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We present a case of a noncommunicating rudimentary uterine horn excised using a robotic-assisted laparoscopic approach. Case Presentation. University based hospital operating room. Our patient is a 28-year-old who presented with dysmenorrhea in the setting of a unicornuate uterus with a non-communicating right rudimentary uterine horn with functional endometrium. Robotic-assisted laparoscopic excision of a non-communicating rudimentary uterine horn. Case Presentation. Our video presents a rare example of symptomatic non communicating rudimentary uterine horn resection, with use of ureteral stenting, hysteroscopy, and instillation of methylene blue dye to guide our surgical technique. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to estimate the clinical utility of performing multi-gene pharmacogenetic testing on patients undergoing gynecologic surgery/procedure by evaluating the prescribing rate of Clinical Pharmacogenetics Implementation Consortium (CPIC) level A medications and frequency of drug-gene interactions (DGIs)., Methods: The electronic health record was queried for 76 current procedural terminology codes to identify gynecologic surgeries/procedures that occurred between 1 January 2015 to 31 December 2020 in patients with at least one of 152 international classification of disease codes. Prescription data for CPIC level A medications was extracted. Those enrolled in the Penn Medicine Biobank were assessed for DGIs., Results: The cohort consisted of 7798 female patients and 682 were in the biobank. Up to 6 years following their surgery or procedure, 80% were ordered ≥1 CPIC level A medication. Over half (54%) of these medications were ordered within 3 days after their surgery or procedure. The most common CPIC level A medications ordered were ibuprofen (57%) and ondansetron (42%). Overall, 7% of the cohort had ≥1 known or predicted DGI with medications they were prescribed., Conclusion: Multi-gene pharmacogenetic testing may be beneficial to gynecologic surgery/procedure patients by assisting clinicians with prescribing postoperative analgesics and future medications.

Study Objective: To examine racial disparities in route of hysterectomy and perioperative outcomes before and after expansion of high-volume minimally invasive surgeons (>10 minimally invasive hysterectomies [MIHs]/year)., Design: Retrospective cohort study., Setting: Multicenter academic teaching institution., Patients: All patients who underwent a scheduled hysterectomy for benign indications during 2018 (preintervention) and 2022 (postintervention)., Interventions: Recruitment of fellowship in minimally invasive gynecologic surgery-trained faculty and increased surgical training for academic specialists in obstetrics and gynecology occurred in 2020., Measurements and Main Results: Patients in the preintervention cohort (n = 171) were older (median age, 45 years vs 43 years; p = .003) whereas patients in the postintervention cohort (n = 234) had a higher burden of comorbidities (26% American Society of Anesthesiologists class III vs 19%; p = .03). Uterine weight was not significantly different between cohorts (p = .328). Between the pre- and postintervention cohorts, high-volume minimally invasive surgeons increased from 27% (n = 4) to 44% (n = 7) of those performing hysterectomies within the division and percentage of hysterectomies performed via minimally invasive route increased (63% vs 82%; p <.001). In the preintervention cohort, Black patients had a lower percentage of hysterectomies performed via minimally invasive route than White patients (Black = 56% MIH vs White = 76% MIH; p = .014). In the postintervention cohort, differences by race were no longer significant (Black = 78% MIH vs White = 87% MIH; p = .127). There was a significant increase (22%) in MIH for Black patients between cohorts (p <.001). After adjusting for age, body mass index, American Society of Anesthesiologists class, previous surgery, and uterine weight, disparities by race were no longer present in the postintervention cohort. Perioperative outcomes including length of stay (p <.001), infection rates (p = .002), and blood loss (p = .01) improved after intervention., Conclusion: Increasing fellowship in minimally invasive gynecologic surgery-trained gynecologic surgeons and providing more opportunities in robotic/laparoscopic training for academic specialists may improve access to MIH for Black patients and reduce disparities., (Copyright © 2024 AAGL. Published by Elsevier Inc. All rights reserved.)

Background: Uterine artery embolization in the treatment of uterine leiomyoma has been rarely associated with dislodgement and expulsion of infarcted uterine fibroids through the vagina, peritoneum, or bowel wall, predominantly occurring within 6 months of uterine artery embolization., Case Presentation: We present the case of a 54-year-old African American woman who underwent uterine artery embolization 11 years prior and developed mechanical small bowel obstruction from the migration of fibroid through a uteroenteric fistula with ultimate impaction within the distal small bowel lumen. Small bowel resection and hysterectomy were curative., Conclusions: Uteroenteric fistula with small bowel obstruction due to fibroid expulsion may present as a delayed finding after uterine artery embolization and requires heightened awareness.

Objectives: The objective of this study was to identify maternal characteristics associated with a failed cell-free DNA (cfDNA) test due to a low fetal fraction (FF)., Method: Retrospective cohort study of women with singleton pregnancies who had cfDNA screening at 10-25 weeks gestation between October 2011 and January 2016. cfDNA screening was performed using methylation techniques until October 2013; thereafter, samples were run with massively parallel sequencing. Multivariable logistic regression was performed to identify maternal characteristics associated with no cell free DNA result secondary to low FF., Results: Thirty-three (1.2%) of 2890 eligible women had a failed cfDNA test, including 18 (0.6%) cases with a low FF. A failed cfDNA test due to a low FF was associated with obesity (aOR 1.11, CI 1.05-1.18, p = 0.0003) and treatment with enoxaparin (aOR 37.5, 11.19-125.87, p < 0.0001). 5 of 28 (18%, 95% CI: 6.1%-36.9%) women on enoxaparin had a failed cfDNA test secondary to a low FFx., Conclusion: Enoxaparin therapy and obesity were associated with an increased incidence of a failed cfDNA test due to low FF. Further research is needed to determine the mechanism by which anticoagulation therapy alters cfDNA test functionality and identify approaches to improve test performance in these women., (© 2017 John Wiley & Sons, Ltd.)