIFU plus LNG-IUS in adenomyosis patients were assessed for eligibility by two independent authors. Risk of bias tool was utilized for risk evaluation. We selected treatment effective rate of dysmenorrhea (pain during menstruation) as the primary outcome; effective rate of menorrhagia severity and reduction rate of adenomyotic lesion as the secondary outcomes. Adverse effects were assessed. Four studies with a total 729 patients were enrolled in the meta-analysis. HIFU plus LNG-IUS showed lower dysmenorrhea [within 6 months: risk ratio (RR) 0.88, 95% confidence interval (CI) 0.83-0.93, p < 0.00001; over 1 year: RR 0.73, 95% CI 0.65-0.82, p < 0.00001] and less menorrhagia severity (RR 0.63, 95% CI 0.60-0.66, p < 0.00001) than HIFU plus GnRH-a. Both groups demonstrated equal efficacy in adenomyotic lesion reduction rate (RR 1.03, 95% CI 0.97-1.09, p = 0.30). Adverse effects happened equally in both groups. Combination therapy of HIFU and LNG-IUS revealed better effectiveness in treating dysmenorrhea and menorrhagia than that of HIFU and GnRH-a. However, interpreting the conclusion should be approached with caution as a result of significant heterogeneity.
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Affiliation(s)
- Yi-Liang Lee
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC; Department of Obstetrics and Gynecology, Kang Ning Hospital, Neihu, Taipei, Taiwan, ROC
| | - Yin-Shiuan Bai
- Graduate Institute of Life Sciences, National Defense Medical Center, Neihu, Taipei, Taiwan, ROC; Department of Nursing, Kang Ning University, Neihu, Taipei, Taiwan, ROC; Department of Obstetrics and Gynecology, Kang Ning Hospital, Neihu, Taipei, Taiwan, ROC
| | - Mu-Hsien Yu
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Fung-Wei Chang
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Yu-Chi Wang
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Kai-Jo Chiang
- Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan, ROC; Department of Nursing, Tri-Service General Hospital Songshan Branch, Taipei, Taiwan, ROC; School of Nursing, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Gwo-Jang Wu
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC; Department of Obstetrics and Gynecology, Kang Ning Hospital, Neihu, Taipei, Taiwan, ROC; Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Neihu, Taipei, Taiwan, ROC.
| | - Chang-Sheng Yin
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC; Department of Obstetrics and Gynecology, Kang Ning Hospital, Neihu, Taipei, Taiwan, ROC.
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207
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Amirkhanloo F, Haddadi M, Ebrahimi M. Paradoxical air embolism in patients undergoing hysteroscopic surgery for cesarean scar pregnancy: A case report and review of the literatures. Clin Case Rep 2024; 12:e9060. [PMID: 38947538 PMCID: PMC11211086 DOI: 10.1002/ccr3.9060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 05/10/2024] [Accepted: 05/28/2024] [Indexed: 07/02/2024] Open
Abstract
Cesarean scar pregnancy cases who undergo hysteroscopic suction aspiration could be at higher risk of air emboli due to dilated, low-resistant, high-velocity blood vessels.
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Affiliation(s)
- Fatemeh Amirkhanloo
- IVF Unit, Obstetrics and Gynecology WardYas Hospital Complex, Tehran University of Medical SciencesTehranIran
| | - Mohammad Haddadi
- Vali‐E‐Asr Reproductive Health Research Center, Family Health Research InstituteTehran University of Medical SciencesTehranIran
| | - Mahbod Ebrahimi
- IVF Unit, Obstetrics and Gynecology WardYas Hospital Complex, Tehran University of Medical SciencesTehranIran
- Vali‐E‐Asr Reproductive Health Research Center, Family Health Research InstituteTehran University of Medical SciencesTehranIran
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208
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Jiang Y, Li X, Wu J, Jiang C, Yang Y, Wei H. The efficacy of levonorgestrelintrauterine system, drospirenone & ethinylestradiol tablets (II) and dydrogesterone in preventing the recurrence of endometrial polyps. Arch Gynecol Obstet 2024:10.1007/s00404-024-07605-z. [PMID: 38951261 DOI: 10.1007/s00404-024-07605-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 06/18/2024] [Indexed: 07/03/2024]
Abstract
OBJECTIVE To analyze the efficacy of levonorgestrelintrauterine system, Drospirenone & ethinylestradiol tablets (II), and dydrogesterone in preventing the recurrence of endometrial polyps after hysteroscopic endometrial polypectomy. METHODS One hundred seventy patients who underwent hysteroscopic endometrial polypectomy in the Gynecology Department of Tianmen First People's Hospital in Hubei Province from January 2022 to June 2023 were randomly divided into the levonorgestrelintrauterine system group, Drospirenone & ethinylestradiol tablets (II) group, dydrogesterone group, and a control group. The recurrence rates, endometrial thickness, and menstrual volume changes at 6 and 12 months post-operation were compared among these four groups. RESULTS The recurrence rates in the levonorgestrelintrauterine system group, Drospirenone & ethinylestradiol tablets (II) group, and dydrogesterone group were lower than the control group, with statistical significance (P < 0.01), with the levonorgestrelintrauterine system group having the lowest recurrence rate. The endometrial thickness at 6 and 12 months post-operation in the levonorgestrelintrauterine system group, Drospirenone & ethinylestradiol tablets (II) group, and dydrogesterone group was thinner than that of the control group and thinner than pre-operation, with statistical significance (P < 0.01). The menstrual volume at 3 months post-operation in the levonorgestrelintrauterine system group, Drospirenone & ethinylestradiol tablets (II) group, and dydrogesterone group was significantly less than the control group, and less than the pre-operation volume. CONCLUSION Dydrogesterone, drospirenone & ethinylestradiol tablets (II), and levonorgestrelintrauterine system all play a role in preventing the recurrence of endometrial polyps, but levonorgestrelintrauterine system is significantly better than dydrogesterone and Drospirenone & ethinylestradiol tablets (II) in terms of postoperative recurrence rate, endometrial thickness, menstrual changes, and compliance, and is worth promoting in clinical application.
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Affiliation(s)
- Yao Jiang
- Department of Obstetrics and Gynecology, The First People's Hospital of Tianmen, Tianmen, China
| | - Xiumei Li
- Department of Obstetrics and Gynecology, The First People's Hospital of Tianmen, Tianmen, China
| | - Jun Wu
- Department of Obstetrics and Gynecology, The First People's Hospital of Tianmen, Tianmen, China
| | - Chen Jiang
- Tendering Office, The First People's Hospital of Tianmen, Tianmen, China.
| | - Yanhua Yang
- Department of Obstetrics and Gynecology, The First People's Hospital of Tianmen, Tianmen, China
| | - Hui Wei
- Department of Cardiology, The First People's Hospital of Tianmen, Tianmen, China
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209
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Liu J, Fang S, Cheng L, Wang L, Wang Y, Gao L, Liu Y. A web-based dynamic predictive model for postoperative nausea and vomiting in patient receiving gynecological laparoscopic surgery. J Obstet Gynaecol Res 2024; 50:1216-1228. [PMID: 38644529 DOI: 10.1111/jog.15956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 04/10/2024] [Indexed: 04/23/2024]
Abstract
OBJECTIVE The aim of this study was to develop a web-based dynamic prediction model for postoperative nausea and vomiting (PONV) in patients undergoing gynecologic laparoscopic surgery. METHODS The patients (N = 647) undergoing gynecologic laparoscopic surgery were included in this observational study. The candidate risk-factors related to PONV were included through literature search. Lasso regression was utilized to screen candidate risk-factors, and the variables with statistical significance were selected in multivariable logistic model building. The web-based dynamic Nomogram was used for model exhibition. Accuracy and validity of the experimental model (EM) were evaluated by generating receiver operating characteristic (ROC) curves and calibration curves. Hosmer-Lemeshow test was used to evaluate the goodness of fit of the model. Decision curve analysis (DCA) was used to evaluate the clinical practicability of the risk prediction model. RESULTS Ultimately, a total of five predictors including patient-controlled analgesia (odds ratio [OR], 4.78; 95% confidence interval [CI], 1.98-12.44), motion sickness (OR, 4.80; 95% CI, 2.71-8.65), variation of blood pressure (OR, 4.30; 95% CI, 2.41-7.91), pregnancy vomiting history (OR, 2.21; 95% CI, 1.44-3.43), and pain response (OR, 1.64; 95% CI, 1.48-1.83) were selected in model building. Assessment of the model indicates the discriminating power of EM was adequate (ROC-areas under the curve, 93.0%; 95% CI, 90.7%-95.3%). EM showed better accuracy and goodness of fit based on the results of the calibration curve. The DCA curve of EM showed favorable clinical benefits. CONCLUSIONS This dynamic prediction model can determine the PONV risk in patients undergoing gynecologic laparoscopic surgery.
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Affiliation(s)
- Jiang Liu
- School of Nursing, Shandong Second Medical University, Weifang, China
| | | | - Lin Cheng
- School of Nursing, Shandong Second Medical University, Weifang, China
| | - Liwei Wang
- School of Nursing, Shandong Second Medical University, Weifang, China
| | - Yuwen Wang
- School of Nursing, Shandong Second Medical University, Weifang, China
| | - Lunan Gao
- School of Nursing, Shandong Second Medical University, Weifang, China
| | - Yuxiu Liu
- School of Nursing, Shandong Second Medical University, Weifang, China
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210
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Kurosawa H, Watanabe T, Sato N, Muraoka Y, Matsuzawa Y, Watanabe Y. A rare case of extraluminal interstitial pregnancy treated with laparoscopic cornuotomy. J Obstet Gynaecol Res 2024; 50:1273-1276. [PMID: 38711243 DOI: 10.1111/jog.15962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 04/22/2024] [Indexed: 05/08/2024]
Abstract
We report an extremely rare case of an extraluminal interstitial pregnancy. A 36-year-old nulliparous woman visited our hospital during the fifth week of gestation. Although no intrauterine gestational sac (GS) was identified, transabdominal ultrasonography revealed a GS-like cyst was detected in the right uterine horn. She underwent laparoscopic surgery for a suspected interstitial ectopic pregnancy. After laparoscopic cornuotomy, dye leakage was observed from the fimbria rather than the incision site. Finally, the patient was diagnosed with a right extraluminal interstitial pregnancy. Hysterosalpingography performed at three postoperative months revealed bilateral tubal passage. She conceived 7 months after surgery, with safe delivery by elective cesarean section at 38 weeks.
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Affiliation(s)
- Hiroki Kurosawa
- Division of Obstetrics and Gynecology, Tohoku Medical and Pharmaceutical University Wakabayashi Hospital, Sendai, Miyagi, Japan
| | - Tadashi Watanabe
- Division of Obstetrics and Gynecology, Tohoku Medical and Pharmaceutical University Wakabayashi Hospital, Sendai, Miyagi, Japan
| | - Naoto Sato
- Division of Obstetrics and Gynecology, Tohoku Medical and Pharmaceutical University Wakabayashi Hospital, Sendai, Miyagi, Japan
- Department of Obstetrics and Gynecology, Sendai Medical Center, Sendai, Miyagi, Japan
| | - Yuma Muraoka
- Division of Obstetrics and Gynecology, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Miyagi, Japan
| | - Yukiko Matsuzawa
- Division of Obstetrics and Gynecology, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Miyagi, Japan
| | - Yoh Watanabe
- Division of Obstetrics and Gynecology, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Miyagi, Japan
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211
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Bozkurt A, Karakoy Z, Aydin P, Ozdemir B, Toktay E, Halici Z, Cadirci E. Targeting Aquaporin-5 by Phosphodiesterase 4 Inhibition Offers New Therapeutic Opportunities for Ovarian Ischemia Reperfusion Injury in Rats. Reprod Sci 2024; 31:2021-2031. [PMID: 38453769 PMCID: PMC11217128 DOI: 10.1007/s43032-024-01496-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/09/2024] [Indexed: 03/09/2024]
Abstract
This study aimed to examine the effect of Phosphodiesterase 4 (PDE4) inhibition on Aquaporin-5 (AQP5) and its potential cell signaling pathway in the ovarian ischemia reperfusion (OIR) model. Thirty adult female rats were divided into five groups: Group 1; Control: Sham operation, Group 2; OIR that 3 hour ischemia followed by 3 hour reperfusion, Group 3; OIR + Rolipram 1 mg/kg, Group 4; OIR + Rolipram 3 mg/kg, Group 5; OIR + Rolipram 5 mg/kg. Rolipram was administered intraperitoneally to the rats in groups 3-4 and 5 at determined doses 30 minutes before reperfusion. From ovary tissue; Tumor necrosis factor-a (TNF-α), Cyclic adenosine monophosphate (cAMP), Nuclear factor kappa (NF-κB), Interleukin-6 (IL-6), Phosphodiesterase 4D (PDE4D), Mitogen-activated protein kinase (MAPK) and AQP5 levels were measured by ELISA. We also measured the level of AQP5 in ovary tissue by real-time reverse-transcription polymerase chain reaction (RT-PCR). In the OIR groups; TNF-α, NF-κB, IL-6, MAPK inflammatory levels increased, and cAMP and AQP5 levels decreased, which improved with the administration of rolipram doses. Also histopathological results showed damaged ovarian tissue after OIR, while rolipram administration decrased tissue damage in a dose dependent manner. We propose that the protective effect of PDE4 inhibition in OIR may be regulated by AQP5 and its potential cell signaling pathway and may be a new target in OIR therapy. However, clinical studies are needed to appraise these data in humans.
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Affiliation(s)
- Ayse Bozkurt
- Faculty of Pharmacy, Department of Pharmacology, Van Yuzuncu Yil University, Van, Turkey
| | - Zeynep Karakoy
- Faculty of Pharmacy, Department of Pharmacology, Erzincan Binali Yildirim University, Erzincan, Turkey
| | - Pelin Aydin
- Faculty of Medicine, Department of Pharmacology, Ataturk University, Erzurum, 25240, Turkey
- Department of Anesthesiology and Reanimation, Educational and Research Hospital, Erzurum, Turkey
| | - Bengul Ozdemir
- Faculty of Medicine, Department of Histology and Embryology, Kafkas University, Kars, Turkey
| | - Erdem Toktay
- Faculty of Medicine, Department of Histology and Embryology, Kafkas University, Kars, Turkey
| | - Zekai Halici
- Faculty of Medicine, Department of Pharmacology, Ataturk University, Erzurum, 25240, Turkey
- Clinical Research, Development and Design Application and Research Center, Ataturk University, 25240, Erzurum, Turkey
| | - Elif Cadirci
- Faculty of Medicine, Department of Pharmacology, Ataturk University, Erzurum, 25240, Turkey.
- Clinical Research, Development and Design Application and Research Center, Ataturk University, 25240, Erzurum, Turkey.
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Wolfman W, Bougie O, Chen I, Tang Y, Goldstein S, Bouteaud J. Guideline No. 451: Asymptomatic Endometrial Thickening in Postmenopausal Women. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102591. [PMID: 38901794 DOI: 10.1016/j.jogc.2024.102591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
OBJECTIVE To formulate strategies for clinical assessments for endometrial thickening on ultrasound in a postmenopausal woman without bleeding. TARGET POPULATION Postmenopausal women of any age. OUTCOMES To reduce unnecessary invasive interventions and investigations in women with asymptomatic endometrial thickening while selectively investigating women at risk for endometrial cancer. BENEFITS, HARMS, AND COSTS It is anticipated that the adoption of these recommendations would save postmenopausal women unnecessary anxiety, pain, and risk of procedural complications. It is also expected to decrease the cost to the health care system by eliminating unnecessary interventions. EVIDENCE English language articles from Medline, Cochrane, and PubMed databases for relevant peer-reviewed articles dating from 1995 to 2022 (e.g., asymptomatic endometrial thickness, endometrial cancer, postmenopausal bleeding, transvaginal ultrasound, endometrial biopsy, cervical stenosis, hormone therapies and the endometrium, tamoxifen, tibolone, aromatase inhibitors). Results were restricted to systematic reviews and meta-analyses, randomized controlled trials/controlled clinical trials, and observational studies. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations). INTENDED AUDIENCE Physicians, including gynaecologists, obstetricians, family physicians, radiologists, pathologists, and internists; nurse practitioners and nurses; medical trainees, including medical students, residents, and fellows; and other providers of health care of the postmenopausal population. SOCIAL MEDIA ABSTRACT Postmenopausal women often have a thickening of the lining of the uterus found during ultrasound. Without bleeding, an endometrium <11 mm is rarely a serious problem but should be evaluated by a health care provider. SUMMARY STATEMENTS RECOMMENDATIONS.
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Wolfman W, Bougie O, Chen I, Tang Y, Goldstein S, Bouteaud J. Directive clinique n o 451 : Épaississement asymptomatique de l'endomètre chez les femmes ménopausées. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102590. [PMID: 38901795 DOI: 10.1016/j.jogc.2024.102590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
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Cao D, Chen L. Effect of previous caesarean section on reproductive and pregnancy outcomes after assisted reproductive technology: A systematic review and meta‑analysis. Exp Ther Med 2024; 28:284. [PMID: 38800052 PMCID: PMC11117117 DOI: 10.3892/etm.2024.12572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 04/17/2024] [Indexed: 05/29/2024] Open
Abstract
Pregnancies following previous caesarean section (CS) are associated with higher incidence of infections, postpartum haemorrhage and obstetric complications. The present study aimed to explore the effect of previous CS on reproductive, maternal and neonatal outcomes in women who underwent assisted reproductive techniques (ART). A systematic review and meta-analysis were conducted to assess reproductive and pregnancy outcomes following ART in women with and without a previous CS. Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines were followed. Eligible language articles written in English, published up to October 2023, were identified in Medline, Google Scholar and Science Direct databases. The quality of the included studies was assessed using the Newcastle Ottawa Scale. A total of 19 articles, reporting on 13 different outcomes met the inclusion criteria. It was revealed that women with previous CS had 9% lower clinical pregnancy rates, 13% lower live birth rates, 11% lower implantation rates and 28% lower multiple pregnancy rates compared with women who had prior natural vaginal deliveries. Additionally, previous CS was associated with an 8-fold higher risk of difficult embryo transfers. No significant differences were noted in ectopic pregnancy rates, miscarriage rates or biochemical pregnancy rates. The present systematic review and meta-analysis demonstrated that previous CS is associated with decreased prospects of clinical pregnancy, live birth and successful embryo implantation during ART. The findings of the present study underscored the need to counsel women with prior CS regarding its potential impact on ART outcomes.
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Affiliation(s)
- Dan Cao
- Department of Gynaecology, Huzhou Maternity and Child Care Hospital, Huzhou, Zhejiang 313000, P.R. China
| | - Lifen Chen
- Reproductive Center, Huzhou Maternity and Child Care Hospital, Huzhou, Zhejiang 313000, P.R. China
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Ekin M, Dura MC, Yildiz S, Gürsoy B, Yildiz YY, Dogan K, Kaya C. Comparison of transvaginal natural orifice transluminal endoscopic surgery versus conventional surgery for uterosacral ligament suspension in patients who had concomitant vaginal hysterectomy for subtotal uterine prolapse. Asian J Endosc Surg 2024; 17:e13333. [PMID: 38839273 DOI: 10.1111/ases.13333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 04/28/2024] [Accepted: 05/21/2024] [Indexed: 06/07/2024]
Abstract
INTRODUCTION The study aimed to compare the short-term outcomes of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for uterosacral ligament suspension (USLS) versus nonendoscopic USLS in patients with subtotal uterine prolapse who had a concomitant vaginal hysterectomy. METHODS There were 51 patients who underwent vNOTES USLS, whereas the nonendoscopic conventional USLS group had 49 patients. The information about patient demographics, and perioperative data including the operative duration, blood loss, intraoperative and postoperative complications, and length of postoperative hospital stay were determined from the patients' files. Postoperative follow-up visits were scheduled at the first week and 1 month after surgery. RESULTS The demographic variables including age, body mass index, menopausal status, and parity were comparable, and no significant differences were found. A total of 90.2% of the patients in the vNOTES group and 69.4% of the patients in the shull group were at menopause (p = .09). Operation time was significantly shorter in the shull group (p < .001), and the hospitalization period (p = .029) was significantly shorter in the vNOTES group. Ba, Bp, and D points and total vaginal length (TVL) were significantly behind the hymenal ring in patients who had vNOTES USLS procedure (p < .001). None of the patients who had intraoperative significant blood loss required transfusion. One patient in the vNOTES and two patients in the shull group had a postoperative cuff hematoma. CONCLUSION vNOTES USLS has a good safety profile, higher percentage of adnexal surgeries with better improvement on POP-Q points Ba, Bp, D, and TVL compared with classic USLS in patients with subtotal uterine prolapse. Studies evaluating short- and long-term results of vNOTES versus conventional USLS are needed.
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Affiliation(s)
- Murat Ekin
- Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Cengiz Dura
- Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Sukru Yildiz
- Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Berk Gürsoy
- Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Yagmur Yucebas Yildiz
- Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Keziban Dogan
- Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Cihan Kaya
- Department of Obstetrics and Gynecology, Istanbul Aydın University, Istanbul, Turkey
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van Maldegem LDPR, van der Zande JA, van Werkhoven LA, Ewing‐Graham PC, Heemskerk‐Gerritsen BAM, van Doorn HC. Recurrent postmenopausal bleeding: Pathological findings and predictive factors. A multicenter, prospective, observational study. Acta Obstet Gynecol Scand 2024; 103:1283-1291. [PMID: 38695570 PMCID: PMC11168275 DOI: 10.1111/aogs.14851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 06/13/2024]
Abstract
INTRODUCTION Recurrent postmenopausal bleeding (PMB) occurs in 6%-25% of postmenopausal women who have experienced a previous episode of PMB. The question of whether recurrent PMB leads to a higher risk of endometrial cancer (EC) in comparison to a single episode of PMB is, however, controversial. Furthermore, little is known about predictive factors for recurrent PMB. MATERIAL AND METHODS A multicenter prospective cohort study was conducted over a 5-year period in four hospitals in the Netherlands. Women with PMB undergoing endometrial sampling and aged 40 years and older were included. Occurrence of recurrent PMB was retrospectively determined. Primary outcomes included (1) the incidence of recurrent PMB and (2) differences in pathological findings between patients with a single episode vs recurrent PMB. Secondary outcomes included (1) the association between diagnosis of benign polyps at first PMB and pathological findings at recurrent PMB and (2) factors predictive for recurrent PMB. RESULTS A total of 437 women with PMB were included, of whom 360 were at risk of recurrent PMB. With a median follow-up of 61 months (IQR (Interquartile range) 44-73), 26.4% experienced recurrent PMB. Patients with recurrent PMB were more often diagnosed with benign polyps (34.7% vs. 25.1%, p-value 0.015) and less frequently with a malignancy (5.3% vs. 17.8%, p-value 0.015), compared to patients with a single episode of PMB. Benign polyps at initial PMB were not associated with a (pre)malignancy at recurrence (OR 4.16, 95% CI 0.75-23.03). Predictive factors for recurrent PMB included use of hormone replacement therapy (HRT) (OR 3.32, 95% CI 1.64-6.72), and benign polyps at initial PMB (OR 1.80, 95% CI 1.07-3.04). CONCLUSIONS Recurrent PMB is common in women with a previous episode of PMB. Compared to patients with a single episode of PMB, patients with recurrent PMB and benign histological outcomes at accurate workup during their first episode were less often diagnosed with malignancies and more frequently with benign polyps. Benign polyps at first PMB are predictive for recurrent PMB, but not for a higher risk of (pre)malignancy.
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Affiliation(s)
- Laura D. P. R. van Maldegem
- Department of Gynecologic OncologyErasmus MC Cancer Institute, University Medical Center RotterdamRotterdamthe Netherlands
| | - Johanna A. van der Zande
- Department of Gynecologic OncologyErasmus MC Cancer Institute, University Medical Center RotterdamRotterdamthe Netherlands
| | - Lucy A. van Werkhoven
- Department of Gynecologic OncologyErasmus MC Cancer Institute, University Medical Center RotterdamRotterdamthe Netherlands
| | - Patricia C. Ewing‐Graham
- Department of PathologyErasmus MC Cancer Institute, University Medical Center RotterdamRotterdamthe Netherlands
| | | | - Helena C. van Doorn
- Department of Gynecologic OncologyErasmus MC Cancer Institute, University Medical Center RotterdamRotterdamthe Netherlands
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217
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Shi J, Gu Z, Wu Y, Li X, Zhang J, Zhang C, Yan H, Dai Y, Leng J. Long-term efficacy and safety of levonorgestrel releasing intrauterine system in the treatment of adenomyosis: evidence mapping. Arch Gynecol Obstet 2024; 310:55-67. [PMID: 38836931 DOI: 10.1007/s00404-024-07546-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 05/02/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE To summarize evidence on levonorgestrel releasing intrauterine system (LNG-IUS) in the treatment of adenomyosis (AM) and to identify potential research gaps. METHODS Search was conducted in MEDLINE, The Cochrane Library, EMBASE, CBM, CNKI, and Wanfang. We included studies investigating patients with AM treated with LNG-IUS combined with conservative therapy. RESULTS Thirty-nine studies compared LNG-IUS with other conservative therapeutic drugs. The most common comparison was GnRH-a + LNG-IUS vs. LNG-IUS alone, followed by LNG-IUS vs. mifepristone, expected treatment, and GnRH-a. GnRH-a + LNG-IUS was more beneficial in reducing the intensity of dysmenorrhea than LNG-IUS alone at the 6-month follow-up in patients with an enlarged uterus and moderate to severe dysmenorrhea. Large and well-designed studies are needed to confirm the efficacy of LNG-IUS and GnRH-a on reducing uterine volume at 6-month follow-up. Thirty-two studies investigated LNG-IUS as the postoperative management. The most common comparison was surgical excision + LNG-IUS vs. surgical excision. Results showed VAS scores were lower in the surgical excision + LNG-IUS group than in the surgical excision group at the 1-year follow-up. Evidence on endometrial thickness, quality of life, adverse events and beneficial effect at 3 and 5 years are needed. CONCLUSIONS Combined GnRH-a and LNG-IUS treatment was more efficacious than LNG-IUS alone for patients with an enlarged uterus and moderate to severe dysmenorrhea. Moreover, LNG-IUS seemed to show potential long-term benefits in postoperative therapy, warranting further meta-analysis for confirmation.
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Affiliation(s)
- Jinghua Shi
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing 100730, China
- National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Zhiyue Gu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing 100730, China
- National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Yushi Wu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing 100730, China
- National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Xiaoyan Li
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing 100730, China
- National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Jing Zhang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing 100730, China
- National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Chenyu Zhang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing 100730, China
- National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Hailan Yan
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing 100730, China
- National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Yi Dai
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing 100730, China
- National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Jinhua Leng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing 100730, China.
- National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China.
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Qu H, Liu N, Liang H, Wang Y, Zhuang H, Li H. Aggressive angiomyxoma of female pelvis and perineum: Retrospective study of 17 cases. Eur J Obstet Gynecol Reprod Biol 2024; 298:165-170. [PMID: 38762952 DOI: 10.1016/j.ejogrb.2024.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 04/22/2024] [Accepted: 05/11/2024] [Indexed: 05/21/2024]
Abstract
OBJECTIVE Aggressive angiomyxoma is an uncommon mesenchymal neoplasm characterized by a high recurrence rate, usually observed in the lower genital tract of women during their reproductive age. STUDY DESIGN Seventeen cases of aggressive angiomyxoma confirmed by pathology from January 2007 to December 2021 in Beijing Chao-yang Hospital were included. We collected clinical data and summarized the clinical and immunohistochemical features. RESULTS All seventeen included patients were females, aged between 23 and 57 years (mean, 37.7 years; median, 42 years). Fourteen patients were newly diagnosed and three were recurrent. The tumors were located in vulva (58.8 %), vagina (23.5 %), buttock (11.8 %), and cervix (5.9 %). The tumors size were 2 to 15 cm in greatest dimension (mean 8 ± 4.4 cm, median 6 cm). Follow-up data was available for nine patients, which ranged from 25 to 124 months (mean, 82 months; median, 80 months). At the end of follow-up, no other recurrence or metastasis was reported. Immunohistochemical analysis showed immunoreactive for estrogen (10/11) and progesterone (8/11) receptor, desmin (6/8), smooth muscle actin (4/10), and vimentin (4/4), S-100 (1/8) and CD34 (1/7). The Ki67 level was less than 5 % in five cases. CONCLUSIONS AAM is a hormone-sensitive, distinct rare mesenchymal neoplasm with high incidence of local recurrence. Surgery is the preferred treatment, with complete resection being an essential prerequisite for minimizing the risk of recurrence.
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Affiliation(s)
- Hong Qu
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Na Liu
- Department of Obstetrics and Gynecology, Beijing Sixth Hospital, Beijing, China
| | - Huamao Liang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Ying Wang
- Department of Pathology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Huiyu Zhuang
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Hua Li
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
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Rosati A, Vargiu V, Capozzi VA, Giannarelli D, Palmieri E, Baroni A, Perrone E, Berretta R, Cosentino F, Scambia G, Fanfani F. Concurrent endometrial cancer in atypical endometrial hyperplasia and the role of sentinel lymph nodes: clinical insights from a multicenter experience. Int J Gynecol Cancer 2024; 34:1011-1019. [PMID: 38431287 DOI: 10.1136/ijgc-2023-005202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
OBJECTIVE This study aimed to evaluate the prevalence of concurrent endometrial cancer in patients pre-operatively diagnosed with atypical endometrial hyperplasia undergoing hysterectomy. Additionally, we assessed the occurrence of high to intermediate-risk and high-risk tumors according to the ESGO-ESTRO-ESP classification. The study also compared surgical outcomes and complications between patients undergoing simple hysterectomy and those undergoing hysterectomy with sentinel lymph node biopsy. METHODS In this multicenter retrospective study, patients with a pre-operative diagnosis of atypical endometrial hyperplasia were identified and divided into two groups: Group 1, which included patients treated with total hysterectomy with or without bilateral salpingo-oophorectomy, and Group 2, where sentinel lymph node biopsy was incorporated into the standard surgical treatment. RESULTS Among 460 patients with atypical endometrial hyperplasia, 192 received standard surgical management (Group 1) and 268 underwent sentinel lymph node biopsy (Group 2). A total of 47.2% (95% CI 42.6% to 51.7%) of patients were upgraded to endometrial cancer on final histopathological examination. High to intermediate-risk and high-risk tumors constituted 12.3% and 9.2% in Group 2 and 7.4% and 3.7% in Group 1. Lymph node metastases were identified in 7.6% of patients with concurrent endometrial cancer who underwent nodal assessment with at least unilateral mapping. Of the 12 sentinel lymph node metastases, 75.0% were micrometastases, 16.7% macrometastases, and 8.3% isolated tumor cells. No significant differences were found in estimated blood loss, operative time, and intra-operative and post-operative complications between the two groups. The rate of patients undergoing sentinel lymph node biopsy doubled every 2 years (OR 2.010, p<0.001), reaching 79.1% in the last 2 years. CONCLUSION This study found a prevalence of concurrent endometrial cancer of 47.2%, and sentinel lymph node biopsy provided prognostic and therapeutic information in 60.8% of cases. It also allowed for the adjustment of adjuvant therapy in 12.3% of high to intermediate-risk patients without increasing operative time or complication rates.
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Affiliation(s)
- Andrea Rosati
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Virginia Vargiu
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | | | - Diana Giannarelli
- Facility of Epidemiology and Biostatistics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | | | - Emanuele Perrone
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Roberto Berretta
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Francesco Cosentino
- Department of Medicine and Health Sciences "Vincenzo Tiberio", Università degli Studi del Molise, Campobasso, Molise, Italy
| | - Giovanni Scambia
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Fanfani
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
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220
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Bahadur A, Mallick BK, Heda A, Pathak A, Heda S, Mundhra R. Comparison of the Outcomes of Enhanced Recovery After Surgery and Traditional Recovery Pathway in Robotic Hysterectomy for Benign Indications: A Randomized Controlled Trial. J Minim Invasive Gynecol 2024; 31:601-606. [PMID: 38697258 DOI: 10.1016/j.jmig.2024.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/22/2024] [Accepted: 04/25/2024] [Indexed: 05/04/2024]
Abstract
STUDY OBJECTIVE The present study aimed to evaluate the impact of the implementation of the enhanced recovery after surgery (ERAS) program in patients undergoing robotic hysterectomy for benign indications in comparison with conventional management. DESIGN Randomized controlled trial. SETTING North Indian tertiary care hospital. PARTICIPANTS Patients aged 40 to 60 years willing to sign the informed written consent were included, whereas cases with contraindications for neuraxial anesthesia were excluded. A total of 130 subjects undergoing robotic hysterectomy were divided into ERAS (n = 65) and conventional (non-ERAS) (n = 65) groups. INTERVENTIONS Components of the ERAS protocol included preoperative counseling, carbohydrate loading, early removal of catheter, and early ambulation. Both groups underwent optimization of medical conditions, standardized anesthesia, and venous thromboembolism prophylaxis. MEASUREMENTS AND MAIN RESULTS Outcome measures included length of hospital stay (LOHS), time to tolerance of diet, postoperative complications, readmission rates, and quality of life assessed by WHO-QOL BREF. Baseline characteristics were comparable between groups. ERAS group showed significantly lower docking time (4.82 ± 0.73 vs 5.31 ± 0.92 minutes), faster tolerance of diet (0.14 ± 0.35 vs 1.14 ± 0.35 days), and earlier resumption of ambulation (0.42 ± 0.5 vs 1.26 ± 0.44 days). Time for "fit for discharge" (1.43 ± 0.61 vs 2.97 ± 1.1 days) and LOHS (2.85 ± 1.09 vs 3.78 ± 1.29 days) were significantly lower in the ERAS group. Postoperative complications and readmission rates were comparable. Quality-of-life scores favored the ERAS group at postoperative days 1 and 30. CONCLUSION The combination of ERAS and robotic surgery improves patient outcomes, shortens hospital stays, and enhances postoperative recovery without increasing complications. This research serves as a pioneering effort in assessing the impact of ERAS on robotic hysterectomy for benign indications, providing valuable insights for future multicentric studies and supporting the integration of ERAS protocols to enhance patient outcomes and quality of life.
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Affiliation(s)
- Anupama Bahadur
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India (all authors)
| | - Bhawana Kumari Mallick
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India (all authors)
| | - Ayush Heda
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India (all authors)
| | - Anjali Pathak
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India (all authors)
| | - Sakshi Heda
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India (all authors)
| | - Rajlaxmi Mundhra
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India (all authors)..
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Fang Y. Comment On: Patients' Use of Virtual Reality Technology for Pain Reduction During Outpatient Hysteroscopy: A Meta-Analysis of Randomized Controlled Trials. J Minim Invasive Gynecol 2024; 31:626. [PMID: 38641050 DOI: 10.1016/j.jmig.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 04/21/2024]
Affiliation(s)
- Yuan Fang
- Department of Obstetrics and Gynecology, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei, China.
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Paik H, Jee BC. Impact of Ablation Versus Cystectomy for Endometrioma on Ovarian Reserve, Recurrence, and Pregnancy: An Updated Meta-Analysis. Reprod Sci 2024; 31:1924-1935. [PMID: 38509401 DOI: 10.1007/s43032-024-01512-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 02/29/2024] [Indexed: 03/22/2024]
Abstract
This study aimed to compare the impact of ablation and cystectomy for ovarian endometrioma on ovarian reserve, recurrence rates, and pregnancy rates. Databases were searched for studies reporting ovarian reserve (measurement of anti-müllerian hormone [AMH] only), recurrence rates, and/or pregnancy rates after cystectomy and ablation for ovarian endometrioma. Six randomized clinical trials and five prospective cohort studies were included in this meta-analysis. All included studies had a low risk of bias. After ablation, weighted mean difference (WMD) between post- and pre-operative AMH values was - 0.40 (95% confidence interval [CI]: -0.61 to -0.19, p = 0.0002, I2 = 0%). After cystectomy, the WMD of AMH was - 1.08 (95% CI: -1.34 to -0.82, p < 0.00001, I2 = 48%). The intergroup comparison revealed that pre-operative AMH values were similar between the two groups, but post-operative AMH was significantly higher in the ablation group (WMD: 0.38, 95% CI: 0.13 to 0.63, p = 0.003, I2 = 3%). Subgroup analysis showed that the favorable effects of ablation compared to cystectomy are evident after three months of operation, in a bilateral setting, or with the laser ablation method. Overall recurrence rate (risk ratio [RR]: 1.51, 95% CI: 1.08 to 2.12, p = 0.02, I2 = 0%) and one-year recurrence rate (RR: 2.36, 95% CI: 1.30 to 4.31, p = 0.005, I2 = 0%) were significantly higher in the ablation group than in the cystectomy group. Pregnancy rates were similar between the two groups (odds ratio: 1.18, 95% CI: 0.92 to 1.52, p = 0.20, I2 = 72%). These results demonstrate that ablation could result in a smaller serum AMH decrement than cystectomy, but the recurrence rate could be higher after ablation.
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Affiliation(s)
- Haerin Paik
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, 82 Gumi- ro 173beon-gil, Bundang-gu, 13620, Seongnam, Republic of Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Byung Chul Jee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, 82 Gumi- ro 173beon-gil, Bundang-gu, 13620, Seongnam, Republic of Korea.
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Capezzuoli T, Toscano F, Ceccaroni M, Roviglione G, Stepniewska A, Fambrini M, Vannuccini S, Petraglia F. Conservative surgical treatment for adenomyosis: New options for looking beyond uterus removal. Best Pract Res Clin Obstet Gynaecol 2024; 95:102507. [PMID: 38906739 DOI: 10.1016/j.bpobgyn.2024.102507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/07/2024] [Accepted: 05/19/2024] [Indexed: 06/23/2024]
Abstract
Adenomyosis is a common benign uterine disorders and patients may present dysmenorrhea, dyspareunia, abnormal uterine bleeding (AUB) and infertility. The treatment is very complex, including medical, surgical or radiological approaches. Hormonal drugs represent the first line therapy of adenomyosis, highly effective on symptoms and uterine volume reduction. Radiological procedures (UAE and HIFU), RFA and hysteroscopy may be proposed in those cases in which medical therapy is ineffective. Considering surgical treatment, hysterectomy remains the only existing definitive treatment but in the last decades the desire of uterus preservation is becoming more and more diffuse. On the other hand, surgical conservative treatments of adenomyosis are very effective in ameliorating AUB and pelvic pain and in reducing uterine volume, with some post-operative risks and obstetrics complications. Cytoreductive surgery for adenomyosis may be very complex, therefore it should be performed by experienced surgeons in dedicated centers, above all in case of concomitant endometriosis.
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Affiliation(s)
- Tommaso Capezzuoli
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Via Don A. Sempreboni, 5, 37024, Negrar, Verona, Italy
| | - Federico Toscano
- Department of Clinical Experimental and biomedical Sciences, University of Florence, Florence, Italy
| | - Marcello Ceccaroni
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Via Don A. Sempreboni, 5, 37024, Negrar, Verona, Italy
| | - Giovanni Roviglione
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Via Don A. Sempreboni, 5, 37024, Negrar, Verona, Italy
| | - Anna Stepniewska
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Via Don A. Sempreboni, 5, 37024, Negrar, Verona, Italy
| | - Massimiliano Fambrini
- Department of Clinical Experimental and biomedical Sciences, University of Florence, Florence, Italy
| | - Silvia Vannuccini
- Department of Clinical Experimental and biomedical Sciences, University of Florence, Florence, Italy
| | - Felice Petraglia
- Department of Clinical Experimental and biomedical Sciences, University of Florence, Florence, Italy.
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Solomon A, Mastroliasa S, Andre N, Schwarzman P. Ectopic pregnancy in uterosacral ligament following in vitro fertilisation (IVF) in a patient with Allen-Masters syndrome. BMJ Case Rep 2024; 17:e260553. [PMID: 38955380 DOI: 10.1136/bcr-2024-260553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024] Open
Abstract
We describe the case of a woman with mild endometriosis and Allen-Masters syndrome after in vitro fertilisation (IVF), presenting at 7 weeks 2 days gestation with abdominal pain. A transvaginal ultrasound revealed a gestational sac with a non-viable fetus near the right ovary. Laparoscopy was performed due to escalating abdominal pain which revealed a ruptured ectopic pregnancy at the right uterosacral ligament (USL) and blood in the pouch of Douglas. A peritoneal incision along the USL facilitated drainage and removal of the ectopic pregnancy. A pathological investigation described the presence of endometrial tissue directly adjacent to products of conception, which suggested a retroperitoneal implantation that may have been facilitated by the presence of an endometriotic lesion. This case underscores the distinctive clinical trajectory of unconventional ectopic pregnancies, provides novel insights into the pathophysiological mechanism of ectopic implantation and underscores the crucial role of comprehensive patient assessment during IVF and subsequent pregnancy in ensuring effective management.
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Affiliation(s)
- Adam Solomon
- Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Salvatore Mastroliasa
- Department of Obstetrics and Gynecology, Ospedale Madonna delle Grazie, Matera, Italy
| | - Nicolas Andre
- Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Polina Schwarzman
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, School of Medicine, Ber Sheva, Israel
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225
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Rahimi AM, Uluç E, Hardon SF, Bonjer HJ, van der Peet DL, Daams F. Training in robotic-assisted surgery: a systematic review of training modalities and objective and subjective assessment methods. Surg Endosc 2024; 38:3547-3555. [PMID: 38814347 PMCID: PMC11219449 DOI: 10.1007/s00464-024-10915-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 05/05/2024] [Indexed: 05/31/2024]
Abstract
INTRODUCTION The variety of robotic surgery systems, training modalities, and assessment tools within robotic surgery training is extensive. This systematic review aimed to comprehensively overview different training modalities and assessment methods for teaching and assessing surgical skills in robotic surgery, with a specific focus on comparing objective and subjective assessment methods. METHODS A systematic review was conducted following the PRISMA guidelines. The electronic databases Pubmed, EMBASE, and Cochrane were searched from inception until February 1, 2022. Included studies consisted of robotic-assisted surgery training (e.g., box training, virtual reality training, cadaver training and animal tissue training) with an assessment method (objective or subjective), such as assessment forms, virtual reality scores, peer-to-peer feedback or time recording. RESULTS The search identified 1591 studies. After abstract screening and full-texts examination, 209 studies were identified that focused on robotic surgery training and included an assessment tool. The majority of the studies utilized the da Vinci Surgical System, with dry lab training being the most common approach, followed by the da Vinci Surgical Skills Simulator. The most frequently used assessment methods included simulator scoring system (e.g., dVSS score), and assessment forms (e.g., GEARS and OSATS). CONCLUSION This systematic review provides an overview of training modalities and assessment methods in robotic-assisted surgery. Dry lab training on the da Vinci Surgical System and training on the da Vinci Skills Simulator are the predominant approaches. However, focused training on tissue handling, manipulation, and force interaction is lacking, despite the absence of haptic feedback. Future research should focus on developing universal objective assessment and feedback methods to address these limitations as the field continues to evolve.
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Affiliation(s)
- A Masie Rahimi
- Department of Surgery, Amsterdam UMC, Vrije Universiteit, Tafelbergweg 47, 1105 BD, Amsterdam, The Netherlands.
- Amsterdam Skills Centre for Health Sciences, Tafelbergweg 47, 1105 BD, Amsterdam, The Netherlands.
- Cancer Center Amsterdam, Amsterdam, The Netherlands.
| | - Ezgi Uluç
- Department of Surgery, Amsterdam UMC, Vrije Universiteit, Tafelbergweg 47, 1105 BD, Amsterdam, The Netherlands
| | - Sem F Hardon
- Department of Surgery, Amsterdam UMC, Vrije Universiteit, Tafelbergweg 47, 1105 BD, Amsterdam, The Netherlands
| | - H Jaap Bonjer
- Department of Surgery, Amsterdam UMC, Vrije Universiteit, Tafelbergweg 47, 1105 BD, Amsterdam, The Netherlands
- Amsterdam Skills Centre for Health Sciences, Tafelbergweg 47, 1105 BD, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Donald L van der Peet
- Department of Surgery, Amsterdam UMC, Vrije Universiteit, Tafelbergweg 47, 1105 BD, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Freek Daams
- Department of Surgery, Amsterdam UMC, Vrije Universiteit, Tafelbergweg 47, 1105 BD, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
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Nagata H, Komatsu H, Yamamoto K, Okawa M, Hikino K, Iida Y, Wada I, Ikebuchi A, Sawada M, Azuma Y, Sato S, Harada T, Taniguchi F. Comparison of surgical outcomes of da Vinci surgical systems X and Xi: A single-center study. Asian J Endosc Surg 2024; 17:e13358. [PMID: 38986520 DOI: 10.1111/ases.13358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 06/27/2024] [Accepted: 07/01/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND The da Vinci surgical systems (X and Xi) are fourth-generation systems marketed by Intuitive Inc. The X system is less expensive than the Xi system. This study compared the surgical outcomes of patients who underwent hysterectomy using the X and Xi systems. METHODS Data from 172 patients who underwent robot-assisted total hysterectomies by four surgeons between April 2019 and March 2023 were retrospectively analyzed in a single-center study. The patients were divided into two groups based on the surgical system used. Approval was granted by the Institutional Review Board of the Tottori University Hospital (22A134). All patients provided opt-out consent in accordance with the institutional guidelines. RESULTS Operative time (126.6 ± 29.5 for X, 138.2 ± 38.5 for Xi, p = .227) and console time (92.9 ± 27.0 for X, 105.5 ± 34.7 for Xi, p = .089) were insignificantly shorter in group X than in group Xi after propensity score matching for age, body mass index, nulliparity, previous history of abdominal or pelvic surgery, preoperative diagnosis, and surgical approach. No significant differences between X and Xi were observed in a subgroup analysis of patients who underwent robot-assisted total laparoscopic hysterectomy without lymphadenectomy (operative time: 199.0 ± 26.5 for X, 221.5 ± 45.1 for Xi, p = .227; console time: 162.1 ± 25.0 for X, 178.3 ± 0.314 for Xi, p = .314). CONCLUSION Perioperative outcomes for the X and Xi da Vinci surgical systems were equivalent. The cost-effective X system may allow the widespread use of robotic surgeries.
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Affiliation(s)
- Hiroki Nagata
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago, Japan
| | - Hiroaki Komatsu
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago, Japan
| | - Koji Yamamoto
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago, Japan
| | - Masayo Okawa
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago, Japan
| | - Kohei Hikino
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago, Japan
| | - Yuki Iida
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago, Japan
| | - Ikumi Wada
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago, Japan
| | - Ai Ikebuchi
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago, Japan
| | - Mayumi Sawada
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago, Japan
| | - Yukihiro Azuma
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago, Japan
| | - Shinya Sato
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago, Japan
| | - Tasuku Harada
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago, Japan
| | - Fuminori Taniguchi
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago, Japan
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Strand N, Gomez DA, Kacel EL, Morrison EJ, St Amand CM, Vencill JA, Pagan-Rosado R, Lorenzo A, Gonzalez C, Mariano ER, Reece-Nguyen T, Narouze S, Mahdi L, Chadwick AL, Kraus M, Bechtle A, Kling JM. Concepts and Approaches in the Management of Transgender and Gender-Diverse Patients. Mayo Clin Proc 2024; 99:1114-1126. [PMID: 38960496 DOI: 10.1016/j.mayocp.2023.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 12/10/2023] [Accepted: 12/28/2023] [Indexed: 07/05/2024]
Abstract
The terms transgender and gender diverse (TGD) describe persons whose gender is different from the sex assigned to them at birth. While TGD persons have experienced a rise in cultural and social visibility in recent decades, they continue to experience significant health inequities, including adverse health outcomes and multiple barriers to accessing medical care. Transgender and gender-diverse persons are at a higher risk for pain conditions than their cisgender counterparts, but research on chronic pain management for TGD persons is lacking. Clinicians from all disciplines must be informed of best practices for managing chronic pain in the TGD population. This includes all aspects of care including history, physical examination, diagnosis, treatment, and perioperative management. Many TGD persons report delaying or avoiding care because of negative interactions with medical practitioners who do not have sufficient training in navigating the specific health care needs of TGD patients. Furthermore, TGD persons who do seek care are often forced to educate their practitioners on their specific health care needs. This paper provides an overview of existing knowledge and recommendations for physicians to provide culturally and medically appropriate care for TGD persons.
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Affiliation(s)
- Natalie Strand
- Division of Pain Medicine, Department of Anesthesiology, Mayo Clinic, Phoenix, AZ, USA
| | - Diego Alan Gomez
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Elizabeth L Kacel
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Eleshia J Morrison
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Colt M St Amand
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA; Department of Psychology, University of Houston, TX, USA, and the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Jennifer A Vencill
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA; Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Robert Pagan-Rosado
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Andrea Lorenzo
- Department of Internal Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Cesar Gonzalez
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
| | - Edward R Mariano
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA, and Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Travis Reece-Nguyen
- Division of Pediatric Anesthesiology, Department of Anesthesiology, Stanford Children's Hospital, Palo Alto, CA, USA
| | - Samer Narouze
- Center for Pain Relief, Summa Western Reserve Hospital, Cuyahoga Falls, OH, USA
| | - Layth Mahdi
- Department of Emergency Medicine, NYP Brooklyn Methodist, Brooklyn, New York
| | - Andrea L Chadwick
- Department of Anesthesiology, Pain, and Perioperative Medicine, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Molly Kraus
- Division of Pain Medicine, Department of Anesthesiology, Mayo Clinic, Phoenix, AZ, USA
| | - Alexandra Bechtle
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Juliana M Kling
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA
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Baekelandt J, Jespers A, Huber D, Badiglian‐Filho L, Stuart A, Chuang L, Ali O, Burnett A. vNOTES retroperitoneal sentinel lymph node dissection for endometrial cancer staging: First multicenter, prospective case series. Acta Obstet Gynecol Scand 2024; 103:1311-1317. [PMID: 38623778 PMCID: PMC11168257 DOI: 10.1111/aogs.14843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 03/11/2024] [Accepted: 03/19/2024] [Indexed: 04/17/2024]
Abstract
INTRODUCTION The current standard treatment for endometrial cancer is a laparoscopic hysterectomy with adnexectomies and bilateral sentinel node resection. A retroperitoneal vNOTES sentinel node resection has several theoretical potential advantages. These include being less invasive, leaving no visible scars, operating without Trendelenburg, and therefore offering the anesthetic advantage of easier ventilation in obese patients and following the natural lymph node trajectory from caudally to cranially and therefore a lower risk of missing the sentinel node. The aim of this study is to determine the feasibility of a retroperitoneal vNOTES approach to sentinel lymph node dissection for staging of endometrial cancer. MATERIAL AND METHODS A prospective multicenter case series was performed in four hospitals. A total of 64 women with early-stage endometrial carcinoma suitable for surgical staging with sentinel lymph node removal were operated via a transvaginal retroperitoneal vNOTES approach. The paravesical space was entered through a vaginal incision after injecting the cervix with indocyanine green. A vNOTES port was placed into this space and insufflation of the retroperitoneum was performed. Sentinel lymph nodes were identified bilaterally using near-infrared light followed by endoscopic removal of these nodes. RESULTS A total of 64 women with early-stage endometrial cancer underwent sentinel lymph node removal by retroperitoneal vNOTES technique. All patients also underwent subsequent vNOTES hysterectomy and bilateral salpingo-oophorectomy. The median age was 69.5 years, median total operative time was 126 min and the median estimated blood loss was 80 mL. In 97% of the cases bilateral sentinel nodes could be identified. A total of 60 patients had negative sentinel nodes, three had isolated tumor cells and one had macroscopically positive sentinel nodes. No complications with sequel occurred. CONCLUSIONS This prospective multicenter case series demonstrates the feasibility of the vNOTES approach for identifying and removing sentinel lymph nodes in women with endometrial carcinoma successfully and safely. vNOTES allows sole transvaginal access with exposure of the entire retroperitoneal space, following the natural lymph trajectory caudally to cranially, and without the need for a Trendelenburg position.
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Affiliation(s)
- Jan Baekelandt
- Department of GynecologyImelda HospitalBonheidenBelgium
- Department of Development and Regeneration, Faculty of MedicineGroup Biomedical Sciences, KU LeuvenLeuvenBelgium
| | | | - Daniela Huber
- Department of Obstetrics and GynecologySion HospitalSionSwitzerland
- Department of Pediatrics, Gynecology and ObstetricsGeneva University HospitalGenevaSwitzerland
| | | | - Andrea Stuart
- Department of Obstetrics and Gynecology, Institute for Clinical SciencesLund UniversityLundSweden
| | - Linus Chuang
- Department of Gynecologic Oncology, Nuvance Health, Larner College of MedicineUniversity of VermontBurlingtonVermontUSA
| | - Oudai Ali
- Department of GynecologyEpsom and St Helier UniversityLondonUK
| | - Alexander Burnett
- Department of Obstetrics and Gynecology, Division of Gynecologic OncologyUniversity of Arkansas for Medical SciencesLittle RockArkansasUSA
- The Winthrop P Rockefeller Cancer InstituteUniversity of Arkansas for Medical SciencesLittle RockArkansasUSA
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Barra F, Zorzi C, Albanese M, De Mitri P, Stepniewska A, Roviglione G, Giani M, Albertini G, Ferrero S, Ceccaroni M. Ultrasonographic characterization of parametrial endometriosis: a prospective study. Fertil Steril 2024; 122:150-161. [PMID: 38382700 DOI: 10.1016/j.fertnstert.2024.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVE To study the ultrasonographic diagnostic accuracy and characteristics of parametrial endometriosis comprehensively. DESIGN This prospective study enrolled patients with suspected deep endometriosis (DE) scheduled for laparoscopic surgical treatment. Preoperative ultrasonographic examinations were performed following the International Deep Endometriosis Analysis criteria. This study aimed to evaluate the presence of parametrial endometriosis and its ultrasonographic characteristics, using surgical diagnosis as the reference standard. Additionally, indirect signs of DE and concomitant DE nodules associated with parametrial involvement were identified, assessing their predictive significance in the anterior, lateral, and posterior parametrial areas. SETTING Referral institution for endometriosis. PATIENTS Patients with suspected DE scheduled for surgical treatment. INTERVENTIONS Standardized preoperative ultrasonographic examination. MAIN OUTCOME MEASURES The diagnostic accuracy of transvaginal ultrasound in identifying parametrial endometriosis, including sensitivity and specificity, and the ultrasonographic characteristics of parametrial nodules, prevalence in distinct parametrial areas, and associations with indirect DE signs and concomitant DE nodules. RESULTS Surgical confirmation of parametrial nodules was observed in 105 of 545 patients (left, 18.5; right, 17.0%). Transvaginal ultrasound demonstrated a sensitivity of 77.1% (95% confidence interval, 68.0%-84.8%) and specificity of 99.1% (95% confidence interval, 67.7%-99.8%). Parametrial nodules typically exhibited characteristics such as a mild hypoechoic appearance (83.6%), starry morphology (74.7%), irregular margins (70.2%), and low vascularization. The posterior parametrial region was the most common location (52.2%), followed by the lateral (41.0%) and anterior (6.8%) parametrial regions. Concomitant DE nodules in the rectum (63.5%) and infiltrating the rectovaginal septum (56.5%) were significantly more prevalent in patients with parametrial involvement. Indirect DE signs, such as the ovaries fixed to the uterine wall (71.8%) and the absence of a posterior sliding sign (51.8%), were also more common in women with parametrial nodules. Hydronephrosis, although relatively uncommon in patients with parametrial involvement (8.2%), was largely detected in lateral parametrial nodules (70.0%). CONCLUSIONS This study represents a systematic ultrasonographic characterization of parametrial endometriosis. Specifically, it comprehensively assesses the diagnostic accuracy of transvaginal ultrasound in identifying parametrial involvement within a sizable cohort of patients with preoperative suspicion of DE. CLINICAL TRIAL REGISTRATION NUMBER NCT06017531.
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Affiliation(s)
- Fabio Barra
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore-Don Calabria, Negrar (Verona), Italy; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Carlotta Zorzi
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore-Don Calabria, Negrar (Verona), Italy
| | - Mara Albanese
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore-Don Calabria, Negrar (Verona), Italy
| | - Paola De Mitri
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore-Don Calabria, Negrar (Verona), Italy
| | - Anna Stepniewska
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore-Don Calabria, Negrar (Verona), Italy
| | - Giovanni Roviglione
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore-Don Calabria, Negrar (Verona), Italy
| | - Milo Giani
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore-Don Calabria, Negrar (Verona), Italy
| | - Giorgia Albertini
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore-Don Calabria, Negrar (Verona), Italy
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Genoa, Italy.
| | - Marcello Ceccaroni
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore-Don Calabria, Negrar (Verona), Italy
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Vink MDH, Portrait FRM, Hehenkamp WJK, van Wezep T, Koolman X, Bongers MY, van der Hijden EJE. Regional practice variation in hysterectomy and the implementation of less invasive surgical procedures: A register-based study in the Netherlands. Acta Obstet Gynecol Scand 2024; 103:1292-1301. [PMID: 38629485 PMCID: PMC11168279 DOI: 10.1111/aogs.14844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/11/2024] [Accepted: 03/27/2024] [Indexed: 06/13/2024]
Abstract
INTRODUCTION Many women experience bleeding disorders that may have an anatomical or unexplained origin. Although hysterectomy is the most definitive and common treatment, it is highly invasive and resource-intensive. Less invasive therapies are therefore advised before hysterectomy for women with fibroids or bleeding disorders. This study has two aims related to treating bleeding disorders and uterine fibroids in the Netherlands: (1) to evaluate the regional variations in prevalence and surgical approaches; and (2) to assess the associations between regional rates of hysterectomies and less invasive surgical techniques to analyze whether hysterectomy can be replaced in routine practice. MATERIAL AND METHODS We completed a register-based study of claims data for bleeding disorders and fibroids in women between 2016 and 2020 using data from Statistics Netherlands for case-mix adjustment. Crude and case-mix adjusted regional hysterectomy rates were examined overall and by surgical approach. Coefficients of variation were used to measure regional variation and regression analyses were used to evaluate the association between hysterectomy and less invasive procedure rates across regions. RESULTS Overall, 14 186 and 8821 hysterectomies were performed for bleeding disorders and fibroids, respectively. Laparoscopic approaches predominated (bleeding disorders 65%, fibroids 49%), followed by vaginal (bleeding disorders 24%, fibroids 5%) and abdominal (bleeding disorders 11%, fibroids 46%) approaches. Substantial regional differences were noted in both hysterectomy rates and the surgical approaches. For bleeding disorders, regional hysterectomy rates were positively associated with endometrial ablation rates (β = 0.11; P = 0.21) and therapeutic hysteroscopy rates (β = 0.14; P = 0.31). For fibroids, regional hysterectomy rates were positively associated with therapeutic hysteroscopy rates (β = 0.10; P = 0.34) and negatively associated with both embolization rates (β = -0.08; P = 0.08) and myomectomy rates (β = -0.03; P = 0.82). CONCLUSIONS Regional variation exists in the rates of hysterectomy and minimally invasive techniques. The absence of a significant substitution effect provides no clear evidence that minimally invasive techniques have replaced hysterectomy in clinical practice. However, although the result was not significant, embolization could be an exception based on its stronger negative association.
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Affiliation(s)
- Maarten D. H. Vink
- Department of Health Economics, School of Business and Economics & Talma InstituteVrije UniversiteitAmsterdamthe Netherlands
- Department of Obstetrics and GynecologyMeander Medical CenterAmersfoortthe Netherlands
| | - France R. M. Portrait
- Department of Health Economics, School of Business and Economics & Talma InstituteVrije UniversiteitAmsterdamthe Netherlands
| | - Wouter J. K. Hehenkamp
- Department of Obstetrics and GynecologyAmsterdam University Medical Centers, location VUmcAmsterdamthe Netherlands
| | | | - Xander Koolman
- Department of Health Economics, School of Business and Economics & Talma InstituteVrije UniversiteitAmsterdamthe Netherlands
| | - Marlies Y. Bongers
- Grow School of Oncology and Developmental BiologyMaastricht University Medical CenterMaastrichtthe Netherlands
- Department of Obstetrics and GynecologyMaxima Medical CenterVelthoventhe Netherlands
| | - Eric J. E. van der Hijden
- Department of Health Economics, School of Business and Economics & Talma InstituteVrije UniversiteitAmsterdamthe Netherlands
- Zilveren Kruis Health InsuranceLeusdenthe Netherlands
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Valdés‐Bango M, Gracia M, Rubio E, Vergara A, Casals‐Pascual C, Ros C, Rius M, Martínez‐Zamora MÁ, Mension E, Quintas L, Carmona F. Comparative analysis of endometrial, vaginal, and gut microbiota in patients with and without adenomyosis. Acta Obstet Gynecol Scand 2024; 103:1271-1282. [PMID: 38661227 PMCID: PMC11168268 DOI: 10.1111/aogs.14847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/30/2024] [Accepted: 04/02/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Alterations in microbiota composition have been implicated in a variety of human diseases. Patients with adenomyosis present immune dysregulation leading to a persistent chronic inflammatory response. In this context, the hypothesis that alterations in the microbiota may be involved in the pathogenesis of adenomyosis, by affecting the epigenetic, immunologic, and biochemical functions of the host, has recently been postulated. The aim of the present study was to compare the microbiota composition in the vagina, endometrium, and gut of individuals with and without adenomyosis. MATERIAL AND METHODS Cross-sectional study including 38 adenomyosis patients and 46 controls, performed between September 2021 and October 2022 in a university hospital-based research center. The diagnosis of adenomyosis was based on sonographic criteria. Fecal, vaginal, and endometrial samples were collected. Study of the microbiota using 16S rRNA gene sequencing. RESULTS Patients with adenomyosis exhibited a significant reduction in the gut microbial alpha diversity compared with healthy controls (Chao1 p = 0.012, Fisher p = 0.005, Observed species p = 0.005). Beta-diversity analysis showed significant differences in the compositions of both gut and vaginal microbiota between adenomyosis patients and the control group (Adonis p-value = 0.001; R2 = 0.03 and Adonis p-value = 0.034; R2 = 0.04 respectively). Specific bacterial taxa were found to be either overrepresented (Rhodospirillales, Ruminococcus gauvreauii group, Ruminococcaceae, and Actinomyces) or underrepresented in the gut and endometrial microbiota of adenomyosis patients compared with controls. Distinct microbiota profiles were identified among patients with internal and external adenomyosis phenotypes. CONCLUSIONS The study revealed reduced gut microbiota diversity in adenomyosis patients, accompanied by distinct compositions in gut and vaginal microbiota compared with controls. Overrepresented or underrepresented bacterial taxa were noted in the gut and endometrial microbiota of adenomyosis patients, with variations in microbiota profiles among those with internal and external adenomyosis phenotypes. These findings suggest a potential association between microbiota and adenomyosis, indicating the need for further research to comprehensively understand the implications of these differences.
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Affiliation(s)
- Marta Valdés‐Bango
- Endometriosis Unit, Gynecology Department, Institute Clinic of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic of BarcelonaUniversitat de BarcelonaBarcelonaSpain
| | - Meritxell Gracia
- Endometriosis Unit, Gynecology Department, Institute Clinic of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic of BarcelonaUniversitat de BarcelonaBarcelonaSpain
| | - Elisa Rubio
- Department of Clinical Microbiology, Hospital Clinic of BarcelonaUniversitat de BarcelonaBarcelonaSpain
| | - Andrea Vergara
- Department of Clinical Microbiology, Hospital Clinic of BarcelonaUniversitat de BarcelonaBarcelonaSpain
- Barcelona Institute for Global Health (ISGlobal)BarcelonaSpain
- CIBER Enfermedades Infecciosas (CIBERINFEC)Instituto Salud Carlos IIIMadridSpain
| | - Climent Casals‐Pascual
- Department of Clinical Microbiology, Hospital Clinic of BarcelonaUniversitat de BarcelonaBarcelonaSpain
- Barcelona Institute for Global Health (ISGlobal)BarcelonaSpain
- CIBER Enfermedades Infecciosas (CIBERINFEC)Instituto Salud Carlos IIIMadridSpain
| | - Cristina Ros
- Endometriosis Unit, Gynecology Department, Institute Clinic of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic of BarcelonaUniversitat de BarcelonaBarcelonaSpain
| | - Mariona Rius
- Endometriosis Unit, Gynecology Department, Institute Clinic of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic of BarcelonaUniversitat de BarcelonaBarcelonaSpain
| | - Maria Ángeles Martínez‐Zamora
- Endometriosis Unit, Gynecology Department, Institute Clinic of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic of BarcelonaUniversitat de BarcelonaBarcelonaSpain
| | - Eduard Mension
- Endometriosis Unit, Gynecology Department, Institute Clinic of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic of BarcelonaUniversitat de BarcelonaBarcelonaSpain
| | - Lara Quintas
- Endometriosis Unit, Gynecology Department, Institute Clinic of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic of BarcelonaUniversitat de BarcelonaBarcelonaSpain
| | - Francisco Carmona
- Endometriosis Unit, Gynecology Department, Institute Clinic of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic of BarcelonaUniversitat de BarcelonaBarcelonaSpain
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Coryn N, Vergauwe B, Weyers S, Verstraelen H. Long-Term Effectiveness of Vestibulectomy for the Treatment of Vulvodynia: A Retrospective Cohort Study. J Low Genit Tract Dis 2024; 28:258-263. [PMID: 38864720 DOI: 10.1097/lgt.0000000000000810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
OBJECTIVE To evaluate the effectiveness and complication rate of vestibulectomy for vulvodynia. METHODS A retrospective cohort study in a teaching and university hospital analyzing patients with vulvodynia with insufficient response to conservative treatment who underwent a vestibulectomy. Data from 114 consecutive vestibulectomy procedures done between September 2009 and October 2018 were retrospectively analyzed. All procedures were performed by the same surgeon.The primary outcome was difference in pain scale (6-point Q-tip test, Nociceptive Rating Scale) between preoperative consultation, postoperative visit, and last follow-up consultation. The secondary outcome was surgical complications, such as wound dehiscence and hematoma. RESULTS Complete data were available for 80 patients. There was a significant reduction in median pain scores of between 65% and 80% on all 6 evaluated vestibular points during Q-tip tests. The median follow-up was 21 months, ranging from 1 to 92 months (interquartile range [IQR]). Overall, 75% of patients needed no further treatment at the end of the follow-up period. In 22.6% (18/80), a limited wound dehiscence was noted. No other complications were reported nor were there any cases of worsening of the complaints. CONCLUSION/DISCUSSION In this retrospective cohort study, a significant pain reduction occurred after vestibulectomy in patients who were not responding to conservative treatment. The complication rate of this surgical procedure is low. Vestibulectomy seems to be an effective technique for management of vulvodynia.
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Affiliation(s)
- Nele Coryn
- Ghent University Hospital, Ghent, Belgium
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Vitagliano A, Nicolì P, Damiani GR, Dellino M, Cicinelli E, D' Amato A. Authors' Reply. J Minim Invasive Gynecol 2024; 31:627. [PMID: 38641051 DOI: 10.1016/j.jmig.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 04/10/2024] [Indexed: 04/21/2024]
Affiliation(s)
- Amerigo Vitagliano
- Department of Interdisciplinary Medicine (DIM), Unit of Obstetrics and Gynecology, Policlinico of Bari, University of Bari "Aldo Moro", Bari, Italy (all authors)..
| | - Pierpaolo Nicolì
- Department of Interdisciplinary Medicine (DIM), Unit of Obstetrics and Gynecology, Policlinico of Bari, University of Bari "Aldo Moro", Bari, Italy (all authors)
| | - Gianluca Raffaello Damiani
- Department of Interdisciplinary Medicine (DIM), Unit of Obstetrics and Gynecology, Policlinico of Bari, University of Bari "Aldo Moro", Bari, Italy (all authors)
| | - Miriam Dellino
- Department of Interdisciplinary Medicine (DIM), Unit of Obstetrics and Gynecology, Policlinico of Bari, University of Bari "Aldo Moro", Bari, Italy (all authors)
| | - Ettore Cicinelli
- Department of Interdisciplinary Medicine (DIM), Unit of Obstetrics and Gynecology, Policlinico of Bari, University of Bari "Aldo Moro", Bari, Italy (all authors)
| | - Antonio D' Amato
- Department of Interdisciplinary Medicine (DIM), Unit of Obstetrics and Gynecology, Policlinico of Bari, University of Bari "Aldo Moro", Bari, Italy (all authors)
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Dou Y, Deng L, Liang X, Cao F, Chen B, Tang S, Wang Y. A Retrospective Cohort Study of vNOTES Extraperitoneal Versus Laparoscopic Sacral Hysteropexy With Uterine Preserving Regarding Surgical Outcomes and Two-Year Follow-Up Results. J Minim Invasive Gynecol 2024; 31:584-591. [PMID: 38642887 DOI: 10.1016/j.jmig.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/06/2024] [Accepted: 04/13/2024] [Indexed: 04/22/2024]
Abstract
STUDY OBJECTIVE To explore the effectiveness of transvaginal natural orifice transluminal endoscopic surgery extraperitoneal sacral hysteropexy (vNOTES-ESH) in women with symptomatic uterine prolapse over a 2 year follow-up. DESIGN Retrospective cohort study. SETTING Gynecological minimally invasive center. PATIENTS Women undergoing sacral hysteropexy either by vNOTES (n = 25) or laparoscopic (n = 74) between November 2016 and December 2020. INTERVENTIONS Both vNOTES-ESH and laparoscopic sacral hysteropexy (LAP-SH) were used for uterine prolapse. Demographic data, operative characteristics, perioperative outcomes, and follow-up information 2 years postsurgery in the 2 groups were retrospectively evaluated. RESULTS Both procedures showed similar operation time, estimated blood loss, hospital stays, and pain scores (p >0.05). During a median follow-up of 59 (24-72) months, the surgical success rate was 96% for vNOTES-ESH and 97.3% for LAP-SH (p >0.05), with no differences in anatomical position or pelvic organ function after the operation. Women in the LAP-SH group experienced more bothersome symptoms of constipation compared to those in the vNOTES-ESH group (5.41% vs 0, p <0.05). Lastly, 1 case in the vNOTES-ESH group had a mesh exposed area of less than 1 cm2, and 1 patient in the LAP-SH group experienced stress incontinence. CONCLUSIONS In this retrospective study, vNOTES-ESH met our patients' preference for uterine preservation and was a successful and effective treatment for uterine prolapse, providing good functional improvement in our follow-up. This procedure should be considered as an option for patients with pelvic organ prolapse.
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Affiliation(s)
- Yuya Dou
- Department of Obstetrics and Gynaecology, Southwest Hospital (Dou, Deng, and Cao), Army Military Medical University, Chongqing, China
| | - Li Deng
- Department of Obstetrics and Gynaecology, Southwest Hospital (Dou, Deng, and Cao), Army Military Medical University, Chongqing, China
| | - Xiaolong Liang
- Department of Obstetrics and Gynaecology, Southwest Hospital (Dou, Deng, and Cao), Army Military Medical University, Chongqing, China
| | - Feng Cao
- Department of Obstetrics and Gynaecology, Southwest Hospital (Dou, Deng, and Cao), Army Military Medical University, Chongqing, China
| | - Bingyu Chen
- The First Clinical College (Chen), Chongqing Medical University, Chongqing, China
| | - Shuai Tang
- Department of Obstetrics and Gynaecology, Southwest Hospital (Dou, Deng, and Cao), Army Military Medical University, Chongqing, China
| | - Yanzhou Wang
- Department of Obstetrics and Gynaecology, Southwest Hospital (Dou, Deng, and Cao), Army Military Medical University, Chongqing, China.
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Naem A, Krentel H, Moawad G, Naem J, Venezia R, Etrusco A, Terzic S, Laganà AS. Hormonal Therapies before in vitro fertilization in women with endometriosis: The Minotaur's Labyrinth and the Ariadne's Thread. Best Pract Res Clin Obstet Gynaecol 2024; 95:102500. [PMID: 38772765 DOI: 10.1016/j.bpobgyn.2024.102500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 05/02/2024] [Indexed: 05/23/2024]
Abstract
Endometriosis-related infertility is one of the most debated topics in reproductive medicine. In recent years, prolonged pre-cycle hormonal regimens gained attention as a mean of improving the assisted reproduction technologies (ART) success rates in endometriosis patients. GnRH agonists, dienogest, medroxyprogesterone acetate, and aromatase inhibitors are the most studied medications. Conflicting results and a high risk of bias exist in almost all of the conducted studies in the field. However, current evidence suggests that pre-cycle treatment with GnRH agonists may be beneficial for patients with stage III/IV endometriosis. Dienogest and medroxyprogesterone acetate-based progestin-primed ovarian stimulation protocol was shown to be comparable to the prolonged GnRH agonists protocol. Finally, aromatase inhibitors seem to be of limited benefit to the assisted reproductive outcomes of endometriosis patients. Although it is challenging to draw any clinical conclusions, pre-cycle hormonal treatments seem to be best indicated in endometriosis patients who had previously failed ART treatment.
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Affiliation(s)
- Antoine Naem
- Department of Obstetrics, Gynecology, Gynecologic Oncology and Senology, Bethesda Hospital Duisburg, 47053 Duisburg, Germany; Faculty of Mathematics and Computer Science, University of Bremen, 28359 Bremen, Germany.
| | - Harald Krentel
- Department of Obstetrics, Gynecology, Gynecologic Oncology and Senology, Bethesda Hospital Duisburg, 47053 Duisburg, Germany
| | - Gaby Moawad
- Department of Obstetrics and Gynecology, George Washington University, Washington, DC 20037, USA; The Center for Endometriosis and Advanced Pelvic Surgery, Washington, DC 22101, USA
| | - Joelle Naem
- Faculty of Medicine of Damascus University, Damascus, Syria
| | - Renato Venezia
- Unit of Obstetrics and Gynecology, "Paolo Giaccone" Hospital, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Andrea Etrusco
- Unit of Obstetrics and Gynecology, "Paolo Giaccone" Hospital, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Sanja Terzic
- Department of Medicine, School of Medicine, Nazarbayev University, Zhanybek-Kerey Khans Street 5/1, Astana 010000, Kazakhstan
| | - Antonio Simone Laganà
- Unit of Obstetrics and Gynecology, "Paolo Giaccone" Hospital, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
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Peng H, Jiang J, Li L, Hao Z, Lian H, Du H, Wang W. Mismatch repair deficiency and abnormal p53 expression has significant predictive value for progesterone resistance and endometrial tumorigenesis in patients with endometrial atypical hyperplasia receiving fertility-preserving treatment. Gynecol Oncol 2024; 186:154-160. [PMID: 38691985 DOI: 10.1016/j.ygyno.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/21/2024] [Accepted: 04/18/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE This study aimed to evaluate the prognostic ability of mismatch repair deficiency (MMR-d) and abnormal p53 expression (p53abn) in patients with endometrial atypical hyperplasia (EAH) who underwent fertility-preserving treatment. METHODS This retrospective study evaluated 51 patients with EAH who underwent fertility-sparing treatment. Endometrial biopsy specimens obtained before hormone therapy were collected and used for immunohistochemical staining for MMR and p53 proteins. Response, relapse, and progression rates were assessed based on age, body mass index, diabetes, polycystic ovary syndrome, reproductive history, MMR status, and p53 status. RESULTS Overall, 11/51 (21.6%) patients had loss of MMR proteins and 6/51 (11.8%) had p53abn. Patients with MMR-d had lower complete response (CR) rates than those with normal staining patients at 12 months after initial treatment (p = 0.049). Patients with MMR-d had significantly higher relapse rates than those with MMR-p at the 1-year follow-ups after achieving CR (p = 0.035). Moreover, patients with MMR-d had a higher incidence of disease progression at 2, 3, and 4 years after fertility-sparing treatment (p = 0.001, p = 0.01 and p = 0.035, respectively). Patients with p53abn had higher relapse rates than those with p53wt at the 1- and 2-year follow-ups after achieving CR (p = 0.047 and p = 0.036, respectively). Moreover, patients with p53abn had a higher incidence of disease progression at 3 and 4 years after fertility-sparing treatment (p = 0.02 and p = 0.049, respectively). CONCLUSIONS EAH patients with MMR-d and p53abn have a significantly higher risk of disease relapse and progression. Thus, MMR-d and p53abn may be used as predictive biomarkers of progestin resistance and endometrial tumorigenesis in EAH.
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Affiliation(s)
- Hongfa Peng
- Department of Obstetrics and Gynecology, Second Hospital of Hebei Medical University, China
| | - Jingjing Jiang
- Department of Obstetrics and Gynecology, Hebei General Hospital, China
| | - Limeng Li
- Department of Obstetrics and Gynecology, Second Hospital of Hebei Medical University, China
| | - Zengfang Hao
- Department of Pathology, Second Hospital of Hebei Medical University, China
| | - Hongguang Lian
- Department of Pathology, Second Hospital of Hebei Medical University, China
| | - Hui Du
- Department of Obstetrics and Gynecology, Second Hospital of Hebei Medical University, China
| | - Wei Wang
- Department of Reproductive Medicine, Second Hospital of Hebei Medical University, China.
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Okabe H, Masuda T, Tomita M, Ono A, Kuroda D, Kuroki H, Nitta H, Hibi T, Baba H, Sugita H. Diagnostic accuracy of preoperative adhesion mapping by ultrasonography for laparoscopic surgery in patients with past abdominal surgery with special reference to loose adhesion. Asian J Endosc Surg 2024; 17:e13332. [PMID: 38922724 DOI: 10.1111/ases.13332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/27/2024] [Accepted: 05/21/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE Endoscopic surgery is widely accepted for both elective and emergent abdominal surgery. This study was performed to assess the accuracy of preoperative adhesion mapping by abdominal ultrasonography (US). METHODS Intra-abdominal intestinal adhesions on the abdominal wall in 50 patients with a history of abdominal surgery were prospectively assessed by the visceral slide test with US before laparoscopic surgery from 2019 to 2022. Adhesion was assessed in six separate abdominal zones during US. Actual adhesion on the abdominal wall was confirmed during laparoscopic surgery. RESULTS The sliding distances in upper right, upper central, upper left, lower right, lower central, and lower left zones in patients with versus without intestinal adhesion were 4.4 versus 1.4 cm (P = .004), 3.4 versus 2.5 cm, 4.3 versus 1.3 cm (P = .011), 3.1 versus 1.5 cm (P = .0014), 3.3 versus 1.1 cm (P = .013), and 3.4 versus 0.8 cm (P = .0061), respectively. Receiver operating characteristic analysis revealed the optimal value of sliding distance as 2.5 cm and the area under the curve as 0.86. The specificity of US assessment of adhesion was lower in the central zone than in lateral zones. Loose adhesion mostly seen around the scar was attributed to either filmy tissue or omental adhesion, leading to visceral sliding during US. CONCLUSION This study revealed the reason for insufficient accuracy of preoperative US assessment of intestinal adhesion around the scar area because of loose adhesion. The upper lateral area might be optimal for first port insertion.
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Affiliation(s)
- Hirohisa Okabe
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Toshiro Masuda
- Department of Surgery, Kumamoto Regional Medical Center, Kumamoto, Japan
| | - Masahiro Tomita
- Department of Surgery, Kumamoto Regional Medical Center, Kumamoto, Japan
| | - Asuka Ono
- Department of Surgery, Kumamoto Regional Medical Center, Kumamoto, Japan
| | - Daisuke Kuroda
- Department of Surgery, Kumamoto Regional Medical Center, Kumamoto, Japan
| | - Hideyuki Kuroki
- Department of Surgery, Kumamoto Regional Medical Center, Kumamoto, Japan
| | - Hidetoshi Nitta
- Department of Surgery, Kumamoto Regional Medical Center, Kumamoto, Japan
| | - Taizo Hibi
- Department of Pediatric Surgery and Transplantation, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiroki Sugita
- Department of Surgery, Kumamoto Regional Medical Center, Kumamoto, Japan
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Naumann RW. The SHAPE trial: is good is good enough? J Gynecol Oncol 2024; 35:e107. [PMID: 38789397 PMCID: PMC11262908 DOI: 10.3802/jgo.2024.35.e107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 04/09/2024] [Accepted: 04/09/2024] [Indexed: 05/26/2024] Open
Affiliation(s)
- R Wendel Naumann
- Division of Gynecologic Oncology, Levine Cancer, Atrium Health, Wake Forest University, Charlotte, NC, USA.
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Nian J, Li Z, Chen P, Ye P, Liu C. Enhanced recovery after surgery versus conventional postoperative care in patients undergoing hysterectomy: a systematic review and meta-analysis. Arch Gynecol Obstet 2024; 310:515-524. [PMID: 38836927 DOI: 10.1007/s00404-024-07475-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 03/11/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE Hysterectomy is a common gynecological surgery associated with significant postoperative discomfort and extended hospital stays. Enhanced recovery after surgery (ERAS), a multidisciplinary approach, has emerged as a strategy aimed at improving perioperative outcomes and promoting faster patient recovery and satisfaction. This meta-analysis aimed to evaluate the impact of ERAS protocols on clinical outcomes, such as hospital stay length, readmission rates, and postoperative complications, in patients undergoing gynecological hysterectomy. METHODS Following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, a systematic review and meta-analysis were conducted. Databases including PubMed, Embase, and Cochrane library were searched for relevant studies published up to January 31, 2023. A total of seventeen studies were selected based on predefined eligibility and exclusion criteria. Meta-analysis was carried out using a random-effects model with the STATA SE 14.0 software, focusing on outcomes like length of hospital stay, postoperative complications, and readmission rates. RESULTS ERAS protocols significantly reduced the length of hospital stays and incidence of postoperative complications such as ileus, without increasing readmission rates or the level of patient-reported pain. Notable heterogeneity was observed among included studies, attributed to the variation in patient populations and the specificity of the documented study protocols. CONCLUSION The findings underscore the effectiveness of ERAS protocols in enhancing recovery trajectories in gynecological hysterectomy patients. This reinforces the imperative for broader, standardized adoption of ERAS pathways as an evidence-based approach, fostering a safer and more efficient perioperative care paradigm.
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Affiliation(s)
- Jinxia Nian
- Operating Room, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, 18 Daoshan Road, Fuzhou, 350001, China
| | - Zhenming Li
- Operating Room, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, 18 Daoshan Road, Fuzhou, 350001, China
| | - Pinying Chen
- Operating Room, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, 18 Daoshan Road, Fuzhou, 350001, China
| | - Peiying Ye
- Central Sterile Supply Department, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, 18 Daoshan Road, Fuzhou, 350001, China.
| | - Chenyin Liu
- Nursing Department, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, 18 Daoshan Road, Fuzhou, 350001, China.
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Vurture G, Mendelson J, Grigorescu B, Lazarou G. Decreasing post hysterectomy surgical site infections with the implementation of a hysterectomy-specific bundle. Am J Infect Control 2024; 52:790-794. [PMID: 38395313 DOI: 10.1016/j.ajic.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/15/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Surgical site infections (SSI) are a common complication of hysterectomy. Surgical bundles have been shown to reduce SSIs. Here we describe a bundle that was used to combat an abnormal rise in SSI events that resulted in a greater than 75% reduction at our institution. METHODS A hysterectomy-specific bundle was developed based on the prior success of SSI prevention bundles. Development involved longitudinal education and training to ensure accuracy and compliance. All inpatient abdominal, laparoscopic, and vaginal hysterectomies performed at a tertiary referral center were included. The preintervention, intervention, and postintervention periods were each one year in length. SSI rates were peer-reviewed monthly and overall trends were tracked, including compliance with bundle guidelines. RESULTS Preintervention, an abnormal rise in SSI was identified at 3.76%. During the intervention, 309 inpatient hysterectomies were completed. In this period, 6 posthysterectomy SSI events occurred (3.76% vs 1.94%, P = .21). Four SSIs followed laparotomy and 2 followed laparoscopy. Compliance during the intervention period ranged from 79% to 89% with a mean of 85%. In the postintervention period, there were 6 SSI following 689 hysterectomies (3.76% vs 0.87%, P = .004). The majority of SSI occurred after abdominal hysterectomy. CONCLUSIONS Implementation of a hysterectomy-specific surgical bundle allowed for a significant reduction in post hysterectomy SSI during a yearlong intervention period and a sustained, further reduction in the postintervention period.
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Affiliation(s)
- Gregory Vurture
- Department of Obstetrics and Gynecology, Jersey Shore University Medical Center, Neptune, NJ, USA.
| | - Jordan Mendelson
- Department of Urology, New York University Langone Hospital, Long Island, Mineola, NY, USA
| | - Bogdan Grigorescu
- Department of Obstetrics and Gynecology, New York University Langone Hospital, Long Island, Mineola, NY, USA
| | - George Lazarou
- Department of Obstetrics and Gynecology, New York University Langone Hospital, Long Island, Mineola, NY, USA
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Szabó G, Bokor A, Fancsovits V, Madár I, Darici E, Pashkunova D, Arányi Z, Fintha A, Rigó J, Lipták L, Mázsár B, Hudelist G. Clinical and ultrasound characteristics of deep endometriosis affecting sacral plexus. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 64:104-111. [PMID: 38315642 DOI: 10.1002/uog.27602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/03/2023] [Accepted: 01/24/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVE To describe the sonomorphological changes and appearance of deep endometriosis (DE) affecting the nervous tissue of the sacral plexus (SP). METHODS This was a retrospective study of symptomatic patients who underwent radical resection of histologically confirmed DE affecting the SP and who had undergone preoperative transvaginal sonography (TVS) between 2019 and 2023. Lesions were described based on the terms and definitions of the International Deep Endometriosis Analysis (IDEA), International Ovarian Tumor Analysis (IOTA) and Morphological Uterus Sonographic Assessment (MUSA) groups. A diagnosis of DE affecting the SP on TVS was made when the sonographic criteria of DE were visualized in conjunction with fibers of the SP and the presence of related symptoms corresponding to sacral radiculopathy. Clinical symptoms, ultrasound features and histological confirmation were analyzed for each patient included. RESULTS Twenty-seven patients with DE infiltrating the SP were identified in two contributing tertiary referral centers. Median age was 37 (range, 29-45) years and all patients were symptomatic and presented one or more of the following neurological symptoms: dysesthesia in the ipsilateral lower extremity (n = 17); paresthesia in the ipsilateral lower extremity (n = 10); chronic pelvic pain radiating in the ipsilateral lower extremity (n = 9); chronic pain radiating in the pudendal region (n = 8); and motor weakness in the ipsilateral lower extremities (n = 3). All DE lesions affecting the SP were purely solid tumors in the posterior parametrium in direct contact with, or infiltrating, the S1, S2, S3 and/or S4 roots of the SP. The median of the largest diameter recorded for each of the DE nodules was 35 (range, 18-50) mm. Echogenicity was non-uniform in 23 (85%) of the DE nodules, with all but one of these nodules containing hyperechogenic areas. The shape of the lesions was irregular in 24 (89%) cases. Only one lesion exhibited a lobulated form, with all other irregular lesions showing a spiculated appearance. An acoustic shadow was produced in 20 (74%) of the nodules, all of which were internal. On color or power Doppler examination, 21 (78%) of the nodules showed no signal (color score of 1). The remaining six (22%) lesions showed a minimal color content (color score of 2). According to pattern recognition, most DE nodules were purely solid, non-uniform, hypoechogenic nodules containing hyperechogenic areas, with internal shadows and irregular spiculated contours, and were poorly vascularized on color/power Doppler examination. CONCLUSION The ultrasound finding of a parametrial, unilateral, solid, non-uniform, hypoechogenic nodule with hyperechogenic areas and possible internal shadowing, as well as irregular spiculated contours, demonstrating poor vascularization on Doppler examination in proximity to or involving the structures of the SP, indicates DE affecting the SP. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- G Szabó
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - A Bokor
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - V Fancsovits
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - I Madár
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - E Darici
- Brussels IVF, Center for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - D Pashkunova
- Department of Gynecology, Center for Endometriosis, Hospital St John of God, Vienna, Austria
| | - Z Arányi
- Department of Neurology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - A Fintha
- First Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - J Rigó
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- Department of Clinical Studies in Obstetrics and Gynecology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
| | - L Lipták
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - B Mázsár
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - G Hudelist
- Department of Gynecology, Center for Endometriosis, Hospital St John of God, Vienna, Austria
- Rudolfinerhaus Private Clinic and Campus, Vienna, Austria
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Yoo N, Mun JY, Kye BH, Kim CW, Lee JI, Park YY, Kang BM, Park BK, Kwak HD, Kang WK, Bae SU, Oh HK, Hong Y, Kim HJ. Plastic Wound Protector vs Surgical Gauze for Surgical Site Infection Reduction in Open GI Surgery: A Randomized Clinical Trial. JAMA Surg 2024; 159:737-746. [PMID: 38656413 PMCID: PMC11044008 DOI: 10.1001/jamasurg.2024.0765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/02/2024] [Indexed: 04/26/2024]
Abstract
Importance Surgical site infections (SSIs) are prevalent hospital-acquired infections with significant patient impacts and global health care burdens. The World Health Organization recommends using wound protector devices in abdominal surgery as a preventive measure to lower the risk of SSIs despite limited evidence. Objective To examine the efficacy of a dual-ring, plastic wound protector in lowering the SSI rate in open gastrointestinal (GI) surgery irrespective of intra-abdominal contamination levels. Design, Setting, and Participants This multicenter, patient-blinded, parallel-arm randomized clinical trial was conducted from August 2017 to October 2022 at 13 hospitals in an academic setting. Patients undergoing open abdominal bowel surgery (eg, for bowel perforation) were eligible for inclusion. Intervention Patients were randomized 1:1 to a dual-ring, plastic wound protector to protect the incision site of the abdominal wall (experimental group) or a conventional surgical gauze (control group). Main Outcomes and Measures The primary end point was the rate of SSI within 30 days of open GI surgery. Results A total of 458 patients were randomized; after 1 was excluded from the control group, 457 were included in the intention-to-treat analysis (mean [SD] age, 58.4 [12.1] years; 256 [56.0%] male; 341 [74.6%] with a clean-contaminated wound): 229 in the wound protector group and 228 in the surgical gauze group. The overall SSI rate in the intention-to-treat analysis was 15.7% (72 of 458 patients). The SSI rate for the wound protector was 10.9% (25 of 229 patients) compared with 20.5% (47 of 229 patients) with surgical gauze. The wound protector significantly reduced the risk of SSI, with a relative risk reduction (RRR) of 46.81% (95% CI, 16.64%-66.06%). The wound protector significantly decreased the SSI rate for clean-contaminated wounds (RRR, 43.75%; 95% CI, 3.75%-67.13%), particularly for superficial SSIs (RRR, 42.50%; 95% CI, 7.16%-64.39%). Length of hospital stay was similar in both groups (mean [SD], 15.2 [10.5] vs 15.3 [10.2] days), as were the overall postoperative complication rates (20.1% vs 18.8%). Conclusions and Relevance This randomized clinical trial found a significant reduction in SSI rates when a plastic wound protector was used during open GI surgery compared with surgical gaze, supporting the World Health Organization recommendation for use of wound protector devices in abdominal surgery. Trial Registration ClinicalTrials.gov Identifier: NCT03170843.
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Affiliation(s)
- Nina Yoo
- Department of Surgery, Seoul St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Surgery, St Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Ji Yeon Mun
- Department of Surgery, St Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Bong-Hyeon Kye
- Department of Surgery, St Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Chang Woo Kim
- Department of Surgery, Ajou University Hospital, Suwon, Korea
| | - Jae Im Lee
- Department of Surgery, Uijeongbu St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Youn Young Park
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
| | - Byung Mo Kang
- Department of Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Byung Kwan Park
- Department of Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Han Deok Kwak
- Department of Surgery, Chonnam National University Hospital, College of Medicine, Chonnam National University, Gwangju, Korea
| | - Won-Kyung Kang
- Department of Surgery, Yeouido St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Uk Bae
- Department of Surgery, Keimyung University and Dongsan Medical Center, Daegu, Korea
| | - Heung-Kwon Oh
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Youngki Hong
- Department of Surgery, National Health Insurance Service, Ilsan Hospital, Goyang, Korea
| | - Hyung Jin Kim
- Department of Surgery, EunPyeong St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Zeng CH, Cao CW, Shin JH, Kim GH, Kim SH, Lee SR, Lee SW. Safety and Clinical Outcomes of Two-Session Catheter-Directed Sclerotherapy Using Ethanol for Endometrioma. Cardiovasc Intervent Radiol 2024; 47:901-909. [PMID: 38528174 DOI: 10.1007/s00270-024-03700-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/27/2024] [Indexed: 03/27/2024]
Abstract
PURPOSE To evaluate the safety and clinical outcome of two-session catheter-directed sclerotherapy (CDS) with 99% ethanol in patients with endometrioma. MATERIALS AND METHODS This prospective study was approved by the institutional review board with written informed consent obtained from all participants and was registered on clinicaltrial.gov. Consecutive patients with ovarian endometrioma between June 2020 and March 2023 were prospectively evaluated for two sessions of CDS. After successful transvaginal ultrasound-guided puncture of the endometrioma, the biopsy needle was exchanged for a 7- or 8.5-F catheter for aspiration and ethanol injection. The catheter was retained in situ for a second session the next day. Endometrioma volume was measured on ultrasound before and 1, 3, and 6 months after CDS, and volume reduction ratio (VRR) was calculated. Serum anti-Müllerian hormone (AMH) was measured before and 6 months after CDS to assess ovarian reserve. RESULTS Thirty-one endometriomas in 22 patients (mean age, 31.0 years; range, 19-44 years) were treated; 28 endometriomas were successfully treated with two-session CDS, while one session was incomplete in three endometriomas in three patients due to contrast medium leakage or pain. Minor procedure-related complications developed in four patients and resolved spontaneously before discharge on the same day of the second session. No recurrence was identified during follow-up. At the 6-month follow-up, the mean endometrioma diameter decreased from 5.5 ± 1.7 to 1.4 ± 0.9 cm (P < 0.001), and the serum AMH level was lowered without statistical significance (1.37 ± 0.96 ng/mL vs. 1.18 ± 0.92 ng/mL; P = 0.170). VRRs at 1, 3, and 6 months after CDS were 84.3 ± 13.7%, 94.3 ± 5.8%, and 96.4 ± 4.7%, respectively. CONCLUSION Two-session CDS with 99% ethanol is safe, feasible, and effective for treating endometrioma with the ovarian function well preserved.
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Affiliation(s)
- Chu Hui Zeng
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Chuan Wu Cao
- Department of Integrated Traditional Chinese and Western Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
| | - Gun Ha Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Sung Hoon Kim
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sa Ra Lee
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Shin Wha Lee
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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244
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Abbott J. Do MDTs Create More Noises, or More Choices? J Minim Invasive Gynecol 2024; 31:547-548. [PMID: 38750693 DOI: 10.1016/j.jmig.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Indexed: 05/20/2024]
Affiliation(s)
- Jason Abbott
- Division of Obstetrics and Gynaecology, School of Clinical Medicine, Health and Medicine, UNSW Sydney, Australia.
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245
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GiglioAyers P, Ezike O, Foley CE, Brown BP. Demographic Correlates of Endometriosis Diagnosis Among United States Women Aged 15-50. J Minim Invasive Gynecol 2024; 31:607-612. [PMID: 38697259 DOI: 10.1016/j.jmig.2024.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/10/2024] [Accepted: 04/25/2024] [Indexed: 05/04/2024]
Abstract
OBJECTIVE To compare demographic characteristics of women with and without a diagnosis of endometriosis. DESIGN Data were collected from the National Survey of Family Growth-a publicly available survey designed and administered by the Centers for Disease Control, which uses a nationally-representative sample of the United States population. Univariate data were reported as survey-weighted percentages and means and were analyzed using chi-square, t tests, and logistic regression. Analyses accounted for complex survey design. SETTING United States. PARTICIPANTS Interviews were conducted with 6141 female respondents, aged 15 to 50, between 2017 and 2019. INTERVENTIONS Data were collected through in-person interviews. RESULTS Nationally, 5.7% reported a diagnosis of endometriosis (95% CI 4.6-6.9%). Those with endometriosis were older, with a mean age of 39 (95% CI 38.1-39.9), compared to 31.7 (95% CI 31.2-32.2) among those without (p <.0005). Endometriosis diagnosis was significantly associated with race. Compared to non-Hispanic White women, Hispanic women had an adjusted odds ratio (aOR) of 0.37 (95% CI 0.21-0.65) for diagnosis of endometriosis, and non-Hispanic Black women had an aOR of 0.54 (95% CI 0.35-0.84). We also observed a difference in diagnosis by health insurance: compared to those with private insurance or Medi-Gap coverage, those with Medicare or military insurance had an aOR for endometriosis diagnosis of 2.49 (95% CI 1.36-4.55). Finally, compared to those with less than a high school education, those who had completed high school or greater had an aOR for endometriosis diagnosis of 2.84 (95% CI 1.15-6.99). CONCLUSION These disparities in endometriosis diagnosis suggest that intersecting barriers may preclude certain groups from accessing timely endometriosis diagnosis and management. Further studies are warranted to explore these hypothesis-generating data and to identify and address specific barriers to equitable endometriosis diagnosis and management.
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Affiliation(s)
- Patricia GiglioAyers
- Department of Obstetrics and Gynecology, Women and Infants Hospital, Providence, Rhode Island (all authors)..
| | - Ogechukwu Ezike
- Department of Obstetrics and Gynecology, Women and Infants Hospital, Providence, Rhode Island (all authors)
| | - Christine E Foley
- Department of Obstetrics and Gynecology, Women and Infants Hospital, Providence, Rhode Island (all authors)
| | - Benjamin P Brown
- Department of Obstetrics and Gynecology, Women and Infants Hospital, Providence, Rhode Island (all authors)
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246
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Chen CM, Tseng YH, Jui-Shan Lin S, Chen LL, Lin JD, Su YC. A quick method to customize pictorial blood assessment tools towards better measurement: Method development and validation. Taiwan J Obstet Gynecol 2024; 63:506-512. [PMID: 39004477 DOI: 10.1016/j.tjog.2022.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2022] [Indexed: 07/16/2024] Open
Abstract
OBJECTIVE Identification of heavy menstrual bleeding (HMB) cases in primary care settings is often done by using pictorial blood assessment charts (PBAC). The study aims to highlight the challenge of assessing blood loss, to develop a standardized method to efficiently customize a patient-reported pictorial chart, to validate the tool produced with our proposed method, and to demonstrate the feasibility of using PBACs in settings where resources are scarce. MATERIALS AND METHODS Using blood samples and feedback from 21 women aged 30-51 years, we followed guidelines suggested in the literature, developed a method to produce PBACs for regular, long and night sizes, and had 9 participants testuse them. Linear regression analysis was performed to determine the correlation between participants' scores and menstrual blood weight. RESULTS The study demonstrated the feasibility of customizing product-sensitive and size-specific pictorial charts by adopting essential steps including collecting menstrual blood with menstrual cups, employing fluid application techniques, and using sanitary pads as icons for easy identification. Linear regression analyses of score versus blood weight showed that the recorded blood weight was around 95% of the scored values (R2 = 0.9428, 0.947, and 0.9508, respectively; p < 0.001). CONCLUSION Valid patient-reported PBACs created by the proposed method provides an innovative women's healthcare solution to assist HMB identification and reduce health expenditure by preventing risks for HMB related complications in varying economic and technological contexts. Women's participation in tracking menstrual abnormalities may improve health literacy.
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Affiliation(s)
- Chien-Ming Chen
- Graduate Institute of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Yu-Hwei Tseng
- Department of Public Health, National Cheng Kung University, Tainan, Taiwan
| | - Sunny Jui-Shan Lin
- Department of Chinese Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
| | - Li-Li Chen
- School of Nursing, College of Health Care, China Medical University, Taichung, Taiwan
| | - Jun-Dai Lin
- Department of Nursing & Department of Health Administration, Asia University, Taichung, Taiwan
| | - Yi-Chang Su
- National Research Institute of Chinese Medicine, Ministry of Health and Welfare, Taipei, Taiwan.
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Choi SH, Won S, Lee N, Shim SH, Kim MK, Kim ML, Jung YW, Yun BS, Jun HS, Seong SJ. Robotic Single-Site Plus One-Port Myomectomy versus Robotic Single-Site Plus Two-Port Myomectomy: A Propensity Score Matching Analysis. Yonsei Med J 2024; 65:406-412. [PMID: 38910303 PMCID: PMC11199179 DOI: 10.3349/ymj.2023.0434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/17/2024] [Accepted: 01/30/2024] [Indexed: 06/25/2024] Open
Abstract
PURPOSE Robotic single-site plus one-port myomectomy (RSOM) was designed to reduce the number of incision sites for greater cosmetic satisfaction of patients while retaining the benefits of conventional robotic multi-site myomectomy (CRM). Robotic single-site plus two-port myomectomy (RSTM) eliminated one port relative to conventional CRM, and RSOM achieved the same advantage with respect to RSTM. This study aimed to compare RSOM with RSTM in terms of their respective methodologies and surgical outcomes. MATERIALS AND METHODS The medical records of 230 patients who had undergone RSOM and 146 patients who had undergone RSTM were reviewed. The groups' surgical outcomes were compared using propensity score matching (PSM) analysis. RESULTS In the total data, RSOM had a shorter operative time (135.1±57.4 min vs. 149.9±46.2 min, p=0.009) and a shorter hospital stay (5.2±0.5 days vs. 5.4±0.7 days, p=0.033) relative to RSTM. The PSM analysis showed that there were no statistically significant intergroup differences in the patients' baseline characteristics. Regarding the surgical outcomes, the RSOM group showed shorter operative time (129.2±49.3 min vs. 148.7±46.3 min, p=0.001) compared to the RSTM group. CONCLUSION Compared with RSTM, RSOM was associated with shorter operative time. Additionally, more detailed comparative and prospective studies are needed to evaluate RSOM relative to RSTM.
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Affiliation(s)
- Su Hyeon Choi
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Seyeon Won
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Nara Lee
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - So Hyun Shim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Mi Kyoung Kim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Mi-La Kim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Yong Wook Jung
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Bo Seong Yun
- Department of Obstetrics and Gynecology, CHA Ilsan Medical Center, CHA University School of Medicine, Goyang, Korea
| | - Hye Sun Jun
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Seok Ju Seong
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea.
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Darwish A, Ismail L, Manek S, Hellner K, Kehoe S, Soleymani Majd H. Prognostic characteristics, recurrence patterns, and survival outcomes of vulval squamous cell carcinoma - A twelve-year retrospective analysis of a tertiary centre. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108447. [PMID: 38843661 DOI: 10.1016/j.ejso.2024.108447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/20/2024] [Accepted: 05/28/2024] [Indexed: 07/03/2024]
Abstract
INTRODUCTION Vulval cancer is a rare gynaecological malignancy. In this study, we present a tertiary centre case analysis to examine the recurrence patterns and survival outcomes of vulval squamous cell carcinoma (SCC). METHODS This is a retrospective cohort study of women who received treatment at Oxford University Hospitals between February 2010 and July 2022 for primary vulval SCC. RESULTS We included 98 cases. The median age at diagnosis was 68 years. Human Papillomavirus (HPV) infection and lichen sclerosis were observed in 21 and 50 cases, respectively. Surgical excision was the primary treatment. Recurrence within 2 years was more common with advanced stage (p = 0.047, RR = 2.26) and extracapsular lymph node spread (p = 0.013, RR = 2.88). Local recurrence was not associated with a specific cut-off value for tumour-free margin. Poor survival outcomes were observed with higher grade (p = 0.01), advanced FIGO stage (p < 0.001), HPV-independent cancer (p = 0.048), lymph node involvement (p < 0.001, HR = 7.14), extracapsular spread (p < 0.001, HR = 7.93), lymphovascular space invasion (p = 0.002, HR = 3.17), tumour diameter wider than 23 mm (p = 0.029, HR = 2.53) and depth of invasion more than 6 mm (p = 0.006, HR = 3.62). Perineural invasion is associated with shorter disease-free survival. Five-year cancer-specific survival rates for stages I, III, and IV were 90.2%, 40.8%, and 14.3%, respectively. CONCLUSION
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Affiliation(s)
- Ahmed Darwish
- Department of Obstetrics and Gynaecology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, OX3 9DU, Oxford, United Kingdom.
| | - Lamiese Ismail
- Department of Obstetrics and Gynaecology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, OX3 9DU, Oxford, United Kingdom.
| | - Sanjiv Manek
- Department of Gynaecological Oncology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, OX3 7LE, Oxford, United Kingdom.
| | - Karin Hellner
- Department of Obstetrics and Gynaecology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, OX3 9DU, Oxford, United Kingdom; Nuffield Department of Women's & Reproductive Health, Women's Center, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, OX3 9DU, Oxford, United Kingdom.
| | - Sean Kehoe
- Department of Gynaecological Oncology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, OX3 7LE, Oxford, United Kingdom.
| | - Hooman Soleymani Majd
- Department of Gynaecological Oncology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, OX3 7LE, Oxford, United Kingdom.
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Grimstad FW, Lee J. Overview of gender-affirming surgery. Pediatr Radiol 2024; 54:1363-1370. [PMID: 38349521 DOI: 10.1007/s00247-024-05874-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/30/2024] [Accepted: 01/30/2024] [Indexed: 07/18/2024]
Abstract
This publication will discuss the diversity of procedures that are common to those with intersex traits,/differences of sex development (I/DSD), and transgender and gender diverse (TGD) patients. It will address how these procedures are performed, and common after care and long-term considerations which are relevant to the pediatric radiologist. Some surgeries offered to these patient populations have shared surgical approaches and radiographic considerations. With the growth of TGD procedures as a field, more pediatric subspecialties are performing these procedures, and the approaches are informing the surgical care of the growing number of I/DSD individuals who are seeking surgery in adolescence and young adulthood. Surgeries discussed will include procedures to masculinize or feminize breast/chest tissue, facial bony contours, as well as internal and external genital structures. Patients are diverse and this includes their embodiment goals. As such, not all TGD and I/DSD patients will desire to undergo these procedures. It is important for radiologists to have a foundational understanding of this heterogenous set of procedures so they can provide optimal care for these patient populations.
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Affiliation(s)
- Frances W Grimstad
- Department of Surgery, Boston Children's Hospital Gynecology, 333 Longwood Avenue, Boston, MA, 02115, USA.
| | - Jessica Lee
- Department of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
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Aliabadi AR, Wilailak S, McNally O, Berek JS, Sridhar A. Contraceptive strategies for reducing the risk of reproductive cancers. Int J Gynaecol Obstet 2024; 166:141-151. [PMID: 38725288 DOI: 10.1002/ijgo.15567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Reproductive cancers, encompassing various malignancies like endometrial, ovarian, cervical cancer, and gestational trophoblastic neoplasia, pose a significant global health burden. Understanding their patterns is vital for effective prevention and management. Contraceptives show a protective effect against some of these cancers. This clinical guidance document aims to elucidate the disease burden of reproductive cancers and the evidence supporting contraceptive methods in prevention and management. Regional disparities in incidence and mortality highlight the urgent need for targeted interventions, particularly in low-resource settings. Healthcare providers must weigh individual risk profiles and medical eligibility criteria when discussing contraceptive options. Enhanced health literacy through direct patient education is essential for leveraging low-cost behavioral interventions to mitigate reproductive cancer risks.
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Affiliation(s)
- A R Aliabadi
- Department of Obstetrics, Gynecology and Reproductive Sciences, The University of California, San Francisco, San Francisco, California, USA
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
| | - Sarikapan Wilailak
- Department of Obstetrics and Gynecology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Orla McNally
- Department of Oncology and Dysplasia, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Jonathan S Berek
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California, USA
| | - Aparna Sridhar
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
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