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Objective: To compare vaginally‐assisted natural orifices endoscopic transluminal endoscopic surgery (vNOTES) hysterectomy with salpingectomy/salpingo‐oophorectomy with standard laparoscopic access. Methods: Medical records for patients undergoing hysterectomy with adnexectomy for benign disease indication between February 1, 2019 and February 1, 2020 were retrospectively examined. Exclusion criteria were endometriosis, previous pelvic radiotherapy, inflammatory pelvic disease history, any other concurrent surgery, laparotomy, robotic surgery, and/or traditional vaginal hysterectomy. Results: Among 86 patients, 21 (24.4%) were allocated to a vNOTES group and 65 (75.6%) were allocated to a conventional laparoscopy (LAP) group. Mean ages for the groups were 47.19 ± 11.11 years and 46.69 ± 9.11 years, respectively (P = 0.928). There were no statistically significant differences in age, body mass index, arterial hypertension/diabetes, smoking, menopausal status, obstetric history, number of abdominal surgeries, or preoperative hemoglobin level between the two groups. The mean (range) operative times were 111.90 min (80–180 min) in the vNOTES group and 113.98 min (64–350 min) in the LAP group (P = 0.904). There were no statistically significant differences in terms of surgery indication, specific and unspecific complications, conversions, blood transfusion, reoperation, significant ileus/emesis, and hospital stay. Conclusions: Based on the parameters assessed, we found vNOTES to be comparable to laparoscopy among our cohort. SYNOPSIS: Vaginal‐NOTES hysterectomy with adnexectomy was found to be comparable to laparoscopy in regard to each parameter we assessed. [ABSTRACT FROM AUTHOR]

Aim: To evaluate if the long‐term results (on fertility, need of hysterectomy and persistence of endometriosis) after a minimally invasive intervention (transvaginal ultrasound‐guided puncture‐aspiration [TUGPA]) for endometriomas are significantly different from performing the traditional conservative surgery (CS) by laparoscopy or laparotomy. Methods: We performed a retrospective study of cohorts on patients undergoing surgery for ovarian endometriomas between January 1998 and April 2015. Cohort 1 consisted of 75 women whose first intervention for endometriomas had been TUGPA. For the cohort 2, we selected a randomized paired case in which the first operation for endometriomas had been CS by laparoscopic or laparotomy (another set of 75 patients). Results: There were significantly more recurrences and the time to recurrence and repetition of operations were also significantly shorter in patients with TUGPA. However, there were no significant differences in overall pregnancy/delivery outcomes, in hysterectomy performances, or in endometriosis persistence at the last follow‐up visit. There were no significant differences related to the symptoms or to analytical presurgical values but the application of multivariate analysis with binary logistic regression to each dependent variable adjusted for age, symptoms, and presurgical analyses showed a significant risk of recurrence and reoperation of TUGPA versus CS. Conclusions: Those patients with endometriomas who underwent TUGPA (with or without associated medications) had a significant increase in recurrence and the need for reoperation. However, in the long‐term there were no significant differences in the results of pregnancy/childbirth, need for hysterectomy, or in the clinical or doubtful persistence of endometriosis. [ABSTRACT FROM AUTHOR]

Minimally invasive surgery for gynecologic cancers is associated with fewer postoperative complications including less blood loss and quicker recovery time compared to traditional laparotomy. The robotic platform has allowed patients access to minimally invasive surgery due to its increased utilization by gynecologic oncologists. Many surgeons have embraced the robotic platform due to its technological advances over traditional laparoscopy including high‐definition 3D optics, wristed instrumentation, camera stability and improved ergonomics. While robotic surgery continues as a mainstay in the management of gynecologic cancers, it remains controversial in regards to its cost effectiveness and more recently, its long‐term impact on clinical and oncologic outcomes. A strong component of the justification of this surgical platform is based on extrapolated data from traditional laparoscopy despite limited prospective randomized trials for robotic‐assisted surgery. In this review, we highlight the use of robotic surgery in the management of gynecologic cancers in special populations: fertility sparing patients, the morbidly obese, the elderly, and patients with a favorable response to neoadjuvant chemotherapy. [ABSTRACT FROM AUTHOR]

Abstract: In 2014, the US Food and Drug Administration issued a safety communication warning against the use of power morcellators during laparoscopic hysterectomy or myomectomy. We report a case of peritoneal leiomyosarcomatosis attributable to power morcellation. A 49‐year‐old nulligravid woman presented with a huge uterine tumor measuring 15 × 8 cm that was diagnosed as benign leiomyoma on magnetic resonance imaging. The uterine tumor had shrunk to 13 × 7 cm after five treatment courses with a gonadotropin‐releasing hormone agonist. She underwent laparoscopic hysterectomy using power morcellation; postoperative pathological diagnosis was benign leiomyoma. After 6 months, urinary ascites developed because of right ureteral rupture. She underwent laparotomy and was diagnosed with peritoneal leiomyosarcomatosis. Meticulous and thorough reevaluation of the morcellated specimens revealed a small component of leiomyosarcoma. Use of power morcellation should be minimized until the advent of novel methods that can perfectly differentiate benign from malignant uterine tumors preoperatively. [ABSTRACT FROM AUTHOR]

Objective To evaluate the efficacy and systematic impact of different sized endoscopes for pure transgastric natural orifice transluminal endoscopic surgery ( NOTES) peritoneoscopy relative to laparoscopy. Methods A total of 15 dogs were randomly assigned to the small-sized endoscope ( SS), large-sized endoscope ( LS) and standard laparoscopy ( SL) groups. The procedure time, visualization scores for abdominal organs, gastric incision healing times and procedure-associated complications were recorded. Blood samples were collected at 1 h preoperation and at 1 h, 12 h, 2 days and 7 days postoperation. Serum tumor necrosis factor ( TNF)-α and interleukin ( IL)-6 levels as well as peripheral white blood cell ( WBC) counts were analyzed. Results Peritoneoscopy was successfully performed with both pure transgastric NOTES and laparoscopy. The peritoneoscopy required less time to complete in the SL group (44.0 ± 7.0 min) than the LS (83.0 ± 28.9 min) and SS (106.6 ± 81.3 min) groups ( P < 0.01), but no statistical difference was observed between the SS and LS groups ( P > 0.05). The visualization scores of peritoneal organs among the three groups did not differ significantly ( P > 0.05). The gastric incision exhibited satisfactory healing in both the SS and LS groups. Moreover, serum TNF-α and IL-6 levels and WBC counts at each time point were similar among the three groups ( P > 0.05). Conclusions Small-sized endoscope is not superior to a large-sized one for pure transgastric NOTES peritoneoscopy. Pure transgastric NOTES is not less invasive or less time-consuming than laparoscopy. [ABSTRACT FROM AUTHOR]

Uterine fibroids are the most common benign tumors in the female reproductive tract during the reproductive years. Among the options in the treatment spectrum, myomectomy is always considered one of the best choices in the management of women with symptomatic uterine fibroids who wish to preserve future fertility. Myomectomy through conventional exploratory laparotomy may be the most familiar surgical approach. However, with the advances being made in techniques and instruments, there are many alternative approaches to myomectomy, including mini-laparotomy, ultramini-laparotomy, laparoscopy, laparoscopy-aided, and vaginal and hysteroscopic approaches. The focus of this review article is limited to discussing the use of the ultramini-laparotomy approach to completing myomectomy in the management of the uterine fibroids. [ABSTRACT FROM AUTHOR]

In order to reduce the risk of visceral injury for patients with upper abdominal adhesions, we devised an alternative to the umbilical approach. Five patients who had undergone a previous upper abdominal laparotomy and were scheduled for gynecologic laparoscopic surgeries at our hospital were evaluated. A micro-trocar was inserted via the posterior vaginal fornix and the periumbilicus was observed using a micro-laparoscope inserted in the micro-trocar. A trocar for conventional laparoscopy was inserted into the umbilicus under micro-laparoscopic observation in the cul-de-sac to avoid visceral organ adherent to the periumbilicus. Four cases had adhesions of the transverse colon, small bowel or omentum to the upper abdomen due to previous surgery; however, we were able to accomplish laparoscopic surgery without injury to adhesive organs in all patients. The micro-laparoscopic primary approach via the posterior vaginal fornix is a safe primary approach for patients who have undergone a previous upper abdominal laparotomy. [ABSTRACT FROM AUTHOR]

Natural orifice transluminal endoscopic surgery (NOTES) is an emerging experimental alternative to conventional surgery. NOTES eliminates abdominal incisions and incision-related complications by combining endoscopic and laparoscopic techniques to diagnose and treat abdominal pathology. Since the first NOTES was reported by Kalloo et al. in 2004, significant achievements in the laboratory have occurred. Clinical use in humans has been limited, but several cases and one small clinical trial were published recently. As a further technical revolution in minimally invasive surgery, NOTES has the promising potential to be safer, less invasive, provide better cosmesis and possibly be more cost-effective. The purpose of the present article was to review the development and current status of NOTES and highlight important advances associated with this innovative approach. [ABSTRACT FROM AUTHOR]

Background: The da Vinci Surgical Robotic System is being increasingly used to perform complex urological operations by minimally invasive techniques. Prior abdominal surgery associated with intra-abdominal adhesions may complicate robotic surgery. Methods: We used a cohort of consecutive 49 patients undergoing a variety of robotic urological procedures at our institution to study the impact of prior abdominal operations on early perioperative complications. Results: A total of 21/49 (43%) patients (Group A) had no history of prior abdominal surgery and the rest 28/49 (57%; Group B) had undergone prior abdominal surgery. The incidence of peritoneal adhesions was significantly higher in patients with prior abdominal surgery compared to the rest of the cohort, 54% versus 10% ( P = 0.002). The median operative time, estimated blood loss, postoperative drop in hemoglobin, time to hospital discharge, postoperative narcotic analgesic use and postoperative complication rate between group A and group B were not statistically different. The overall perioperative complication rate for the entire cohort was 14.3%, with 6–8% of complications occurring in each of the two groups ( P = 1.0). Comparative subset analysis of 28 patients in Group B, 15 (54%) and 13 (46%) with or without intra-abdominal adhesions did not reveal a significant difference in perioperative complication rates either. However, operative time was longer in patients with intra-abdominal adhesions compared to patients without, median of 590 (281-922) and 434 (153–723) min respectively, although not statistically significant ( P = 0.059). Conclusion: Our study demonstrates that robotic urological surgery can be performed in patients with prior abdominal surgery without increased perioperative complications. [ABSTRACT FROM AUTHOR]

The article discusses the video that shows the laparoscopic repair of an incarcerated obturator hernia on a 68-year-old woman with a virgin abdomen. Topics discussed include reduction of loop of incarcerated small bowel with gentle traction, introduction of small polypropylene mesh folded and fixed with suture in the middle for an hourglass shape via the umbilical port into the hernia defect, and safety and feasibility of laparoscopic approach for emergency obturator hernia repair.