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Ding C, Wei W, Ding F, Ding J, Li B, Ma Q. Ultrasound diagnostic of intrauterine adhesions: Systematic review and meta-analysis. J Obstet Gynaecol Res 2024. [PMID: 39030921 DOI: 10.1111/jog.16027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 07/10/2024] [Indexed: 07/22/2024]
Abstract
PURPOSE To summarize and compare the accuracy of transvaginal ultrasound (TVS), 3D-TVS, and sonohysterography (SHG) for the diagnosis of intrauterine adhesions (IUA). METHODS The computer searches databases such as web of science, Medline, EMBASE, and PubMed collecting diagnostic studies of IUA via ultrasound. The retrieval time was included from inception to January 1, 2023. Two researchers independently screened the literature, extracted information, and used RevMan 5.3 to complete an assessment of the risk of bias in the included literature. Meta-analysis of included studies using Stata 16.0 and Meta Disc 1.4 software. RESULTS Thirteen studies were included. The analysis results of 2D-TVS are The sensitivity (SEN): 0.54 (95% CI [0.28078]), specificity (SPE): 0.96 (95% CI [0.78, 0.99]), and the area (AUC) under the operating characteristic curve (SROC): 0.83 (95% CI [0.80, 0.86]); the SEN, SPE, and AUC of 3D-TVS are: 0.96 (95% CI [0.90, 0.98]), 0.84 (95% CI [0.68, 0.93]), 0.97 (95% CI [0.95, 0.98]); and the SEN, SPE, and AUC of SHG are: 0.74 (95% CI [0.53, 0.88]), 0.97 (95% CI [0.94, 0.99]), 0.95 (95% CI [0.93, 0.97]). CONCLUSION The current results show that the diagnostic value of 3D-TVS for IUA is better than SHG and significantly higher than that of 2D-TVS. However, the analysis of subgroups is still limited by the number of included studies. In order to better explore the application of ultrasound in intrauterine adhesion, more high-quality studies are needed in the future.
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Affiliation(s)
- Caiyun Ding
- Department of Basic Medical Science, Wannan Medical College, Wuhu, People's Republic of China
| | - Wei Wei
- Department of Ultrasound, First Affiliated Hospital of Wannan Medical College, Wuhu, People's Republic of China
| | - Fengzhi Ding
- Department of Basic Medical Science, Wannan Medical College, Wuhu, People's Republic of China
| | - Jin Ding
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Wannan Medical College, Wuhu, People's Republic of China
| | - Bozheng Li
- Department of Ultrasound, First Affiliated Hospital of Wannan Medical College, Wuhu, People's Republic of China
| | - Qiang Ma
- Department of Ultrasound, First Affiliated Hospital of Wannan Medical College, Wuhu, People's Republic of China
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Ichikawa M, Shiraishi T, Okuda N, Matsuda S, Nakao K, Kaseki H, Ichikawa G, Akira S, Toyoshima M, Kuwabara Y, Suzuki S. Feasibility of Predicting Surgical Duration in Endometriosis Using Numerical Multi-Scoring System of Endometriosis (NMS-E). Biomedicines 2024; 12:1267. [PMID: 38927474 PMCID: PMC11201286 DOI: 10.3390/biomedicines12061267] [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: 03/25/2024] [Revised: 05/14/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Endometriosis is a multifaceted gynecological condition that poses diagnostic challenges and affects a significant number of women worldwide, leading to pain, infertility, and a reduction in patient quality of life (QoL). Traditional diagnostic methods, such as the revised American Society for Reproductive Medicine (r-ASRM) classification, have limitations, particularly in preoperative settings. The Numerical Multi-Scoring System of Endometriosis (NMS-E) has been proposed to address these shortcomings by providing a comprehensive preoperative diagnostic tool that integrates findings from pelvic examinations and transvaginal ultrasonography. METHODS This retrospective study aims to validate the effectiveness of the NMS-E in predicting surgical outcomes and correlating with the severity of endometriosis. Data from 111 patients at Nippon Medical School Hospital were analyzed to determine the correlation between NMS-E scores, including E-score-a severity indicator-traditional scoring systems, surgical duration, blood loss, and clinical symptoms. This study also examined the need to refine parameters for deep endometriosis within the NMS-E to enhance its predictive accuracy for disease severity. RESULTS The mean age of the patient cohort was 35.1 years, with the majority experiencing symptoms such as dysmenorrhea, dyspareunia, and chronic pelvic pain. A statistically significant positive correlation was observed between the NMS-E's E-score and the severity of endometriosis, particularly in predicting surgical duration (Spearman correlation coefficient: 0.724, p < 0.01) and blood loss (coefficient: 0.400, p < 0.01). The NMS-E E-score also correlated strongly with the r-ASRM scores (coefficient: 0.758, p < 0.01), exhibiting a slightly more excellent predictive value for surgical duration than the r-ASRM scores alone. Refinements in the methodology for scoring endometriotic nodules in uterine conditions improved the predictive accuracy for surgical duration (coefficient: 0.752, p < 0.01). CONCLUSIONS Our findings suggest that the NMS-E represents a valuable preoperative diagnostic tool for endometriosis, effectively correlating with the disease's severity and surgical outcomes. Incorporating the NMS-E into clinical practice could significantly enhance the management of endometriosis by addressing current diagnostic limitations and guiding surgical planning.
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Affiliation(s)
- Masao Ichikawa
- Department of Obstetrics and Gynecology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo, Tokyo 113-8602, Japan; (N.O.); (S.M.); (K.N.); (M.T.); (Y.K.); (S.S.)
- Department of Obstetrics and Gynecology, Nippon Medical School Chiba Hokuso Hospital, 1715 Kamagari, Inzai, Chiba 270-1694, Japan; (T.S.); (H.K.); (G.I.)
| | - Tatsunori Shiraishi
- Department of Obstetrics and Gynecology, Nippon Medical School Chiba Hokuso Hospital, 1715 Kamagari, Inzai, Chiba 270-1694, Japan; (T.S.); (H.K.); (G.I.)
| | - Naofumi Okuda
- Department of Obstetrics and Gynecology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo, Tokyo 113-8602, Japan; (N.O.); (S.M.); (K.N.); (M.T.); (Y.K.); (S.S.)
| | - Shigeru Matsuda
- Department of Obstetrics and Gynecology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo, Tokyo 113-8602, Japan; (N.O.); (S.M.); (K.N.); (M.T.); (Y.K.); (S.S.)
| | - Kimihiko Nakao
- Department of Obstetrics and Gynecology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo, Tokyo 113-8602, Japan; (N.O.); (S.M.); (K.N.); (M.T.); (Y.K.); (S.S.)
| | - Hanako Kaseki
- Department of Obstetrics and Gynecology, Nippon Medical School Chiba Hokuso Hospital, 1715 Kamagari, Inzai, Chiba 270-1694, Japan; (T.S.); (H.K.); (G.I.)
| | - Go Ichikawa
- Department of Obstetrics and Gynecology, Nippon Medical School Chiba Hokuso Hospital, 1715 Kamagari, Inzai, Chiba 270-1694, Japan; (T.S.); (H.K.); (G.I.)
| | - Shigeo Akira
- Meirikai Tokyo Yamato Hospital, 36-3 Honcho Itabashi, Tokyo 173-0001, Japan;
| | - Masafumi Toyoshima
- Department of Obstetrics and Gynecology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo, Tokyo 113-8602, Japan; (N.O.); (S.M.); (K.N.); (M.T.); (Y.K.); (S.S.)
| | - Yoshimitu Kuwabara
- Department of Obstetrics and Gynecology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo, Tokyo 113-8602, Japan; (N.O.); (S.M.); (K.N.); (M.T.); (Y.K.); (S.S.)
| | - Shunji Suzuki
- Department of Obstetrics and Gynecology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo, Tokyo 113-8602, Japan; (N.O.); (S.M.); (K.N.); (M.T.); (Y.K.); (S.S.)
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Lamersdorf L, Tahmasbi Rad M, Karn T, Gasimli B, Bachmann A, Becker S, Gasimli K. Predictive factors for conversion to laparotomy in women undergoing laparoscopic hysterectomy. A re-evaluation of clinicopathological factors in the era of minimally invasive gynaecology. Facts Views Vis Obgyn 2024; 16:185-193. [PMID: 38950532 DOI: 10.52054/fvvo.16.2.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2024] Open
Abstract
Background Abdominal hysterectomy has been largely replaced by minimally invasive surgery. Nevertheless, in some situations, a minimally invasive intervention must be converted to laparotomy. Factors associated with conversion to laparotomy are still a matter of debate. Objective The aim of this study was to evaluate the clinicopathological factors associated with the conversion of laparoscopic hysterectomy to laparotomy. Materials and Methods The risk factors for conversion of a preplanned laparoscopic procedure to laparotomy were retrospectively evaluated in 441 patients undergoing a hysterectomy for a benign indication between 2016 and 2020. Associations between the clinical factors were analysed using Pearson's chi-square and Fisher's exact test, and predictive values for conversion were assessed through multivariate logistic regression. Result Conversion occurred in 32 (7.3%) of the cases. Significant differences were detected for uterus weight (576.9gr vs 174.6gr, p<0.001), myoma size (7.0 cm vs. 1.8 cm, p<0.001), and presence of triple diagnosis consisting of leiomyoma, adenomyosis uteri, and pathological adnexal findings (p<0.013). The conversion resulted in prolonged surgery time (181.6 min vs. 119.6 min, p<0.001) and hospital stay (4.0 vs. 3.1 days, p<0.001), as well as an increased rate of wound infection (15.6% vs. 3.4%, p<0.001). A 10g increase in uterus weight raised the risk of conversion by 7.0%, and a 1cm increase in myoma diameter by 7.3%, while adnexal pathologies and extensive adhesions increased the odds of conversion to laparotomy threefold (ORs of 3.2, 1.09-9.6 and 3.6, 1.3-10.0, respectively). Conclusion Uterus weight, myoma size, the coexistence of pathological adnexal findings, and non-physiological adhesions are independent risk factors for conversion. What is new? This study provides data regarding the risk and factors increasing this risk for conversion to laparotomy during laparoscopic hysterectomy.
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Sparić R, Andrić L, Guler O, Malvasi A, Babović I, Hatirnaz S, Dellino M, Tinelli A. Cesarean Myomectomy: Reflections on Clinical and Surgical Controversies between a New Trans-Decidual Technique vs. Traditional Method. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:609. [PMID: 38674255 PMCID: PMC11052397 DOI: 10.3390/medicina60040609] [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: 02/15/2024] [Revised: 04/04/2024] [Accepted: 04/06/2024] [Indexed: 04/28/2024]
Abstract
Up to 70-80% of women of reproductive age may be affected with the most common uterine tumors, known as fibroids or myomas. These benign tumors are the second most prevalent cause of surgery among premenopausal women. Predictions show that the occurrence of myomas in pregnancy will increase, and that the risk of having myomas during pregnancy increases with advanced maternal age. Although most women with fibroids do not experience any symptoms during pregnancy, up to 30% of women experience problems during pregnancy, childbirth, and the puerperium. The viability of myoma excision during cesarean surgery (CS) is a contentious issue raised by the rising incidence of myomas in pregnancy and CS rates. A new surgical procedure for removing fibroids using a trans-endometrial approach, which involves making an incision through the decidua itself, has put into doubt the long-standing practice of cesarean myomectomy (CM) with a trans-serosal approach. Some authors have recently advocated for this last approach, highlighting its advantages and potential uses in real-world situations. The purpose of this paper is to critique the present approach to cesarean myomectomy by analyzing the clinical and surgical distinctions between the two approaches and providing illustrations of the CM methods.
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Affiliation(s)
- Radmila Sparić
- Faculty of Medicine, University of Belgrade, Dr Subotića 8, 11000 Belgrade, Serbia;
- Clinic for Gynecology and Obstetrics, University Clinical Centre of Serbia, Dr Koste Todorovića 26, 11000 Belgrade, Serbia;
| | - Luka Andrić
- Clinic for Gynecology and Obstetrics, University Clinical Centre of Serbia, Dr Koste Todorovića 26, 11000 Belgrade, Serbia;
| | - Oguz Guler
- Department of Obstetrics and Gynecology, Private Asya Hospital, Yenimahalle mh. 537, St. No.5 Gaziosmanpasa, 34250 Istanbul, Turkey;
| | - Antonio Malvasi
- Department of Interdisciplinary Medicine (DIM), University of Bari, Aldo Moro, 70100 Bari, Italy; (A.M.); (M.D.)
| | - Ivana Babović
- Faculty of Medicine, University of Belgrade, Dr Subotića 8, 11000 Belgrade, Serbia;
- Clinic for Gynecology and Obstetrics, University Clinical Centre of Serbia, Dr Koste Todorovića 26, 11000 Belgrade, Serbia;
| | - Safak Hatirnaz
- Mediliv Medical Center, Kale, Mevlevihane Cd. No.11, 55100 Samsun, Turkey;
| | - Miriam Dellino
- Department of Interdisciplinary Medicine (DIM), University of Bari, Aldo Moro, 70100 Bari, Italy; (A.M.); (M.D.)
| | - Andrea Tinelli
- Department of Obstetrics and Gynecology, CERICSAL (CEntro di RIcerca Clinico SALentino), “Veris delli Ponti Hospital”, Via Giuseppina Delli Ponti, 73020 Scorrano, Italy;
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Ichikawa M, Shiraishi T, Okuda N, Nakao K, Shirai Y, Kaseki H, Akira S, Toyoshima M, Kuwabara Y, Suzuki S. Clinical Significance of a Pain Scoring System for Deep Endometriosis by Pelvic Examination: Pain Score. Diagnostics (Basel) 2023; 13:diagnostics13101774. [PMID: 37238258 DOI: 10.3390/diagnostics13101774] [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: 01/31/2023] [Revised: 05/09/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
Endometriosis-associated pain is an essential factor in deciding surgical indications of endometriosis. However, there is no quantitative method to diagnose the intensity of local pain in endometriosis (especially deep endometriosis). This study aims to examine the clinical significance of the pain score, a preoperative diagnostic scoring system for endometriotic pain that can be performed only with pelvic examination, devised for the above purpose. The data from 131 patients from a previous study were included and evaluated using the pain score. This score measures the pain intensity in each of the seven areas of the uterus and its surroundings via a pelvic examination using a numeric rating scale (NRS) which contains 10 points. The maximum value was then defined as the max pain score. This study investigated the relationship between the pain score and clinical symptoms of endometriosis or endometriotic lesions related to deep endometriosis. The preoperative max pain score was 5.93 ± 2.6, which significantly decreased to 3.08 ± 2.0 postoperatively (p = 7.70 × 10-20). Regarding preoperative pain scores for each area, those of the uterine cervix, pouch of Douglas, and left and right uterosacral ligament areas were high (4.52, 4.04, 3.75, and 3.63, respectively). All scores decreased significantly after surgery (2.02, 1.88, 1.75, and 1.75, respectively). The correlations between the max pain score and dysmenorrhea, dyspareunia, perimenstrual dyschezia (pain with defecation), and chronic pelvic pain were 0.329, 0.453, 0.253, and 0.239, respectively, and were strongest with dyspareunia. Regarding the pain score of each area, the combination of the pain score of the pouch of Douglas area and the VAS score of dyspareunia showed the strongest correlation (0.379). The max pain score in the group with deep endometriosis (endometrial nodules) was 7.07 ± 2.4, which was significantly higher than the 4.97 ± 2.3 score obtained in the group without (p = 1.71 × 10-6). The pain score can indicate the intensity of endometriotic pain, especially dyspareunia. A local high value of this score could suggest the presence of deep endometriosis, depicted as endometriotic nodules at that site. Therefore, this method could help develop surgical strategies for deep endometriosis.
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Affiliation(s)
- Masao Ichikawa
- Department of Obstetrics and Gynecology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo, Tokyo 113-8602, Japan
| | - Tatunori Shiraishi
- Department of Obstetrics and Gynecology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo, Tokyo 113-8602, Japan
| | - Naofumi Okuda
- Department of Obstetrics and Gynecology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo, Tokyo 113-8602, Japan
| | - Kimihiko Nakao
- Department of Obstetrics and Gynecology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo, Tokyo 113-8602, Japan
| | - Yuka Shirai
- Department of Obstetrics and Gynecology, Nippon Medical School, Chibe Hokuso Hospital, 1715 Kamagari, Inzai 270-1694, Chiba, Japan
| | - Hanako Kaseki
- Department of Obstetrics and Gynecology, Nippon Medical School, Chibe Hokuso Hospital, 1715 Kamagari, Inzai 270-1694, Chiba, Japan
| | - Shigeo Akira
- Meirikai Tokyo Yamato Hospital, 36-3 Honcho Itabashi, Tokyo 173-0001, Japan
| | - Masafumi Toyoshima
- Department of Obstetrics and Gynecology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo, Tokyo 113-8602, Japan
| | - Yoshimitu Kuwabara
- Department of Obstetrics and Gynecology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo, Tokyo 113-8602, Japan
| | - Shunji Suzuki
- Department of Obstetrics and Gynecology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo, Tokyo 113-8602, Japan
- Department of Obstetrics and Gynecology, Nippon Medical School, Musashikosugi Hospital, 1-383 Kosugicho, Nakahara, Kawasaki 211-8533, Kanagawa, Japan
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Ghobrial S, Ott J, Parry JP. An Overview of Postoperative Intraabdominal Adhesions and Their Role on Female Infertility: A Narrative Review. J Clin Med 2023; 12:jcm12062263. [PMID: 36983263 PMCID: PMC10051311 DOI: 10.3390/jcm12062263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
Postoperative intraabdominal adhesions can occur after more than 90% of gynecologic surgeries. They not only cause chronic pelvic pain and small bowel obstruction, but are also one of the main reasons for infertility. Adhesions are not only a burden for the affected patients, but are also a burden for the healthcare system, since the treatment of adhesion-associated complications costs a considerable amount of money. The gold standard for the diagnosis of adhesions is by laparoscopy, although other methods, such as transvaginal hydro-laparoscopy, are being discussed as better alternatives. Ideally, adhesions are avoided inherently, by operating carefully and by using microsurgical principles. If this is not possible, gel barriers have been shown to be successful in reducing postoperative adhesions.
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Affiliation(s)
- Stefan Ghobrial
- Clinical Division of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Johannes Ott
- Clinical Division of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, 1090 Vienna, Austria
- Correspondence: ; Tel.: +43-1-40400-28130
| | - John Preston Parry
- Parryscope and Positive Steps Fertility, Madison, Madison, WI 39110, USA
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, MS 39216, USA
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Advances in Imaging for Assessing Pelvic Endometriosis. Diagnostics (Basel) 2022; 12:diagnostics12122960. [PMID: 36552967 PMCID: PMC9777476 DOI: 10.3390/diagnostics12122960] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022] Open
Abstract
In recent years, due to the development of standardized diagnostic protocols associated with an improvement in the associated technology, the diagnosis of pelvic endometriosis using imaging is becoming a reality. In particular, transvaginal ultrasound and magnetic resonance are today the two imaging techniques that can accurately identify the majority of the phenotypes of endometriosis. This review focuses not only on these most common imaging modalities but also on some additional radiological techniques that were proposed for rectosigmoid colon endometriosis, such as double-contrast barium enema, rectal endoscopic ultrasonography, multidetector computed tomography enema, computed tomography colonography and positron emission tomography-computed tomography with 16α-[18F]fluoro-17β-estradiol.
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Suzuki N, Wakaki Y, Watanabe K, Kumasaka Y, Suzuki R. Difficulty in predicting intra‐abdominal adhesion before cesarean section: A case report. Clin Case Rep 2022; 10:e05643. [PMID: 35356188 PMCID: PMC8958188 DOI: 10.1002/ccr3.5643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/11/2022] [Accepted: 03/09/2022] [Indexed: 12/14/2022] Open
Abstract
Severe adhesions between the bladder and uterus necessitated an atypical incision in the cesarean section of a woman with endometriosis. This could not be predicted with pre‐surgery MRI. No methods in the literature are able to predict adhesions with true certainty; it is therefore still difficult to diagnose intra‐abdominal adhesions.
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Affiliation(s)
- Nanao Suzuki
- Department of Obstetrics and Gynecology Ohara General Hospital Fukushima Japan
| | - Yu Wakaki
- Department of Obstetrics and Gynecology Ohara General Hospital Fukushima Japan
| | - Kaori Watanabe
- Department of Obstetrics and Gynecology Ohara General Hospital Fukushima Japan
| | - Yukiko Kumasaka
- Department of Radiology Ohara General Hospital Fukushima Japan
| | - Rika Suzuki
- Department of Obstetrics and Gynecology Ohara General Hospital Fukushima Japan
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Vermeulen N, Abrao MS, Einarsson JI, Horne AW, Johnson NP, Lee TTM, Missmer S, Petrozza J, Tomassetti C, Zondervan KT, Grimbizis G, De Wilde RL. Endometriosis Classification, Staging and Reporting Systems: A Review on the Road to a Universally Accepted Endometriosis Classification. J Minim Invasive Gynecol 2021; 28:1822-1848. [PMID: 34690085 DOI: 10.1016/j.jmig.2021.07.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/08/2021] [Accepted: 07/08/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE In the field of endometriosis, several classification, staging and reporting systems have been developed. Which endometriosis classification, staging and reporting systems have been published and validated for use in clinical practice? DATA SOURCES A systematic PUBMED literature search was performed. Data were extracted and summarized. METHODS OF STUDY SELECTION na TABULATION, INTEGRATION AND RESULTS: Twenty-two endometriosis classification, staging and reporting systems have been published between 1973 and 2021, each developed for specific, and different, purposes. There still is no international agreement on how to describe the disease. Studies evaluating the different systems are summarized showing a discrepancy between the intended and the evaluated purpose, and a general lack of validation data confirming a correlation with pain symptoms or quality of life for any of the current systems. A few studies confirm the value of the ENZIAN system for surgical description of deep endometriosis. With regards to infertility, the endometriosis fertility index has been confirmed valid for its intended purpose. CONCLUSION Of the 22 endometriosis classification, staging and reporting systems identified in this historical overview, only a few have been evaluated for the purpose for which they were developed. The literature search was limited to PUBMED. Unpublished classification, staging or reporting systems, or those published in books were not considered. It can be concluded that there is no international agreement on how to describe endometriosis or how to classify it, and that most classification/staging systems show no or very little correlation with patient outcomes. This overview of existing systems is a first step in working towards a universally accepted endometriosis classification.
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Affiliation(s)
- Nathalie Vermeulen
- ESHRE, Central office (Dr. Vermeulen), Meerstraat 60, Grimbergen, BE 1852, Belgium
| | - Mauricio S Abrao
- Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia (Dr. Abrao), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil; Gynecologic Division, BP - A Beneficencia Portuguesa de Sao Paulo, Sao Paulo, Brazil
| | - Jon I Einarsson
- Brigham and Women's Hospital, Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery (Dr. Einarsson), Boston, MA, USA
| | - Andrew W Horne
- University of Edinburgh, MRC Centre for Reproductive Health (Dr. Horne), QMRI, 49 Little France Crescent, Edinburgh, UK EH16 4TJ
| | - Neil P Johnson
- Repromed Auckland, 105 Remuera Road, Remuera, Auckland (Dr. Johnson), New Zealand 1050
| | - Ted T M Lee
- Magee Womens Hospital of UPMC, Department of Obstetrics, Gynecology and Reproductive Sciences (Dr. Lee), Pittsburgh, PA, USA
| | - Stacey Missmer
- Michigan State University College of Human Medicine, Department of Obstetrics, Gynecology and Reproductive Biology (Dr. Missmer), East Lansing, MI, USA; Harvard University T H Chan School of Public Health, Department of Epidemiology, Boston, MA, USA; World Endometriosis Research Foundation, WERF, London, UK
| | - John Petrozza
- Massachusetts General Hospital Fertility Center, Department of Obstetrics and Gynecology (Dr. Petrozza), Boston, MA, USA
| | - Carla Tomassetti
- University Hospital Leuven, Department of Obstetrics and Gynaecology, Leuven University Fertility Centre (Dr. Tomassetti), Leuven, Belgium
| | - Krina T Zondervan
- University of Oxford, Oxford Endometriosis CaRe Centre, Nuffield Department of Women's & Reproductive Health (Dr. Zondervan), Oxford, Oxfordshire, UK; University of Oxford, Wellcome Centre for Human Genetics, Oxford, Oxfordshire, UK
| | - Grigoris Grimbizis
- Medical School, Aristotle University of Thessaloniki (Dr. Grimbizis), 1st Dept Obstet Gynecol, Tsimiski 51 Street, Thessaloniki, Greece 54623
| | - Rudy Leon De Wilde
- Carl von Ossietzky Universitat Oldenburg, University Hospital for Gynecology (Dr. De Wilde), Oldenburg, Germany.
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Vermeulen N, Abrao MS, Einarsson JI, Horne AW, Johnson NP, Lee TTM, Missmer S, Petrozza J, Tomassetti C, Zondervan KT, Grimbizis G, De Wilde RL. Endometriosis classification, staging and reporting systems: a review on the road to a universally accepted endometriosis classification . Hum Reprod Open 2021; 2021:hoab025. [PMID: 34693032 PMCID: PMC8530712 DOI: 10.1093/hropen/hoab025] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/11/2021] [Indexed: 12/14/2022] Open
Abstract
STUDY QUESTION Which endometriosis classification, staging and reporting systems have been published and validated for use in clinical practice? SUMMARY ANSWER Of the 22 endometriosis classification, staging and reporting systems identified in this historical overview, only a few have been evaluated, in 46 studies, for the purpose for which they were developed. WHAT IS KNOWN ALREADY In the field of endometriosis, several classification, staging and reporting systems have been developed. PARTICIPANTS/MATERIALS, SETTING, METHODS A systematic PUBMED literature search was performed. Data were extracted and summarized. MAIN RESULTS AND THE ROLE OF CHANCE Twenty-two endometriosis classification, staging and reporting systems have been published between 1973 and 2021, each developed for specific, and different, purposes. There still is no international agreement on how to describe the disease. Studies evaluating the different systems are summarized showing a discrepancy between the intended and the evaluated purpose, and a general lack of validation data confirming a correlation with pain symptoms or quality of life for any of the current systems. A few studies confirm the value of the ENZIAN system for surgical description of deep endometriosis. With regards to infertility, the endometriosis fertility index has been confirmed valid for its intended purpose. LARGE SCALE DATA NA. LIMITATIONS, REASONS FOR CAUTION The literature search was limited to PUBMED. Unpublished classification, staging or reporting systems, or those published in books were not considered. WIDER IMPLICATIONS OF THE FINDINGS It can be concluded that there is no international agreement on how to describe endometriosis or how to classify it, and that most classification/staging systems show no or very little correlation with patient outcomes. This overview of existing systems is a first step in working toward a universally accepted endometriosis classification. STUDY FUNDING/COMPETING INTEREST(S) The meetings and activities of the working group were funded by the American Association of Gynecologic Laparoscopists, European Society for Gynecological Endoscopy, European Society of Human Reproduction and Embryology and World Endometriosis Society. A.W.H. reports grant funding from the MRC, NIHR, CSO, Wellbeing of Women, Roche Diagnostics, Astra Zeneca, Ferring, Charles Wolfson Charitable Trust, Standard Life, Consultancy fees from Roche Diagnostics, AbbVie, Nordic Pharma and Ferring, outside the submitted work. In addition, A.W.H. has a patent Serum biomarker for endometriosis pending. N.P.J. reports personal fees from Abbott, Guerbet, Myovant Sciences, Vifor Pharma, Roche Diagnostics, outside the submitted work; he is also President of the World Endometriosis Society and chair of the trust board. S.M. reports grants and personal fees from AbbVie, and personal fees from Roche outside the submitted work. C.T. reports grants, non-financial support and other from Merck SA, non-financial support and other from Gedeon Richter, non-financial support from Ferring Pharmaceuticals, outside the submitted work and without private revenue. K.T.Z. reports grants from Bayer Healthcare, MDNA Life Sciences, Roche Diagnostics Inc, Volition Rx, outside the submitted work; she is also a Board member (Secretary) of the World Endometriosis Society and World Endometriosis Research Foundation, Research Advisory Board member of Wellbeing of Women, UK (research charity), and Chair, Research Directions Working Group, World Endometriosis Society. The other authors had nothing to disclose. TRIAL REGISTRATION NUMBER NA.
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Affiliation(s)
| | | | - Mauricio S Abrao
- Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.,Gynecologic Division, BP - A Beneficencia Portuguesa de Sao Paulo, Sao Paulo, SP, Brazil
| | - Jon I Einarsson
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA
| | - Andrew W Horne
- University of Edinburgh, MRC Centre for Reproductive Health, QMRI, Edinburgh, UK
| | | | - Ted T M Lee
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee Womens Hospital of UPMC, Pittsburgh, PA, USA
| | - Stacey Missmer
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University College of Human Medicine, East Lansing, MI, USA.,Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, MA, USA.,World Endometriosis Research Foundation, WERF, London, UK
| | - John Petrozza
- Department of Obstetrics and Gynecology, Massachusetts General Hospital Fertility Center, Boston, MA, USA
| | - Carla Tomassetti
- Department of Obstetrics and Gynaecology, University Hospital Leuven, Leuven University Fertility Centre, Leuven, Belgium
| | - Krina T Zondervan
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford Endometriosis CaRe Centre, Oxford, Oxfordshire, UK.,University of Oxford, Wellcome Centre for Human Genetics, Oxford, UK
| | - Grigoris Grimbizis
- 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Rudy Leon De Wilde
- Carl von Ossietzky Universitat Oldenburg, University Hospital for Gynecology, Oldenburg, Germany
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Yıldırım Karaca S, Kantarcı S, Adıyeke M, Bulut S, Özcan A, Rabia Şenkaya A, İleri A. Comparison of transendometrial myomectomy versus conventional myomectomy in cesarean section. Eur J Obstet Gynecol Reprod Biol 2021; 267:68-72. [PMID: 34731639 DOI: 10.1016/j.ejogrb.2021.10.019] [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: 09/19/2021] [Revised: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare the surgical results of transendometrial myomectomy (TEM) and conventional myomectomy (CM) procedures for fibroid in cesarean section. MATERIAL AND METHODS This retrospective study was conducted with computer-based medical records of patients who underwent myomectomy during cesarean section between January 2013 and March 2019. During the study period, 41 patients underwent transendometrial myomectomy, and 52 patients with had conventional myomectomy. In all patients included in the study, myoma was single, intramural, and localized in the anterior of the uterus. RESULTS The total duration of surgery was shorter in the TEM group than in the CM group (50,5 ± 10 min vs 63,6 ± 15,2, p = 0,001). There was no difference in terms of length of hospital stay, procedure-related hemoglobin difference, blood transfusion requirement and postoperative fever (respectively, p = 0,65, p = 0,81, p = 0,33 and p = 0,9). Patients who underwent TEM (0.58 ± 0.61) had significantly lower adhesion scores in their subsequent pregnancy compared to patients who underwent CM (1,76 ± 1,1) (p = 0,001). CONCLUSION Transendometrial myomectomy technique seems to be more advantageous in selected patients compared to the conventional technique due to the shorter operation time.
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Affiliation(s)
- Suna Yıldırım Karaca
- Izmir Tepecik Education and Reseach Hospital, Department of Obstetrics and Gynecology, Izmir, Turkey.
| | - Sercan Kantarcı
- Izmir Tepecik Education and Reseach Hospital, Department of Obstetrics and Gynecology, Izmir, Turkey
| | - Mehmet Adıyeke
- Izmir Tepecik Education and Reseach Hospital, Department of Obstetrics and Gynecology, Izmir, Turkey
| | - Sertaç Bulut
- Izmir Tepecik Education and Reseach Hospital, Department of Obstetrics and Gynecology, Izmir, Turkey
| | - Aykut Özcan
- Izmir Katip Celebi University, School of Medicine, Department of Obstetrics and Gynecology, Izmir, Turkey
| | - Ayşe Rabia Şenkaya
- Izmir Tepecik Education and Reseach Hospital, Department of Obstetrics and Gynecology, Izmir, Turkey
| | - Alper İleri
- Izmir Tepecik Education and Reseach Hospital, Department of Obstetrics and Gynecology, Izmir, Turkey
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Vermeulen N, Abrao MS, Einarsson JI, Horne AW, Johnson NP, Lee TTM, Missmer S, Petrozza J, Tomassetti C, Zondervan KT, Grimbizis G, De Wilde RL. Endometriosis classification, staging and reporting systems: a review on the road to a universally accepted endometriosis classification. Facts Views Vis Obgyn 2021; 13:305-330. [PMID: 34672508 PMCID: PMC9148706 DOI: 10.52054/fvvo.13.3.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background In the field of endometriosis, several classification, staging and reporting systems have been developed. However, endometriosis classification, staging and reporting systems that have been published and validated for use in clinical practice have not been systematically reviewed up to now. Objectives The aim of the current review is to provide a historical overview of these different systems based on an assessment of published studies. Materials and Methods A systematic Pubmed literature search was performed. Data were extracted and summarised. Results Twenty-two endometriosis classification, staging and reporting systems have been published between 1973 and 2021, each developed for specific and different purposes. There is still no international agreement on how to describe the disease. Studies evaluating different systems are summarised showing a discrepancy between the intended and the evaluated purpose, and a general lack of validation data confirming a correlation with pain symptoms or quality of life for any of the current systems. A few studies confirm the value of the Enzian system for surgical description of deep endometriosis. With regards to infertility, the endometriosis fertility index has been confirmed valid for its intended purpose. Conclusions Of the 22 endometriosis classification, staging and reporting systems identified in this historical overview, only a few have been evaluated, in 46 studies, for the purpose for which they were developed. It can be concluded that there is no international agreement on how to describe endometriosis or how to classify it, and that most classification/staging systems show no or very little correlation with patient outcomes. What is new? This overview of existing systems is a first step in working towards a universally accepted endometriosis classification.
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13
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Ovariopexy-Before and after Endometriosis Surgery. Biomedicines 2020; 8:biomedicines8120533. [PMID: 33255531 PMCID: PMC7759852 DOI: 10.3390/biomedicines8120533] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/12/2020] [Accepted: 11/19/2020] [Indexed: 11/17/2022] Open
Abstract
Endometriosis surgery is often very challenging. Key to complete resection of endometriosis is access to the retroperitoneum. Endometriosis can involve the ureter and uterine vessels, and ovary on the lateral pelvic wall makes retroperitoneal access difficult. Primary and post-surgical adhesions prevalence in endometriosis is very high. Ovariopexy, transposition of ovaries temporarily, is done for better surgical access and to reduce postoperative adhesions. We concluded that although limited evidence, ovariopexy is an excellent tool to aid endometriosis surgery and prevent postoperative adhesions. It is cost effective, simple and complication rate almost nil. More robust trials are required to substantiate evidence for its impact on preventing postoperative adhesions and its effect on fertility. In this review, we describe our technique of ovariopexy supplemented with a video, with the aim to put light on this useful and important technique, which is beneficial both for surgeons and patients.
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Hui Y, Zhao S, Gu J, Hang C. Analysis of factors related to fertility after endometriosis combined with infertility laparoscopic surgery. Medicine (Baltimore) 2020; 99:e20132. [PMID: 32481283 PMCID: PMC7249873 DOI: 10.1097/md.0000000000020132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/10/2020] [Accepted: 04/02/2020] [Indexed: 11/26/2022] Open
Abstract
To investigate the influence factors of laparoscopic postoperative pregnancy of patients with endometriosis and infertility, further validate the application of EFI scoring system in endometriosis, and to improve the pregnancy rate.A total of 258 patients with endometriosis and infertility who underwent laparoscopic surgery and follow-up treatment at Wuxi Maternal and Child Health Hospital from January 2015 to December 2016 were selected and divided into pregnant and non-pregnant groups according to whether they were pregnant. All patients were divided into 4 groups according to EFI score: group with EFI score ≥9, 7-8, 4-6, and <4, and divided into I, II, III, and IV groups according to AFS stages. The uterus-laparoscopic surgery was performed. The patients were followed up for 3 years. The factors affecting the pregnancy rate were analyzed. The pregnancy rate and pregnancy types were calculated at different time points.Multivariate analysis showed that age <35 years, infertility time <5 years, secondary infertility, EFI score, postoperative ART application were protection factors of postoperative pregnancy. The 3-year cumulative postoperative pregnancy rate was 75.6%. The cumulative pregnancy rate was 92.2% in group with EFI score ≥9, 85.9% in group with EFI score 7-8, 62.5% in group with EFI score 4-6 and 5.9% in group with EFI score <4, there was significant difference between the 4 groups (P < .05). The proportion of pregnancies in 6 months and 12 months was higher in patients with EFI score ≥7, 61.0% in patients with EFI score ≥9 and 41.1% in patients with EFI score ≥7. The highest natural pregnancy rate was 83.1% in group with EFI score ≥9, and there was significant difference between the 4 groups (P < .05).Age <35 years, infertility time <5 years, secondary infertility, EFI score and ART application were the protective factors of postoperative pregnancy. EFI score had positive significance in predicting and guiding the postoperative pregnancy of patients with endometriosis and infertility. According to EFI score, the pregnancy rate of patients with endometriosis and infertility can be significantly improved by strict management and active pregnancy program.
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Affiliation(s)
- Yuehong Hui
- Department of Obstetrics and Gynecology, The Affiliated Wuxi Matemity and Child Health Care Hospital of Nanjing Medical University, Wuxi, Jiangsu
| | - Shaojie Zhao
- Department of Obstetrics and Gynecology, The Affiliated Wuxi Matemity and Child Health Care Hospital of Nanjing Medical University, Wuxi, Jiangsu
| | - Jinsong Gu
- Zhengzhou Shengma Maternity Hospital, Zhengzhou, Henan, China
| | - Chen Hang
- Department of Obstetrics and Gynecology, The Affiliated Wuxi Matemity and Child Health Care Hospital of Nanjing Medical University, Wuxi, Jiangsu
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