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This article compares the use of ChatGPT, an artificial intelligence language model, with Google Search and institutional sources for providing postoperative patient instructions after gynecological surgery. The study analyzed instructions for five common procedures and evaluated their understandability and actionability using the Patient Education Materials Assessment Tool. The results showed that ChatGPT provided concise instructions with similar understandability scores compared to the other sources, but lower actionability scores and less information on concerning signs and symptoms. The study concludes that while ChatGPT can offer tailored responses, it may compromise patient safety by lacking specific actionable items and important instructions. [Extracted from the article]

Purpose: We aimed to describe the incidence and identify risk factors for the occurrence of short-term major posto-perative complications following colorectal resection for endometriosis. Methods: A cohort study using data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2012–2020. We included patients with a primary diagnosis of endometriosis who underwent colon or rectal resections for endometriosis. Results: Of 755 women who underwent colorectal resection, 495 (65.6%) had laparoscopic surgery and 260 (34.4%) had open surgery. The major complication rate was 13.5% (n = 102). Women who underwent open surgery had a higher proportion of major complications (n = 53, 20.4% vs. n = 49, 9.9%, p < 0.001). In a multivariable regression analysis, Black race (aOR 95%CI 2.81 (1.60–4.92), p < 0.001), Hispanic ethnicity (aOR 95%CI 3.02 (1.42–6.43), p = 0.004), hypertension (aOR 95%CI 1.89 (1.08–3.30), p = 0.025), laparotomy (aOR 95%CI 1.64 (1.03–3.30), p = 0.025), concomitant enterotomy (aOR 95%CI 3.02 (1.26–7.21), p = 0.013), and hysterectomy (aOR 95%CI 2.59 (1.62–4.15), p < 0.001) were independently associated with major post-operative complications. In a subanalysis of laparoscopies only, Hispanic ethnicity, chronic hypertension, lysis of bowel adhesions, and hysterectomy were independently associated with major complications. In a subanalysis of laparotomies only, Black race and hysterectomy were independently positively associated with the occurrence of major complications. Conclusion: This study provides a current population-based estimate of short-term complications after surgery for colorectal endometriosis in the USA. The identified risk factors for complications can assist during preoperative shared decision-making and informed consent process. [ABSTRACT FROM AUTHOR]

The Sonata System is a minimally invasive, ultrasound-guided transcervical fibroid ablation procedure for the management of symptomatic uterine fibroids. Since its approval by the US Food and Drug Administration in 2018, this procedure has demonstrated an excellent safety profile and postprocedure satisfaction rate. We present the case of a patient treated with Sonata, who subsequently developed bacterial sepsis and Asherman's syndrome—serious complications with long-term sequelae and implications for fertility. A nulligravid woman in her 40s presented in the outpatient setting with dysmenorrhea and bulk symptoms, with imaging showing an enlarged myomatous uterus compressing the urinary bladder. She desired minimally invasive, fertility-preserving management and underwent the Sonata procedure at an outside hospital. On postoperative day 3, she was admitted to our institution with abdominal pain, fever, tachycardia, and Enterococcus faecalis bacteremia. Despite 6 days of culture-directed antibiotic therapy, the patient remained septic with worsening symptoms and imaging findings and with persistent bacteremia. On hospital day 7, the patient underwent laparoscopic myomectomy and excision of hemorrhagic, infected myometrium. She recovered appropriately after surgery and was discharged home on hospital day 11 to continue 2 weeks of intravenous antibiotics. Nine months after myomectomy, the patient was diagnosed as having Asherman's syndrome. She subsequently had an early pregnancy loss with retained products of conception, requiring hysteroscopic lysis of adhesions and dilation and curettage. Ultimately, careful patient selection is critical for the optimal application of the Sonata procedure. Limiting the extent of fibroid necrosis after treatment is a reasonable goal to minimize the risk of secondary bacterial infection and adhesiogenesis as procedural sequelae. [ABSTRACT FROM AUTHOR]

The existing literature shows that the current obstetrics and gynecology residency training model is not able to produce proficiency in gynecologic surgery. As benign uterine and adnexal disorders become more complex with more treatment options and surgical routes available, new training and professional structures are needed to provide adequate surgical care to gynecologic patients. (J GYNECOL SURG 38:375) [ABSTRACT FROM AUTHOR]

In response to the COVID-19 pandemic, gynecologists have increased their use of telehealth services to expand access to care and minimize the need for in-person office-visits. While abnormal uterine bleeding (AUB) is the most-common complaint for patients presenting to gynecologic office visits, there is little research on the utility of telehealth in its management. A practical guide to managing AUB using telehealth services was developed for each of the common causes of AUB according to PALM-COEIN [polyp, adenomyosis, leiomyoma, malignancy and hyperplasia, coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, and not yet classified] nomenclature. Examples of applications in assessment include comprehensive history intake, electronic scheduling of transvaginal ultrasounds, laboratory work orders, patient counseling, and referrals to specialists. Telemedicine can also be incorporated into treatment of AUB. Preoperative consultations, prescribing medications (such as non–long-acting reversible hormonal contraceptives), and uncomplicated postoperative management can all be done via telehealth services. Telehealth can improve the efficiency of evaluation and treatment of AUB, including appropriate triage of patients and completing necessary workups needed prior to an in-person visit. Integration of telemedicine services may help overcome challenges with access to care such as geographical or resource limitations. (J GYNECOL SURG 38:344) [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to evaluate the effect of an Enhanced Recovery After Surgery (ERAS) protocol on patient experience after discharge from laparoscopic hysterectomy. Materials and Methods: Patients having laparoscopic hysterectomies by high-volume surgeons (>10 hysterectomies per year) at an urban tertiary-care hospital were divided into 2 cohorts: (1) a perioperative ERAS protocol adopted by the institution or (2) standard perioperative care according to the patient's surgeon. At the postoperative visit, each patient completed a validated questionnaire of self-reported recovery scores in domains of daily functional activities Results: There were 40 patients in the ERAS group and 44 in the standard perioperative care group, and 100% follow-up through the 2-week postoperative visits. Patients in both groups had similar rates of same-day discharges (88% versus 73%; p = 0.09). Both groups reported similar physical activity scores (1.38 versus 1.33; p = 0.79), days of first bowel movements (2.69 versus 2.71; p = 0.94), and days of opioid use after surgery (3.13 versus 2.64; p = 0.48). ERAS patients had fewer unplanned patient contacts than the standard care group (15% versus 50%; p < 0.01). There were no readmissions. Patients took few opioids, with 90% of all patients using <10 opioid tablets post surgery (5-mg oxycodone equivalents). Conclusions: Same-day discharge, patient-reported recovery experience, and opioid requirements did not differ between the ERAS protocol versus standard perioperative care. The ERAS protocol decreased unplanned patient contacts. [ABSTRACT FROM AUTHOR]

Fragmented tissue extraction (morcellation) of uterine and leiomyoma tissue in gynecologic surgery has been performed for decades, but recent years have seen a vast expansion of techniques to address risks associated with tissue dispersion. Use of power, or electromechanical, morcellation has largely been replaced by manual morcellation with a scalpel. Morcellation can take place through a laparoscopic incision, a minilaparotomy incision, or through a colpotomy. Containment systems are now available for both power and manual morcellation, allowing tissue fragmentation to take place within an enclosed specimen bag. These products require additional training and skill and may add operating time, but have the potential to mitigate risks associated with tissue dissemination. [ABSTRACT FROM AUTHOR]