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Objective: To evaluate the safety and feasibility of the new surgical robot HUGO robotic assisted surgery (RAS) in a series of gynecologic surgical procedures. Methods: Between March and October 2022, 138 patients treated at Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy were enrolled in the study. All patients suitable for a minimally‐invasive approach were prospectively included and divided into two groups: Group 1 (78 patients) made up of patients operated on for uterine and/or adnexal pathologies, and Group 2 (60 patients) made up of patients treated for pelvic organ prolapse. Results: In Group 1, median docking time (DT) was 5 min and median console time (CT) was 90 min. In two patients (2.6%) redocking was necessary. In two patients (2.6%), the surgeon continued the surgery laparoscopically. Intraoperative complications occurred in two surgeries (2.6%). In Group 2, median DT was 4 min and median CT was 134.5 min. In three patients (5%), redocking was necessary. In all patients, the surgery was successfully completed robotically without intraoperative complications. Conclusions: The present study demonstrates that the new HUGO RAS system for gynecologic surgery is safe with good results in terms of surgical efficacy and perioperative outcomes. Further studies are needed to investigate its use in other technical and surgical aspects. Synopsis: The new robotic system HUGO RAS is safe with good results in terms of surgical efficacy and perioperative outcomes. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Introduction: Hysterectomy is one of the most common major gynecological surgeries, and it is performed for benign and malignant reasons. Currently, five types of hysterectomies are described: vaginal (VH), abdominal (AH), laparoscopic (LH), robotic, and vNOTES (vaginal natural orifice transluminal endoscopic surgery). This paper compares these two types of surgery in obese patients by analyzing the surgeries performed by our team. Materials and methods: The research was conducted from January 2022 to December 2023 at the Department of Gynecology and Obstetrics of the General Hospital in Zadar. The study included female patients aged 18–75 years with a BMI > 30 kg/m2, regardless of parity, who were operated on for benign pathology. Results: There were 24 patients included in total. One conversion was observed in the TLH group because of excessive bleeding. Median operative time (IQR) was significantly lower in the vNOTES group (p < 0.05) than in the TLH group 35 (10.9) vs 125 (74.0) min. Conclusion: The results concerning the duration of surgery, conversion rate, and postoperative bleeding and complications show that vNOTES hysterectomies seem to be feasible for obese patients. Further studies are needed to confirm these observations. [ABSTRACT FROM AUTHOR]

Simple Summary: The impact of a prior cervical excisional procedure on the oncologic outcomes of patients with early-stage cervical cancer undergoing radical hysterectomy is not established. Smaller retrospective studies suggest that conization prior to the performance of radical hysterectomy may be associated with lower risk of tumor relapse, especially for patients undergoing minimally invasive hysterectomy. We utilized a large hospital-based database and identified patients with FIGO 2009 stage IB1 disease who had primary surgical treatment. Approximately one in three patients had a prior excisional procedure performed within 3 months of radical surgery. We demonstrated that the performance of an excisional procedure prior to radical hysterectomy may be associated with better overall survival. For patients who had a prior excisional procedure, minimally invasive surgery was not associated with worse overall survival compared to laparotomy even after controlling for confounders. Objective: To investigate the impact of a prior cervical excisional procedure on the oncologic outcomes of patients with apparent early-stage cervical carcinoma undergoing radical hysterectomy. Methods: The National Cancer Database (2004–2015) was accessed, and patients with FIGO 2009 stage IB1 cervical cancer who had a radical hysterectomy with at least 10 lymph nodes (LNs) removed and a known surgical approach were identified. Patients who did and did not undergo a prior cervical excisional procedure (within 3 months of hysterectomy) were selected for further analysis. Overall survival (OS) was evaluated following the generation of Kaplan–Meier curves and compared with the log-rank test. A Cox model was constructed to control a priori-selected confounders. Results: A total of 3159 patients were identified; 37.1% (n = 1171) had a prior excisional procedure. These patients had lower rates of lymphovascular invasion (29.2% vs. 34.9%, p = 0.014), positive LNs (6.7% vs. 12.7%, p < 0.001), and a tumor size >2 cm (25.7% vs. 56%, p < 0.001). Following stratification by tumor size, the performance of an excisional procedure prior to radical hysterectomy was associated with better OS even after controlling for confounders (aHR: 0.45, 95% CI: 0.30, 0.66). The rate of minimally invasive surgery was higher among patients who had a prior excisional procedure (61.5% vs. 53.2%, p < 0.001). For these patients, performance of minimally invasive radical hysterectomy was not associated with worse OS (aHR: 1.37, 95% CI: 0.66, 2.82). Conclusions: For patients undergoing radical hysterectomy, preoperative cervical excision may be associated with a survival benefit. For patients who had a prior excisional procedure, minimally invasive radical hysterectomy was not associated with worse overall survival. [ABSTRACT FROM AUTHOR]

Introduction: Salpingitis is caused by ascending microbes from the lower reproductive tract and contributes to tubal factor infertility, ectopic pregnancy, and chronic pelvic pain. The aim of this study was to analyze if the risk for complications and dissatisfaction after hysterectomy and adnexal surgery was increased in women reporting previous salpingitis. Material and methods: This is an observational cohort study including women undergoing gynecologic surgery from 1997 to 2020, registered in the Swedish National Quality Register of Gynecologic Surgery (GynOp). Patient‐reported previous salpingitis was the exposure. Complications up to 8 weeks and satisfaction at 1 year postoperatively were the outcomes. Multivariable logistic regression and ordinal regression were performed. Results were adjusted for potential confounders including age, body mass index, smoking and year of procedure as well as endometriosis and previous abdominal surgery. Multiple imputation was used to handle missing data. Results: In this study, 61 222 women were included, of whom 5636 (9.2%) women reported a previous salpingitis. There was an increased risk for women reporting previous salpingitis in both the unadjusted and fully adjusted models to have complications within 8 weeks of surgery (adjusted odds ratio [aOR] 1.22, 95% confidence interval [CI] 1.14–1.32). The highest odds ratios were found for bowel injury (aOR 1.62, 95% CI 1.29–2.03), bladder injury (aOR 1.52, 95% CI 1.23–1.58), and postoperative pain (aOR 1.37, 95% CI 1.22–1.54). Women exposed to salpingitis were also more likely to report a lower level of satisfaction 1 year after surgery compared with unexposed women (aOR 0.87, 95% CI 0.81–0.92). Conclusions: Self‐reported salpingitis appears to be a risk factor for complications and dissatisfaction after gynecologic surgery. This implies that known previous salpingitis should be included in the risk assessment before gynecologic procedures. [ABSTRACT FROM AUTHOR]

Background: To date, there remains a paucity of present-day literature on the topic of demographics and the biopsy-proven pathological positivity rate of endometriosis. Objective: The goal of this study was to explore the association between patients' demographics and other concomitant gynecological conditions or procedures and the pathological positivity rate of excision of endometriosis. Design: Retrospective cohort study. Methods: All women >18 years old who underwent laparoscopic surgery for endometriosis at a tertiary care hospital from October 2011 to October 2020. Women were classified into two groups: (1) Study group: women with >80% pathological positivity rate of endometriosis and (2) Control group: women with <80% pathological positivity rate. Results: A total of 401 women were included in the analysis. No difference was noted in the 80% pathological positivity rate based on body mass index [BMI; 68.7% in normal BMI versus 80% in underweight, versus 74.5% in overweight, and 74.1% in obese patients (p = 0.72)]. The percentage of patients reaching 80% pathological positivity of endometriosis was lower in women who had undergone previous laparoscopy for endometriosis compared to surgery naïve women (66.5% versus 76.5%, p = 0.03). In addition, a higher percentage of women who underwent concomitant hysterectomy (83.5% versus 68.8% for non-hysterectomy, p = 0.005) or bilateral oophorectomy (92.7% versus 70.0% for non-oophorectomy, p = 0.002) reached 80% pathological positivity. Women with an associated diagnosis of fibroids (79.7% versus 70.5%) or adenomyosis (76.4% versus 71.7%) were more likely to reach 80% pathological positivity compared to women without any other coexisting pathology; however, the observed differences were not statistically significant. After applying a log-binomial regression model, compared to White non-Hispanics, Hispanic patients were 30% less likely to reach 80% positivity (RR: 0.70, 95% CI: 0.49–1.02), although not statistically significant. Conclusion: No significant racial difference was found when comparing the rates of 80% pathological positivity of suspected endometriosis lesions among groups. Endometriosis pathological positivity rate was unaffected by patients' BMI and the presence of concomitant pathologies. In addition, prior laparoscopic surgery for endometriosis might cause tissue changes that result in a decrease in the observed pathological positivity rate of endometriosis lesions during subsequent surgeries. [ABSTRACT FROM AUTHOR]

Purpose: One of the most challenging tasks in laparoscopic gynecological surgeries is suturing. Knotless barbed sutures are intended to enable faster suturing and hemostasis. We carried out a meta-analysis to compare the efficacy and safety of V-Loc™ barbed sutures (VBS) with conventional sutures (CS) in gynecological surgeries. Methods: We systematically searched PubMed and EMBASE for studies published between 2010 and September 2021 comparing VBS to CS for OB/GYN procedures. All comparative studies were included. Primary analysis and subgroup analyses for the different surgery and suturing types were performed. Primary outcomes were operation time and suture time; secondary outcomes included post-operative complications, surgical site infections, estimated blood loss, length of stay, granulation tissue formation, and surgical difficulty. Results were calculated as weighted mean difference (WMD) or risk ratio (RR) and 95% confidence intervals (CI) with a random effects model, and a sensitivity analysis for study quality, study size, and outlier results was performed. PROSPERO registration: CRD42022363187. Results: In total, 25 studies involving 4452 women undergoing hysterectomy, myomectomy, or excision of endometrioma. VBS were associated with a reduction in operation time (WMD – 17.08 min; 95% CI – 21.57, – 12.59), suture time (WMD – 5.39 min; 95% CI – 7.06, – 3.71), surgical site infection (RR 0.26; 95% CI 0.09, 0.78), estimated blood loss (WMD – 44.91 ml; 95% CI – 66.01, – 23.81), granulation tissue formation (RR 0.48; 95% CI 0.25, 0.89), and surgical difficulty (WMD – 1.98 VAS score; 95% CI – 2.83, – 1.13). No difference between VBS and CS was found regarding total postoperative complications or length of stay. Many of the outcomes showed high heterogeneity, likely due to the inclusion of different surgery types and comparators. Most results were shown to be robust in the sensitivity analysis except for the reduction in granulation tissue formation. Conclusion: This meta-analysis indicates that V-Loc™ barbed sutures are safe and effective in gynecological surgeries as they reduce operation time, suture time, blood loss, infections, and surgical difficulty without increasing post-operative complications or length of stay compared to conventional sutures. [ABSTRACT FROM AUTHOR]

Objective: History of cesarean section (CS) can affect future hysterectomy; however most studies on this include all routes of hysterectomy. This study aimed to evaluate the effect of history of CS on laparoscopic and robotic hysterectomies by minimally invasive gynecologic surgery (MIGS) fellowship-trained surgeons. Materials and Methods: This retrospective, cross-sectional study was of patients who had laparoscopic hysterectomy at a single tertiary-care center in the southeastern United States. A convenience sample was collected of all patients who underwent laparoscopic hysterectomy with a MIGS-trained surgeon from 2016 to 2019. Primary outcomes were estimated blood loss (EBL), operative time, and intra- and postoperative complication rates, including blood transfusions, conversion to laparotomy, vascular or visceral injury, surgical-site complications, and emergency-room visits. Measures were compared between patients with a history of CS and those without a history of CS, using χ2 and Student's t-tests. Log-linear models with constant coefficient of variation and logistic-regression models adjusted for body mass index (BMI) were used to estimate the association between history of CS and surgical outcomes. Results: A total of 484 hysterectomies were included. 152 patients had at least 1 CS and 332 did not have any CS. There were no significant demographic differences between the groups. In patients with a history of CS, 69 (45%) had 1, 52 (34%) had 2, and 30 (21%) had 3 or more prior CS. When comparing the cohort with a history of CS and the cohort without a history of CS, log-linear and logistic regression models adjusted for BMI did not show any difference between EBL (mean 62 mL versus 57 mL), operative time (mean 152 minutes versus 148 minutes), or total complication rate (27% versus 25%). There was no relationship between number of prior CS and operative outcomes. Conclusions: Neither a history of any CS nor the total number of prior CS affected EBL, operative time, or intraoperative or postoperative complications of laparoscopic hysterectomies performed by MIGS-trained surgeons. This can be helpful for counseling patients and setting expectations of surgical complexity and complication risks. (J GYNECOL SURG 40:156) [ABSTRACT FROM AUTHOR]

Study Objective: To investigate diverse hysterectomy techniques to determine their influence on patient outcomes, including pain levels, sexual function, anxiety, and quality of life. Of particular focus is the comparison between vessel sealing and traditional suturing in abdominal, vaginal, and laparoscopic hysterectomies. This study is unique in its comprehensive evaluation, considering patient satisfaction, recommendation rates, recovery times, and various other aspects. Method: Our prospective cohort study adhered to ethical guidelines, involving a meticulous assessment of patients, including medical history, anxiety levels, pelvic pain, sexual function, and quality of life. Surgical methods were explained to patients, allowing them to actively participate in the decision-making process. Sociodemographic information was collected, and exclusion criteria were applied. Hysterectomy methods included total abdominal hysterectomy (TAH), laparoscopic hysterectomy (TLH), vaginal hysterectomy (VH), and a modified vaginal technique known as VH Mujas. Several parameters were recorded, including operation indications, uterine volume, hospital stay, operation duration, pre-operative and post-operative complications, and more. Results: In all groups, a statistically significant increase was found in pre-operative–post-operative FSFI sexual function values (p < 0.001). The patient's basal Beck Anxiety Scale scores significantly decreased following the decision for vaginal surgery, both in the VH and VH Mujas groups (p < 0.05). However, Beck Anxiety Scale scores at patients' initial assessments significantly increased following the decision for abdominal and laparoscopic surgery (p < 0.001). According to the results of the SF-36 quality of life assessment, an increase was observed in all post-operative quality of life parameters in patients who underwent surgery with different methods due to VH (p < 0.05). Conclusions: Our comprehensive comparison of hysterectomy techniques demonstrated that VH, particularly when utilizing the Mujas technique, outperforms other hysterectomy methods regarding patient safety and post-operative satisfaction but also offers the benefit of minimal invasiveness. Notably, this is reflected in improved quality of life, enhanced sexual function, lower pain scores, and favorable cosmetic results. The success of a hysterectomy procedure depends on precise indications, surgical planning, proper patient selection, and effective communication. This study emphasizes the significance of these factors in achieving optimal outcomes. The development of specialized vascular closure devices can further enhance the feasibility of vaginal hysterectomy, making it a preferable choice in gynecological surgery. The study contributes valuable insights into selecting the most suitable hysterectomy method for patients and optimizing their recovery. [ABSTRACT FROM AUTHOR]

Objective: To compare surgical outcomes in patients with benign diseases who underwent laparoscopically assisted vaginal hysterectomy (LAVH) to determine the association between surgical outcomes and resident participation in the gynecologic field. Methods: A single‐center retrospective study was conducted of patients diagnosed with benign gynecologic diseases who underwent LAVH between January 2010 and December 2015. Clinicopathologic characteristics and surgical outcomes were compared between the resident involvement and non‐involvement groups. The primary endpoint was the 30‐day postoperative morbidity. Observers were propensity matched for 17 covariates for resident involvement or non‐involvement. Results: Of the 683 patients involved in the study, 165 underwent LAVH with resident involvement and 518 underwent surgery without resident involvement. After propensity score matching (157 observations), 30‐day postoperative morbidity occurred in 6 (3.8%) and 4 (2.5%) patients in the resident involvement and non‐involvement groups, respectively (P = 0.501). The length of hospital stay differed significantly between the two groups: 5 days in the resident involvement group and 4 days in the non‐involvement group (P < 0.001). On multivariate analysis, Charlson Comorbidity Index >2 (odds ratio [OR] 8.01, 95% confidence interval [CI] 2.68–23.96; P < 0.001), operative time (OR 1.02, 95% CI 1.01–1.03; P < 0.001), and estimated blood loss (OR 1.00, 95% CI 1.00–1.00; P < 0.001) were significantly associated with 30‐day morbidity, but resident involvement was not statistically significant. Conclusion: There was no significant difference in the 30‐day morbidity rate when residents participated in LAVH. These findings suggest that resident participation in LAVH may be a viable approach to ensure both residency education and patient safety. Synopsis: Trainee involvement in hysterectomy. [ABSTRACT FROM AUTHOR]

Background: Hysterectomy is the commonest gynecological surgery in females. The aim of this study was to assess the effect of doing hysterectomy with ovarian conservation on the ovarian function. Methods: It was an observational cross-sectional study which was conducted in the department of obstetrics and gynecology, Zagazig University Hospitals on 80 cases scheduled to undergo hysterectomy with ovarian preservation due to benign condition during the period from August 2015 to August 2018. Participants were subjected to assessment of ovarian function by ultrasonographic assessment of ovarian volume, morphology and hormonal levels pre-operative and postoperative. The research was accepted by the Institutional Review Board of the Faculty of Medicine in Zagazig University. The research was done according to the Code of Ethics of the World Medical Association (Declaration Helsinki) for Studies involving humans. Results: There was a statistically non-significant decrease in FSH level preoperatively to one month postoperatively that significantly increased again three months postoperatively.. There was a non-significant difference between right ovarian volume preoperatively and one month postoperatively. There was a significant difference between right ovarian volume preoperatively and three months postoperatively. Conclusions: we concluded that there was no evidencve of adverse effect on the ovarian function of the conserved ovaries 3 months after doing hysterectomy in premenopausal patients as by hormonal and U/S criteria. [ABSTRACT FROM AUTHOR]

Objectives: To determine the effectiveness of early operative management of patients with Vesicovaginal fistula (VVF) secondary to benign gynecological surgeries. Material and methods: It is a descriptive case series of 70 patients selected from August 2018 to Oct 2022. All patients meeting inclusion criteria had routine lab investigations, imaging, cystoscopy, and vaginoscopy. The suprapubic approach described by O'Conor et al; was used. All surgeries were performed between the 4th and 6th weeks after the onset of the fistula to allow some time for tissue healing. All patients were followed after 2 weeks; a cystogram was performed to document fistula closure followed by removal of Foleys catheter. A second follow-up was at 3 months, patients were assessed with patient global impression of improvement score (PGI-I) for improvement in symptoms. Results: The mean age of the patients was 40.6 ± 10.2 years. 14(19.7%) patients were primipara while 56 (78.9%) patients were multipara. The mean fistula size was 11.5 ± 4.5mm. Supra-trigonal fistulas were more common than trigonal fistulas 43(60.6%) vs 27(38%). Hysterectomy (including cesarean hysterectomy and simple hysterectomy) was the commonest cause of VVF followed by cesarean section and difficult labor 33(46.5% vs 21(29.6) vs 12(16.9%). The overall mean operative time was 125.3 ± 10.7 minutes. The mean hospital stay was 3.8 ± 0.8 days. The fistula was successfully closed in 64 (90.1%) patients while 6 (9.9%) patients had failed surgery. The small-size fistulas (5-10mm) had a higher success rate of closure than larger fistulas (11-20mm) with statistical significance (p=0.02). Over 63 (90 %) patients responded PGI score below 3 with much improvement in symptoms. Conclusion: Our results show that early operative management of VVF secondary to benign gynecological and obstetric surgeries is feasible and effective. It also improves the symptoms of patients with PGI-I score. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to compare introduced robotic‐assisted hysterectomy (RAH) and skilled total laparoscopic hysterectomy (TLH) for the treatment of benign gynecological diseases. Methods: Patients who underwent RAH or TLH by two surgeons at the Tottori University Hospital between January 2018 and May 2022 were included in this retrospective study. Inclusion criteria were patients with 100–300 g of uterine weight. The exclusion criteria were patients with stage IV endometriosis. Mean operative time and learning curve were compared among the first‐half RAH, second‐half RAH, and TLH groups. Results: There were 40 eligible cases (first‐half RAH: 20 cases, second‐half RAH: 20 cases) in the RAH group and 44 cases in the TLH group. The total operative time (TOT) of the second half of RAH was significantly shorter than that of the first half of RAH (p = 0.021) and was comparable to that of the TLH group. The operative time (OT) of the second half of RAH was shorter than that of TLH (p = 0.023). The preparation time of TLH was shorter than that of the RAH group (p < 0.01). The learning curve of the TOT in RAH crossed that of TLH on the 31st case of RAH. In contrast, both curves of the OT crossed on the 11th case of RAH. Conclusion: The TOT of the introduced RAH was equivalent to that of skilled TLH in approximately 30 cases since the first RAH. Furthermore, the OT of RAH was comparable to that of TLH in approximately 10 cases of surgery since the first RAH. [ABSTRACT FROM AUTHOR]

Introduction: The primary aim of this study was to determine the incidence of patient‐reported pain 1 year after hysterectomy for benign gynecological conditions in relation to occurrence of preoperative pain. The secondary aim was to analyze clinical risk factors for pain 1 year after the hysterectomy in women with and without preoperatively reported pelvic/lower abdominal pain. Material and methods: This was a historical cohort study using data from the Swedish National Quality Registry for Gynecological Surgery on 16 694 benign hysterectomies. Data were analyzed using multivariable logistic regression models. Results: One year after surgery, 22.4% of women with preoperative pain reported pelvic pain and 7.8% reported de novo pelvic pain. For those with preoperative pain younger age (adjusted odds ratio [aOR] 1.75, 95% confidence interval [CI] 1.38–2.23 and aOR 1.21, 95% CI 1.10–1.34 for women aged <35 and 35–44 years, respectively), not being gainfully employed (aOR 1.43, 95% CI 1.26–1.63), pelvic pain as the main symptom leading to hysterectomy (aOR 1.51, 95% CI 1.19–1.90), endometriosis (aOR 1.18, 95% CI 1.06–1.31), and laparoscopic hysterectomy (aOR 1.30, 95% CI 1.07–1.58), were clinically relevant independent risk factors for pelvic/lower abdominal pain 1 year after surgery, as were postoperative complications within 8 weeks after discharge. Meanwhile, clinically relevant independent risk factors for reporting de novo pain 1 year after surgery were younger age (aOR 2.05, 95% CI 1.08–3.86 and aOR 1.29, 95% CI 1.04–1.60 for women aged <35 and 35–44 years, respectively), and postoperative complications within 8 weeks after discharge. Conclusions: The incidence of pelvic pain and de novo pain 1 year after hysterectomy was relatively high. Women with and without reported preoperative pelvic/lower abdominal pain represented clinically different populations. The risk factors for pelvic pain seemed to differ in these two populations. The differences in risk factors could be taken into consideration in the preoperative counseling and in the decision‐making concerning method of hysterectomy, provided that large well‐designed studies confirm these risk factors. [ABSTRACT FROM AUTHOR]

Objective: This study evaluated the 1-year outcome of laparoscopic high uterosacral-ligament suspension (HULS) of the apical vault following total laparoscopic hysterectomy (TLH) in women with uterine prolapse stage 2 or higher. Methods: Women (N = 11) with pelvic organ prolapse (POP) underwent TLH and laparoscopic HULS between 2018 and 2021. (HULS is shown in a supplementary video.) POP degree was assessed preoperatively via the Pelvic Organ Prolapse Quantification (POP-Q) tool. Successful surgery was: (1) anatomical cure with POP-Q points Aa, Ba, C, Ap, or Bp, less than stage 2 (< 1 cm above the hymen ([–1]) (2) improvement in subjective satisfaction scores on the Pelvic Floor Impact Questionnaire-7 (PFIQ-7). Follow-up time was 12 months with assessment of anatomical outcomes via the POP-Q, and patient satisfaction measured with the PFIQ-7. Results: Mean POP-Q point C improved from 0 to −8.6 cm at 1 year post-laparoscopic HULS. There were no major intraoperative or postoperative complications (e.g., ureteric or rectal injuries, or massive blood losses needing transfusions). PFI-Q-7 scores improved (mean preoperative 135 versus mean 1 year postoperative 0; p = 0.003); this was statistically significant. Conclusions: Laparoscopic HULS of the apical vault following TLH seems to be a highly successful procedure for treating uterine prolapse, although further evaluation with higher-powered studies are needed. Prerequisites to perform laparoscopic HULS safely include familiarity with anatomy of the ureterosacral ligament and its proximity to vital structures as well as surgical expertise in ureterolysis. (J GYNECOL SURG 39:240) [ABSTRACT FROM AUTHOR]

Objective: This study evaluated outcomes following hysterectomies performed for benign indications in surgeries that meet criteria for complexity, compared to those that did not. Materials and Methods: This retrospective study of hysterectomies performed for benign indications compared outcomes in surgeries deemed complex versus noncomplex. Surgery was defined as complex if one or more of the following factors were present: uterine weight >250 g; surgical history of 2 prior cesarean deliveries; or prior laparoscopy or laparotomy for abdominal myomectomy, endometriosis resection, lysis of adhesions, or other surgery on a pelvic organ. Surgeon-level factors were evaluated, including minimally invasive hysterectomy (MIH) use, postoperative length of stay (LOS), and complication rates. Results: From January 2017 to August 2021, 833 women had hysterectomies for benign indications; 603 hysterectomies were complex. These hysterectomies by low-volume surgeons were more likely to have complications than by high-volume surgeons (15.6% versus 5.4%; p < 0.001). These operations by high-volume surgeons were more-frequently MIH (83.4% versus 48.7%; p = 0.009), had fewer blood losses ≥500 mL (1.2% versus 8.0%; p < 0.001), and were less likely to need overnight admissions (74.9% versus 94.5%; p < 0.001). Conclusions: Complex hysterectomies performed for benign indications by high-volume gynecologic surgeons lead to fewer complications and shorter LOS, and are more likely to be performed with a minimally invasive approach. (J GYNECOL SURG 39:229) [ABSTRACT FROM AUTHOR]

Objective: To determine the effectiveness of implementing an Enhanced Recovery After Surgery (ERAS) program, including continuous intraoperative and postoperative intravenous (IV) lidocaine infusion, on perioperative opioid use. Methods: This was a single-institution retrospective pre- post- cohort study. Consecutive patients undergoing planned laparotomy for known or potential gynecologic malignancy were identified after implementation of an ERAS program and compared to a historical cohort. Opioid use was calculated as morphine milligram equivalents (MMEs). Cohorts were compared using bivariate tests. Results: A total of 215 patients were included in the final analysis, 101 patients received surgery before ERAS implementation and 114 received surgery after. A reduction in total opioid use was observed in ERAS patients compared with historical controls (MME 26.5 [9.6-60.8] versus 194.5 [123.8-266.8], p<0.001). Length of stay (LOS) was reduced by 25% in the ERAS cohort (median 3 days, range 2-26, versus 4 days, range 2-18; p<0.001). Within the ERAS cohort, 64.9% received IV lidocaine for the planned 48 hours, and 5.6% had the infusion discontinued early. Within the ERAS cohort, patients who received IV lidocaine infusion used less opioids compared to those who did not (median 16.9, range 5.6-55.1, versus 46.2, range 23.2-76.1; p<0.002). Conclusion: An ERAS program including a continuous IV lidocaine infusion as the opioidsparing analgesic strategy was noted to be safe and effective, leading to decreased opioid consumption and LOS compared with a historic cohort. Additionally, lidocaine infusion was noted to decrease opioid consumption even among patients already receiving other ERAS interventions. [ABSTRACT FROM AUTHOR]

Purpose: The most prevalent and aggressive subtype of epithelial ovarian carcinoma (EOC), high-grade serous carcinoma (HGSC), originates in many cases from the fallopian tubes. Because of poor prognosis and lack of effective screening for early detection, opportunistic salpingectomy (OS) for prevention of EOC is being implemented into clinical routine in several countries worldwide. Taking the opportunity of a gynecological surgery in women at average cancer risk, extramural fallopian tubes are completely resected preserving the ovaries with their infundibulopelvic blood supply. Until recently, only 13 of the 130 national partner societies of the International Federation of Obstetrics and Gynecology (FIGO) have published a statement on OS. This study aimed to analyze the acceptance of OS in Germany. Methods: (1) Survey of German gynecologists in 2015 and 2022 by the Department of Gynecology of the Jena University Hospital in co-operation with the Department of Gynecology at Charité-University Medicine Berlin with support of NOGGO e. V. and AGO e. V. (2) Salpingectomy numbers in Germany for years 2005–2020 as retrieved from the Federal Statistical Office of Germany (Destatis). Results: (1) Survey: Number of participants was 203 in 2015 and 166 in 2022, respectively. Nearly all respondents (2015: 92%, 2022: 98%) have already performed bilateral salpingectomy without oophorectomy in combination with benign hysterectomy with the intention to reduce the risk for malignant (2015: 96%, 2022: 97%) and benign (2015: 47%, 2022: 38%) disorders. Compared to 2015 (56.6%), considerably more survey participants performed OS in > 50% or in all cases in 2022 (89.0%). Recommendation of OS for all women with completed family planning at benign pelvic surgery was approved by 68% in 2015 and 74% in 2022. (2) Case number analysis: In 2020, four times more cases of salpingectomy were reported by German public hospitals compared to 2005 (n = 50,398 vs. n = 12,286). Of all inpatient hysterectomies in German hospitals in 2020, 45% were combined with salpingectomy, and more than 65% in women at the age of 35 to 49 years. Conclusion: Mounting scientific plausibility regarding involvement of fallopian tubes in the pathogenesis of EOC led to change of clinical acceptance of OS in many countries including in Germany. Case number data and widespread expert judgment demonstrate that OS has become a routine procedure in Germany and a de facto standard for primary prevention of EOC. [ABSTRACT FROM AUTHOR]

Objective: This study quantified the COVID-19 pandemic's impact on same-day discharges for minimally invasive hysterectomy and evaluated the effect on postoperative morbidity and health care use. Materials and Methods: This retrospective cohort study, from March 2018 to October 2021 at a single institution, included women older than age 18 who had laparoscopic, vaginal, or robotic-assisted hysterectomy by any gynecologic surgeon. Primary outcome was rate of same-day hospital discharge. Secondary measures were length of stay and rates of 30-day postoperative morbidity and health care use. Univariate and multivariable logistic regression analyses were conducted to evaluate associations between patients' characteristics and likelihood of same-day discharge. Results: There were 1608 women included, 896 in a prepandemic cohort and 712 in a postpandemic cohort. Surgeon subspecialty rates were similar between groups, but surgical approaches differed, with more laparoscopic procedures in the postpandemic cohort (p = 0.007). Case order and lengths, and concurrent procedures were not different between groups. Postpandemic patients were more likely to be discharged on the same day even after controlling for confounders in a multivariable regression (32% versus 54%, respectively; odds ratio: 2.78; p < 0.001). Rates of 30-day postoperative complications, transfusions, emergency department visits, readmissions, reoperations, and mortality were not significantly different. Conclusions: The COVID-19 pandemic was associated with increased same-day discharges without increases in 30-day postoperative complications. The data confirmed that same-day discharge following minimally invasive hysterectomy was safe for managing hospital constraints caused by the COVID-19 pandemic. (J GYNECOL SURG 39:170) [ABSTRACT FROM AUTHOR]

The surgical management of placenta accreta spectrum (PAS) is often challenging. There are a variety of techniques and management options described in the literature ranging from uterine sparing to cesarean hysterectomy. Following the inaugural meeting of the Pan-American Society for Placenta Accreta Spectrum a multidisciplinary group collaborated to describe collective recommendations for the surgical management of PAS. In this manuscript, we outline individual components of the procedure and provide suggested direction at key points of a cesarean hysterectomy in the setting of PAS. Key Points The surgical management of PAS requires careful planning and expertise. Multidisciplinary team care for pregnancies complicated by PAS can decrease morbidity and mortality. Careful surgical techniques can minimize risk of significant hemorrhage by avoiding pitfalls. [ABSTRACT FROM AUTHOR]

Asymptomatic hydronephrosis following hysterectomy is generally transient. Here, we present the case of a 52‐year‐old woman who underwent total abdominal hysterectomy and bilateral salpingo‐oophorectomy for benign indications. Computed tomography (CT) to examine bleeding on the second postoperative day incidentally revealed bilateral grade II hydronephrosis. Asymptomatic hydronephrosis was not reevaluated, and gynecological outpatient follow‐up was terminated with a normal creatinine level on postoperative day 43. On postoperative day 107, the patient noticed weight gain of 10 kg, decreased urine output, and generalized edema. The serum creatinine level was elevated to 5.4 mg/dL, and CT revealed bilateral grade III hydronephrosis. Urgent bilateral ureteral stenting was performed to treat stenosis of the distal ureters that caused postrenal failure. Ureteroneocystostomy was performed for strict stenosis of the right ureter at 10 months postoperatively. Histological examination of the resected distal ureter showed inflammation and fibrosis. Asymptomatic hydronephrosis developing after hysterectomy progress to delayed postrenal failure. [ABSTRACT FROM AUTHOR]

Objective: To compare the perioperative outcomes of patients undergoing abdominal hysterectomies for leiomyomas before and after the implementation of an enhanced recovery after surgery (ERAS) protocol in a teaching hospital. Methods: This prospective cohort study compared a patient group from a historical series (pre‐ERAS) with another group after ERAS implementation. Fasting time, length of hospital stay, complications, readmission rates, and procedure‐related hospital costs were analyzed. Results: Altogether, 187 patients were included in the analysis: 92 (49.2%) and 95 (50.8%) in the pre‐ERAS and ERAS groups, respectively. Both groups had similar clinical characteristics. We observed reductions in surgical outcome findings: fasting time (13.9 to 6.7 h, P < 0.001), bladder catheter usage (21.1 to 10.9 h, P < 0.001), infection rates (20.7% to 5.3%, P = 0.002), length of stay (57.5 to 37.6 h), and 38.4% of the total estimated mean cost per procedure (USD $1570.8 to USD $967.2, P < 0.001) in the pre‐ERAS and ERAS groups, respectively. Hospital readmission rates (P > 0.99) did not increase. Conclusion: ERAS protocol implementation for hysterectomies involving uterine leiomyomas reduced the length of hospital stay, surgical site infection rates, and hospital costs. A mean savings of USD $603.6 per procedure would allow 62.4% more hysterectomies to be performed. Synopsis: The modified enhanced recovery after surgery protocol for gynecological surgery reduced the length of hospital stay, the surgical site infection rate, and overall hospital costs. [ABSTRACT FROM AUTHOR]

Background: Minimally invasive hysterectomy is a common gynecologic procedure. Numerous studies have found that a same day discharge (SDD) is safe following this procedure. Research has found that SDDs decrease resource strain, nosocomial infections, and financial burden for both the patient and healthcare system. Due to the recent COVID‐19 pandemic, the safety of hospital admissions and elective surgeries was called into question. Objective: To assess the rates of SDD among patients who underwent a minimally invasive hysterectomy before and during the COVID‐19 pandemic. Study Design: A retrospective chart review was performed from September 2018 to December 2020 on 521 patients, who met inclusion criteria. Descriptive analysis, chi‐square tests of association, and multivariable logistic regression were used for analysis. Results: There was a significant difference between rate of SDDs pre‐COVID‐19 (12.5%) versus during the COVID‐19 period (28.6%) (p < 0.001). Surgical complexity was predictive of not being discharged the same day of surgery (odds ratio [OR] = 4.4, 95% confidence interval [CI] = 2.2–8.8), as was surgical completion time after 4 p.m. (OR = 5.2, 95% CI = 1.1–25.2). There was no difference in readmissions (p = 0.209) and emergency department (ED) visits (p = 0.973) between SDD and overnight stay. Conclusion: Rates of SDD for patients undergoing minimally invasive hysterectomy were significantly increased during the COVID‐19 pandemic. SDDs are safe; the number of readmissions and ED visits did not increase among patients who were discharged on the same day. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to describe, from a historical perspective, the relevance, resilience and outcomes of vaginal hysterectomy (VH) in gynecology in the age of technological scenario. Methods: The authors searched records from January 2011 to January 2021 on the following databases: Medline, EMBASE, and CENTRAL (The Cochrane Library) for combinations of the terms "vaginal hysterectomy," "outcomes" AND "history"; and before that period, if the search had historical relevance. Inclusion criteria: randomized clinical trials; hysterectomy performed for benign gynecological conditions; and VH outcomes compared with Abdominal Hysterectomy (AH), Laparoscopic Hysterectomy (LH) or Robotic Hysterectomy (RH). Results: The VH combines sequences of reproducible techniques which have been developed over the years to safely and effectively overcome the limitations of difficult cases of vaginal extirpation from the uterus. Conclusion: The authors support endoscopic surgical approaches in complex surgery for benign indications, urogynecology, and gynecologic oncology when appropriate. However, what makes the gynecological surgeon different from the general surgeon is the vaginal access. It is essential to continue to train residents in vaginal surgical skills and provide safe and cost-effective patient care. The art of technology is the resilience of keeping only the patient at the center of innovation. [ABSTRACT FROM AUTHOR]

Introduction. Sexual life has a major importance in a woman’s life during premenopause and beyond. Hysterectomy for benign conditions is a frequent surgical intervention in gynecology, indicated for benign reasons. That can cause various issues regarding physical and psychological well-being, both physical and psychological. Materials and method. In our study, we chose 50 patients who had total hysterectomy with bilateral adnexectomy in a period of one year. They were interviewed using a telephone questionnaire, which included questions about the sexual life before and after the operation. Results. The study revealed preoperative symptoms such as metrorrhagia (43%), menorrhagia (39%), pelvic-abdominal pain (24%), secondary anemia (20%) and other related symptoms (2%). After the surgery, the sexual life was affected, and the patients complained about anxiety in 25% of cases, pain during sexual contact (13%), vaginal dryness (6%), bleeding during or after sexual contact (4%) and anorgasmia (2%). However, most of the patients declared that their sex life was not affected after the surgical intervention (62%), while the rest (38%) answered affirmatively. Conclusions. The low quality of sexual life can lead to changes in behavior, in the perception of her own body, to lower self-esteem and subsequently to a lower quality of life, but this is not significantly affected by hysterectomy. [ABSTRACT FROM AUTHOR]

• In the study's random sample of women aged 18 to 50 years who resided in Olmsted County between 1988 and 2007, median age was 51 years for spontaneous and 46 years for induced menopause. • The frequency of premature spontaneous or induced menopause was 3.1 %. • Bilateral oophorectomy was the most common cause of premature menopause. • Hysterectomy with at least one ovary conserved concealed the onset of menopause. • Gynecologic surgeries for benign conditions should be reduced. There is limited information on the prevalence of premature and early menopause. Therefore, we studied the frequency and type of premature (age < 40 years) or early (age 40–44 years) menopause in a geographically-defined American population. We studied a random sample of women aged 18 to 50 years who resided in Olmsted County, MN between 1988 and 2007. Women were followed through December 2021, and age at cessation of menses was assessed via review of the medical records included in a medical records-linkage system. Menopause was defined as cessation of menses due to spontaneous or induced ovarian insufficiency. 1015 women (71.3 %) underwent spontaneous menopause, 138 (9.7 %) underwent bilateral oophorectomy, 17 (1.2 %) had antecedent chemotherapy or radiation therapy, and 254 (17.8 %) underwent hysterectomy or endometrial ablation. The median age at cessation of menses was 51.0 years (IQR, 49.0–52.0) for spontaneous menopause, 46.0 years (IQR, 41.0–49.0) for menopause induced by oophorectomy, chemotherapy, or radiation therapy, and 38.0 years (IQR, 33.0–44.0) for hysterectomy. Considering both spontaneous and induced menopause, the frequency was 3.1 % (95 % CI, 2.2–4.2) for premature and 6.2 % (95 % CI, 5.0–7.8) for early menopause. Considering only spontaneous menopause, the frequency reduced to 0.4 % (95 % CI, 0.2–1.0) for premature and 5.2 % (95 % CI, 4.0–6.8) for early menopause. However, considering all types of cessations of menses, the frequency was 12.2 % (95 % CI, 10.6–14.0) for premature and 9.7 % (95 % CI, 8.3–11.3) for early cessation of menses. Approximately 3 % of women in the general population experienced either spontaneous or induced premature menopause. The most common cause of premature menopause was bilateral oophorectomy. [ABSTRACT FROM AUTHOR]

Purpose: The use of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) as the first choice of surgical route for patients scheduled to undergo conventional laparoscopy is still being debated. We aimed to evaluate and compare the outcomes of the "vNOTES first" strategy in benign gynecological cases. Methods: All benign gynecological surgeries were initiated using vNOTES during the study period, regardless of the difficulty. Surgical outcomes, short-term patient satisfaction and sexual pain were compared between hysterectomies, adnexal and diagnostic procedures. Visual Analog Score (VAS), Patients Global Impressions of Improvements scale (PGI-I) and Female Sexual Function Index (FSFI) were used to assess the postoperative pain, satisfaction and sexual pain, respectively. Results: A total of 105 vNOTES procedures were performed during the study period: 63 (60.58%) adnexal procedures, 36 (34.62%) hysterectomies, 5 (4.81%) diagnostic procedures and one (0.96%) myomectomy. The median 24th hour VAS scores for adnexal, hysterectomy, and diagnostic procedures were 1.29 ± 1.41, 2.06 ± 2.08, and 2.6 ± 2.41, respectively. The satisfaction rate was 96.19% at the 1st postoperative week and 97.14% at the first month. There was either no change or a slight improvement in the patients' total score on the FSFI/pain domain before and after surgery. There were two conversions (1.9%) from vNOTES to laparoscopy and laparotomy, and two (5.56%) bladder injuries in hysterectomy cases. Conclusion: Implementing the vNOTES technique as an initial approach for all benign gynecological surgeries seems feasible, safe and satisfactory, even in those with a non-prolapsed or enlarged uterus and those that have previously undergone abdominal surgery. The pain scores were found to be low and patients stated a high satisfaction with no or better change in their sexual life. [ABSTRACT FROM AUTHOR]

On average, patients use 15 or fewer 5-mg oxycodone tablets (or equivalent) in the 2 weeks after discharge for major gynecologic surgery for benign indications. OBJECTIVE: To assess the amount of opioid medication used by patients and the prevalence of persistent opioid use after discharge for gynecologic surgery for benign indications. DATA SOURCES: We systematically searched MEDLINE, EMBASE, and ClinicalTrials.gov from inception to October 2020. METHODS OF STUDY SELECTION: Studies with data on gynecologic surgical procedures for benign indications and the amount of outpatient opioids consumed, or the incidence of either persistent opioid use or opioid-use disorder postsurgery were included. Two reviewers independently screened citations and extracted data from eligible studies. TABULATION, INTEGRATION, AND RESULTS: Thirty-six studies (37 articles) met inclusion criteria. Data were extracted from 35 studies; 23 studies included data on opioids consumed after hospital discharge, and 12 studies included data on persistent opioid use after gynecologic surgery. Average morphine milligram equivalents (MME) used in the 14 days after discharge were 54.0 (95% CI 39.9–68.0, seven tablets of 5-mg oxycodone) across all gynecologic surgery types, 35.0 (95% CI 0–75.12, 4.5 tablets of 5-mg oxycodone) after a vaginal hysterectomy, 59.5 (95% CI 44.4–74.6, eight tablets of 5-mg oxycodone) after laparoscopic hysterectomy, and 108.1 (95% CI 80.5–135.8, 14.5 tablets of 5-mg oxycodone) after abdominal hysterectomy. Patients used 22.4 MME (95% CI 12.4–32.3, three tablets of 5-mg oxycodone) within 24 hours of discharge after laparoscopic procedures without hysterectomy and 79.8 MME (95% CI 37.1–122.6, 10.5 tablets of 5-mg oxycodone) from discharge to 7 or 14 days postdischarge after surgery for prolapse. Persistent opioid use occurred in about 4.4% of patients after gynecologic surgery, but this outcome had high heterogeneity due to variation in populations and definitions of the outcome. CONCLUSION: On average, patients use the equivalent of 15 or fewer 5-mg oxycodone tablets (or equivalent) in the 2 weeks after discharge after major gynecologic surgery for benign indications. Persistent opioid use occurred in 4.4% of patients who underwent gynecologic surgery for benign indications. Our findings could help surgeons minimize overprescribing and reduce medication diversion or misuse. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42020146120. [ABSTRACT FROM AUTHOR]

Background: Addition of adjuvants to routinely used intrathecal drugs is cornerstone in safe and effective prolongation of single shot spinal block for gynecological surgery. In resource deficient countries, where epidural anesthesia is usually not used because of cost factor, adjuvants are routinely used to prolong the effect of regional anesthesia. Alpha 2 agonists are considered best drugs as adjuvants, but there is inconclusive data in literature about the block characteristic, dose at which to be used and side effect after use of these drugs. Methods: Clonidine 30 µgm or dexmedetomidine 5 µgm was used intrathecally as an adjuvant with 15 mg bupivacaine 0.5% in 90 female patients undergoing gynecological surgery in this randomized, prospective, single blind study. Results: The mean time to onset of sensory block a (T6 level) and time to attain maximum sensory height were significantly early in group D over group C (124.44 ± 20.64 s, 175.09 ± 68.01 s, p < 0.0001) and (13.53 ± 2.97 min, 18.64 ± 4.82 min, p < 0.0001)respectively. Time to two segment sensory regression, total duration of analgesia, duration of motor blockade was (115.24 ± 8.9 min, 370.60 ± 17.98 min, 316.67 ± 21.39 min) in group D and (103.58 ± 11.25 min, 323.91 ± 23 min, 273.51 ± 18.95 min) in group C respectively (p < 0.001). The post-operative visual analogue scale score (VAS) was more in group C at 240 min onwards (p ≤ 0.01). Analgesic use and intraoperative complications were similar in both the groups. (p > 0.05). Conclusions: We recommend clonidine 30 µg over dexmedetomidine 5 µg as an adjuvant to intrathecal bupivacaine, to effectively and safely prolong the effect of single shot spinal anesthesia. [ABSTRACT FROM AUTHOR]

The article offers clinical studies related to minimally invasive surgery procedures in urogynecology. Topics include information on laparoscopic sacrocolpopexy (LSC), a standard procedure of laparoscopic mesh surgery which is expected to increase as a treatment for pelvic organ prolapse (POP) due to entering an aged society; and Robotic-assisted sacrocolpopexy (RSC) is considered convenient and is expected to have a certain impact on minimally invasive POP surgery.

Mesonephric‐like carcinoma histologically resembles mesonephric adenocarcinoma (MA) of the cervix. MA arises from mesonephric duct remnants. However, the origin of mesonephric‐like carcinoma is not extensively studied because of its rarity. Here, we present a case of synchronous ovarian and uterine mesonephric‐like carcinoma that potentially arose from endometrioid adenofibroma. A 69‐year‐old woman presented with an abdominal mass with no genital bleeding. She underwent simple total abdominal hysterectomy and bilateral adnexal resection. Histological and immunohistochemical analyses were consistent with mesonephric‐like carcinoma involving both ovaries and the uterus. Endometrioid adenofibroma was present in both ovaries, while adenomyosis was observed in the uterus. The glandular duct of the endometrioid adenofibroma in the right ovary had areas suggestive of precursor lesions of mesonephric‐like carcinoma. All tumors exhibited the KRAS G12D mutation. These findings suggest that the origin of the mesonephric‐like carcinoma was the Müllerian duct, and that the ovarian and uterine tumors were monoclonal. [ABSTRACT FROM AUTHOR]

A person's health is not only affected by their disease states, but also the quality of care and posttreatment sequelae. Research shows that disparities exist in benign gynecologic surgery access to care, techniques, and perioperative outcomes. Surgical education, pathways that emphasize minimally invasive approaches, and patient-centered care that recognizes historical influences on patient perspectives are critical to dampening these disparities. [ABSTRACT FROM AUTHOR]

Background: Hysterectomy is one of the most frequently gynecologic surgeries performed in premenopausal women. Many premenopausal patients are unwilling to undergo hysterectomy due to the probable decreased ovarian function. The aim of this study is to determine the effect of hysterectomy on ovarian function. Methods: A meta-analysis has been reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 and the A Measurement Tool to Assess Systematic Reviews (AMSTAR) guidelines. We mainly searched the Embase, PubMed and Web of Science databases for eligible studies. The outcomes were the levels of common indicators of ovarian function, such as anti-müllerian hormone (AMH), follicle stimulating hormone (FSH), inhibin B, estradiol (E2) and luteinizing hormone (LH). The evidence was synthesized using meta-analysis via fixed or random effect model according to heterogeneity. Subgroup analyses were performed to examine the potential sources of heterogeneity. Results: The 14 included studies were conducted between 1989 and 2021, involving a total of 1,457 premenopausal women with 760 and 697 in the hysterectomy and control group, respectively. We found that hysterectomy damage ovarian function compared to the control group, with lower AMH level [Weighted mean difference (WMD) = -0.56, 95% confidence interval (95% CI): -0.72 to -0.39, P = 0.000], higher FSH levels (WMD = 2.96, 95% CI: 1.47 to 4.44, P = 0.000), lower inhibin B levels (WMD = -14.34, 95% CI: -24.69 to -3.99, P = 0.000) and higher LH levels (WMD = 4.07, 95% CI: 1.78 to 6.37, P = 0.000). In addition, E2 levels have a decreasing trend (WMD = -17.13, 95% CI: -35.10 to 0.85, P = 0.631) in the hysterectomy group but were not statistically significant. Conclusion: Hysterectomy has a negative impact on ovarian function, especially in female patients over 40 years old. So, the older patients should closely monitor their ovarian function for early diagnosis and treatment of menopausal symptoms. [ABSTRACT FROM AUTHOR]

Objective: To evaluate how hysterectomy performed for benign gynecologic pathologies affects the quality of life and sexual function of patients aged 35 years or younger, and if outcomes differ according to the surgical technique. Methods: Seventy‐three patients who underwent total laparoscopic hysterectomy (TLH), supracervical laparoscopic hysterectomy (SLH), or vaginal hysterectomy (VH) for benign uterine disorders between April 2014 and June 2020 at the Department of Gynecology and Obstetrics, Saarland University Hospital, Homburg, Germany, were enrolled in this prospective observational cohort study. Quality of life and sexual function were assessed preoperatively and 6 months postoperatively using standardized validated questionnaires: the European Quality of Life Five‐Dimension Scale (EQ‐5D) and the Female Sexual Function Index (FSFI). Results: Thirty‐three (45%) patients underwent TLH, 25 (34%) underwent SLH, and 15 (21%) patients underwent VH. The median preoperative EQ‐5D score, FSFI score, and EQ‐5D visual analog scale were 0.9 (range 0.62–1), 19.25 (range 2.4–27.4), and 50 (range 0–100); postoperative scores were 1 (range 0.61–1), 24.15 (range 3.9–29.3), and 90 (range 30–100), respectively (P ≤ 0.001). Postoperative scores were significantly higher than preoperative scores, with no significant difference according to the surgical technique. Conclusion: Hysterectomy for benign indication in women aged 35 years or less significantly improved the patients' quality of life and sexual function with no differences regarding the surgical technique. Clinical trial registration: The study was registered in the German trial registry (no. DRKS00005622). Synopsis: Hysterectomy for benign indication in women up to 35 years significantly improved their quality of life and sexual function with no differences for surgical technique. [ABSTRACT FROM AUTHOR]

This article discusses mesh biology and known issues with mesh kits. The current mesh recommendations of national and international societies, as well as the impact of hysterectomy on mesh exposure during sacrocolpopexy are also discussed. (J GYNECOL SURG 39:30) [ABSTRACT FROM AUTHOR]

Aim: This study aimed to clarify the impact of coronavirus disease 2019 on gynecology practice in Japan, in particular, on surgeries for benign gynecological diseases. Methods: An online questionnaire was distributed to 966 facilities in Japan, including core facilities, facilities participating in perinatal and gynecologic oncology registries, and facilities certified for training by the Japanese Society of Obstetrics and Gynecology Endoscopy. The number of surgeries performed was compared between 2019 and 2020, when the novel coronavirus disease was prevalent. Results: Five hundred and eighty (58.2%) facilities responded. The total number of surgeries decreased from 129 648 in 2019 to 118 565 in 2020, by 8.5%, for all surgical procedures. However, there was a clear increase in the number of robotic surgeries performed in 2020 compared to that in 2019 for all populations. The number of total hysterectomies decreased markedly from 15 385 in 2019 to 12 531 in 2020, a fall of 10.1%. Conclusions: The number of surgeries for benign gynecological diseases decreased by 8.5% in 2020 compared to that in 2019. This value is among the lowest in the world. [ABSTRACT FROM AUTHOR]

Background: Hysterectomy is one of the most common gynecologic surgeries, with an increasing proportion of hysterectomies performed by a laparoscopic approach. Uterine manipulation is critical for patient safety and surgical efficiency; however, the most junior member of the surgical team assumes the responsibility of uterine manipulation, commonly without preparation. The objective of our study was to determine whether kinesthetic learning using a low-cost simulated pelvic model while learning the uterine manipulation maneuvers of a laparoscopic hysterectomy improves learning efficacy and application efficiency compared to an interactive video module alone. Methods: Our randomized control trial at an academic medical center included forty first-year and second-year medical students. Participants were randomized to the intervention group that used a low-cost simulated pelvic model for kinesthetic learning during the video module or the control group who only had the interactive video module to learn the uterine manipulation maneuvers of a laparoscopic hysterectomy. Results: Participants in the intervention group were less likely to make unnecessary movements with demonstration of both pelvic side walls (right wall: control 78.9%, intervention 42.9%, p < 0.027; left wall: control 94.7%, intervention 66.7%, p < 0.046), and this was more pronounced in novice first-year participants (p < 0.009). Additionally, participants in the intervention group reported higher perceived preparedness (100% versus 71.4% in control group, p < 0.037). However, there was no difference in verbal or physical cues required, time per task, or force used between the groups. Conclusion: Kinesthetic practice may not be required for learning the uterine manipulation maneuvers of a laparoscopic hysterectomy, but it may be beneficial for more novice learners and to increase learners' perceived preparedness. Our novel interactive video module alone may be sufficient to prepare learners to perform uterine manipulation maneuvers prior to the operating room. [ABSTRACT FROM AUTHOR]

Vaginal stump recurrence post‐hysterectomy for gynecologic malignancies occurs in 2%–3% of cases. Local excision has been recognized as the primary treatment of localized recurrence, in which precise surgical margin is critical. However, R0 resection is not always easy, given the deep and narrow operation field, as well as severe postoperative fibrosis or adhesion of the vaginal stump at times. Here, we report four cases of vaginal stump recurrence of gynecologic malignancies resected by bi‐directional (laparoscopic and pneumovaginoscopic) endoscopy to overcome these difficulties. The primary tumors were uterine cancer in two cases and uterine cervical and ovarian cancer in one case each. The mean operating time was 199 (162–235) minutes, blood loss was minimal, and no perioperative complications were observed. Postoperative follow‐up (7.0–19.4 months) revealed no recurrence. This combined procedure could be a therapeutic option for localized vaginal stump recurrence. [ABSTRACT FROM AUTHOR]

Introduction: In recent decades, ERAS (Enhanced Recovery After Surgery) protocols have been developed and implemented, aiming at the safe and rapid recovery of women with gynecological cancer after a surgical procedure, as well as reducing the length of stay (LOS) at the hospital. Aim: To compare the effectiveness of the ERAS protocol and the conventional recovery method, in the postoperative course of patients undergoing major oncological gynecological operations due to cancer of the internal genital organs. Methods: This is a prospective randomized single-center study of 100 women with cancer of the internal genital organs undergoing a major gynecological oncological operation, at a tertiary Oncology center in Athens. Patients are randomized into two equal groups: A following the ERAS protocol and B following conventional postoperative care. Parameters to be compared include LOS in hospital, time to initiation of feeding and mobilization as well as assessment of postoperative pain as reported by patients on Numerical Pain Scales (NPS). Results: According to the results of the pilot study where the sample consisted of 61 patients (35 in group A and 26 in group B) with a mean age of 52.9 years (SD=11.7) it appeared that the hospital stay was significantly longer in the group B compared to group A (5.1±2.4 days vs. 3.1±1.3 days, p=0.001). Pain levels according to NPS were higher in group B at all time points except baseline. There are studies that highlight the contribution of ERAS programs to the reduction of LOS, the effective management of post-op pain, as well as the rapid feeding and mobilization of patients undergoing major gynecological oncological operation. Conclusion: ERAS protocols promote timely feeding and mobilization, offer more effective post-op analgesia, improve the experiential post-op experience of patients, therefore increase their satisfaction, reduce LOS and hospitalization costs. Future studies, well conducted, may increase the certainty of these findings. [ABSTRACT FROM AUTHOR]

Background: One significant procedure in the field of gynaecology with several indications is the hysterectomy. Hysterectomy has become less intrusive and has less risks thanks to improvements in surgical technique and materials. Total laparoscopic hysterectomy (TLH) is currently a popular practise in gynecologic surgery. Objective: To compare the effects of the laparoscopic approach versus the vaginal route for the management of vaginal cuff closure during total laparoscopic hysterectomy. Patients and Methods: The present study was a randomized controlled study conducted on 40 women attending the outpatient gynecology clinic of Al-Azhar University Hospital (New Damietta) and were planned to undergo hysterectomy for benign causes according to the inclusion/exclusion included in the study. The present study was conducted on two groups Group A had vaginal suturing for vaginal vault after total laparoscopic hysterectomy; Group B had laparoscopic suturing for virginal vault after total laparoscopic hysterectomy. Results: Operative time in minutes and suturing time showed significant increase in group 2 (laparoscopic suture) when compared to group A (vaginal suture) (P=0.012 and >0.001) respectively. VAS score show significant increase in group A when compared to group 2 (p<0.001). Post-operative complications, post-operative vaginal bleeding, Vaginal cuff hematoma, Vaginal dehiscence, post-operative infection showed significant increase in group A when compared to group 2. Blood loss showed significant increase in group A when compared to group 2 (p=<0.001). Previous CS and BMI didn't significant correlation with operative time in minutes (p>0.05). Conclusion: Laparoscopic vaginal cuff closure for complete laparoscopic hysterectomy appears to be secure, simple, and efficient. However, it requires more time than vaginal suture closure. [ABSTRACT FROM AUTHOR]

The utilization of MIS techniques is more beneficial in terms of blood loss, the rate of postoperative complications, length of hospitalization, and cosmetic results, making hysterectomy an intervention with less emotional impact, even in the case of cancer. The American Association of Gynecologic Laparoscopists suggests that many hysterectomies for benign conditions should be carried out using laparoscopy, since accumulating evidence confirms that laparoscopic hysterectomy is associated with less perioperative morbidity compared to abdominal hysterectomy [[11], [13]]. By comparing MIS with open radical hysterectomy in ECC, the LACC trial unexpectedly reported inferior oncological outcomes, showing a 6.6 times greater likelihood of death associated with MIS, and lower disease-free survival (DFS) and overall survival (OS) in the MIS group [[16], [18], [20]]. Hysterectomy is one of the most common non-obstetric gynecological surgical procedures carried out in Western countries [[1]]. [Extracted from the article]

Objective: To investigate the possible effects of inflammatory parameters obtained from complete blood count in the postoperative first day of total laparoscopic hysterectomy on the length of hospital stay in patients without any complications. Methods: Linear regression analysis was performed to find associations between hospital stay and the associated variables. Receiver operating characteristic (ROC) curve analysis was performed to determine the cut-off values of postoperative neutrophil-to-lymphocyte ratio (NLR), platelet-tolymphocyte ratio (PLR), and C-reactive protein (CRP) for long hospital stay (>3 days). Results: Postoperative values of NLR (r=0.332, p<0.001), PLR (r=0.325, p<0.001), and CRP (r=0.404, p<0.001) were moderately associated with the duration of hospital stay. In ROC analysis, the post-op cut-off value of 25 mg/L for CRP predicted long hospital stay with a sensitivity of 65% and specificity of 63% [area under the curve (AUC): 0.657, p=0.002, confidence interval (CI) 0.563-0.752], the post-op cut-off value of 159 for PLR with a sensitivity of 60% and specificity of 58% (AUC: 0.688, p<0.001, CI 0.600-0.776) and the post-op cut-off value of 4.96 for NLR with a sensitivity of 60% and specificity of 58% (AUC: 0.618 p=0.017, CI 0.520-0.717). Conclusion: We observed a direct correlation between postoperative first-day values of NLR, PLR, and CRP with the length of hospital stay. NLR, PLR, and CRP values may be helpful to predict the length of hospital stay and can be used instead of each other. [ABSTRACT FROM AUTHOR]

The primary objective of this study was to implement a same-day discharge pathway for patients undergoing minimally invasive gynecologic surgery at an urban, safety-net hospital. Prior to implementation, patients routinely spent one to two nights in the hospital postoperatively. This project was implemented on December 3, 2018. We utilized a screening tool to identify eligible patients for same-day discharge. The primary outcome measure was the percentage of patients discharged the same day of the surgery. We compared data between patients discharged home same day versus patients admitted to the hospital, as well as patients who underwent benign minimally invasive gynecologic surgery prior to and after project implementation. Of the 237 patients undergoing minimally invasive gynecologic surgery, 209 were eligible for same-day discharge. More than half (111, 53.1%) of the eligible patients were discharged home on the same day. Same-day discharge was not found to be associated with an increased risk of adverse events compared to patients who were not discharged same day. Same-day discharge after minimally invasive gynecologic surgery is safe and feasible in an urban safety-net hospital, especially with the addition of a screening tool to identify social determinants of health prior to surgery. [ABSTRACT FROM AUTHOR]

A decline in surgical training and skill acquisition in gynecology has been widely recognized and has been receiving much attention during the past 5 years. Potential solutions have been discussed in a number of publications and forums. A system of tracking is 1 such proposal, with the idea being to provide residents opportunities to direct their training into more-specialized areas after basic training. Gynecologic surgical training, as it relates to obstetrical practice has received little attention. This article discusses the importance of gynecologic surgical training for the practicing obstetrician. (J GYNECOL SURG 38:379) [ABSTRACT FROM AUTHOR]

Background: More common in older women than younger women, rectoceles may be secondary to pelvic floor weakness and/or pelvic floor dysfunction with impaired rectal evacuation. Rectoceles may be small (<2 cm), medium (2–4 cm), or large (>4 cm). Arguably, large rectoceles are more likely to be associated with symptoms (e.g., difficult defecation). It can be challenging to ascertain the extent to which a rectocele is secondary to pelvic floor dysfunction and/or whether a rectocele, rather than associated pelvic floor dysfunction, is responsible for symptoms. Surgical repair should be considered when initial treatment measures (e.g., bowel modifying agents and pelvic floor biofeedback therapy) are unsuccessful. Purpose: We summarize the clinical features, diagnosis, and management of rectoceles, with an emphasis on outcomes after surgical repair. This review accompanies a retrospective analysis of outcomes after multidisciplinary, transvaginal rectocele repair procedures undertaken by three colorectal surgeons in 215 patients at a large teaching hospital in the UK. A majority of patients had a large rectocele. Some patients also underwent an anterior levatorplasty and/or an enterocele repair. All patients were jointly assessed, and some patients underwent surgery by colorectal and urogynecologic surgeons. In this cohort, the perioperative data, efficacy, and harms outcomes are comparable with historical data predominantly derived from retrospective series in which patients had a good outcome (67%–78%), symptoms of difficult defecation improved (30%–50%), and patients had a recurrent rectocele 2 years after surgery (17%). Building on these data, prospective studies that rigorously evaluate outcomes after surgical repair are necessary. [ABSTRACT FROM AUTHOR]

Objective: To explore whether patient characteristics were associated with gender expression, and to further determine impact of gender expression on patient selection of hysterectomy or uterine‐preservation in pelvic organ prolapse (POP) surgery. Methods: Within a prospective cohort, a self‐reported gender expression tool classified patients as expressing gender polar (i.e., reporting only feminine traits) or non‐polar gender scores (i.e., reporting feminine and masculine traits). Multivariate modeling explored associations of gender expression with traditional socio‐demographic variables, and with selection of hysterectomy or uterine‐preserving surgery. Descriptive statistics of socio‐demographic variables were reported by frequency, proportion and mean (SD). Results: 177 participants completed the gender score questionnaire. Overall, the sample had a more feminine gender expression with the majority of respondents classified as gender polar (67.23%, n = 119). Participants with non‐polar gender scores were 2.53 times (95% 1.05–6.09) more likely to choose uterine preservation versus hysterectomy‐based surgery. Gender polarity was weakly associated with age, but no other sociodemographic variables. Conclusion: Gender expression is not tightly associated with socio‐demographic variables, and is thus a novel measurement in gynecologic research. Gender polarity appears to be associated with choice to undergo hysterectomy. Further research is required to understand this relationship and implications in clinical outcomes. [ABSTRACT FROM AUTHOR]

Objective: To review of our hospital's experiences in transvaginal natural orifice transluminal endoscopic surgery (vNOTES) and challenges we encountered in performance of the procedure, so as to provide help to medical institutions who are preparing to carry out vNOTES. Methods: We retrospectively analyzed the data of all patients receiving vNOTES in our hospital from April 2018 to May 2021. Data we collected cover the general characteristics, perioperative outcomes, and complications of the patients. Results: A total of 1147 patients underwent vNOTES in the past 3 years at our hospital. The total numbers of adnexal surgery, myomectomy, hysterectomy, pelvic floor reconstruction surgery, and malignant tumor surgery performed via vNOTES were 902, 98, 82, 51, and 14, respectively. Eighteen patients were converted to transabdominal laparoscopic surgery. A total of 38 patients had complications according to Clavien‐Dindo classification, and the total complication rate was 3.31%. Among these cases of complications, 27 were Grade I, 4 were Grade II, and 7 were Grade III. No complications of Grade IV or V were reported. Conclusion: The application of vNOTES is safe and feasible for most gynecological surgeries. Moreover, hospitals with traditional laparoscopic equipment are advised to try this technique as there is no need to purchase additional expensive equipment. However, since vNOTES represents a novel approach, the long‐term complications and efficacy associated with this technique are pending to be verified through large‐scale prospective multicenter randomized controlled studies. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to establish the rate at which routine postoperative renal ultrasonography is able to detect urinary tract injury following gynecological surgery.Methods: A retrospective analysis was carried out for the study period 2015-2019 of all patients who had undergone subtotal or total hysterectomy, or radical hysterectomy or salpingectomy, salpingo-oophorectomy, or oophorectomy, and subsequently had a urinary tract injury.Results: In a total of 2068 patients, 25 urinary tract injuries occurred (1.21%), including 21 urinary bladder lesions (1.02%) and four ureteral injuries (0.19%). The incidence of urinary tract injuries was 3% in oncologic procedures and 0.86% in procedures for benign disease. Nineteen injuries (76%) were diagnosed intraoperatively, and six injuries (24%) were clinically diagnosed after surgery. All of the patients had uneventful postoperative renal ultrasound examinations.Conclusion: Routine postoperative renal ultrasonography was not capable of diagnosing urinary tract injuries after gynecologic surgery. Routine postoperative renal ultrasound examinations should, therefore, not be performed after gynecologic operations. [ABSTRACT FROM AUTHOR]