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Purpose: This systematic review aims to comprehensively assess the safety and efficacy of transvaginal morcellation within an enclosed bag in gynecological surgeries, with a focus on its benefits, potential risks, and recommendations for its use. Methods: We conducted a comprehensive search of Epistemonikos, Web of Science, Medline (PubMed), Scopus, and Cochrane databases for studies on transvaginal contained morcellation in adult patients undergoing gynecological surgeries. The review included 22 studies that met the inclusion criteria, encompassing diverse surgical procedures, patient profiles, and outcomes. These studies were thoroughly reviewed and analyzed to assess the safety and efficacy of the morcellation technique. Results: Key findings from the selected studies indicate that transvaginal morcellation within an enclosed bag offers several advantages in gynecological surgeries, including reduced invasiveness, shorter operative times, and minimal blood loss when compared to conventional methods. The risk of tumor recurrence or dissemination appears to be low when appropriate precautions are taken, emphasizing the technique's safety, especially when performed by experienced surgical teams. While some studies reported complications, these were generally not directly associated with the morcellation technique. Conclusion: Transvaginal morcellation within an enclosed bag demonstrates potential as a safe and effective option for gynecological surgeries. The technique offers the benefits of minimally invasive procedures, including reduced bleeding, shorter recovery times, and improved cosmetic outcomes. This review also highlights the need for standardization in study methodologies and reporting, as the heterogeneity in outcomes across the selected studies poses challenges in drawing definitive conclusions. [ABSTRACT FROM AUTHOR]

Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is considered to have the advantages of completely scarless, less postoperative pain, earlier flatus, and faster postoperative recovery. However, posterior myoma are relatively difficult to operate through vNOTES in the conventional lithotomy position. Thus, we innovated the application of prone position in the removal of posterior myoma in vNOTES. The aim of this study is the comparison of myomectomy outcomes of patient for single posterior myoma in prone and lithotomy position. A single-center, prospective study. A university teaching hospital. A total of 81 patients with posterior myoma who underwent myomectomy in vNOTES from January 2021 to December 2022. The patients underwent myomectomy in vNOTES in prone or lithotomy position. Among the patients who underwent vNOTES myomectomy, 29 (35.8%) were in the lithotomy position group, and 52 (64.2%) in the prone position group. Of note, 4 (4.9%) patients underwent a conversion to LESS during the operation—3 in the lithotomy and 1 in the prone position group. And a patient in the lithotomy position group underwent resurgery for hemostasis due to postoperative pelvic bleeding. Compared with the lithotomy position, prone position significantly shortens the operation time (12.3, 95% CI: 6.811, 17.761. p =.009) without increasing the complications and postoperative discomfort of patients. Compared to the lithotomy position, the prone position provides greater convenience for operation and exhibits a lower rate of surgical conversion during the removal of single posterior myomas via vNOTES. Further, for patients selecting vNOTES, surgeons need to conduct sufficient preoperative evaluation, timely hemostasis during surgery, and timely surgical conversion if necessary to ensure patient safety. [ABSTRACT FROM AUTHOR]

Introduction: Pre-ablation detection of adenomyosis may be clinically helpful to decrease the risk of ablation failure and subsequent hysterectomy. Two-dimensional (2D) combined with three-dimensional (3D) Transvaginal sonography (TVS) may be able to improve detection of adenomyosis prior to ablation, potentially allowing better identification of candidates for endometrial ablation and reducing the risk of ablation failure. Methods: A single-center, retrospective study of patients with endometrial ablation failure and subsequent hysterectomy between 2005 and 2023 who had pre-ablation TVS and histopathology-proven adenomyosis was performed. Sensitivities of 2D and 2D/3D TVS for pre-operative detection of adenomyosis were calculated. Results: Among a total of 87 women with pathology-proven adenomyosis after hysterectomy, 40 underwent 2D TVS only prior to ablation, while 47 underwent both 2D and 3D TVS. Of the 40 women who only underwent 2D TVS, 22 were found to have adenomyosis while 18 were negative for adenomyosis. Of the 47 women who underwent both 2D and 3D TVS, 34 were found to have adenomyosis while 13 were negative for adenomyosis. The sensitivities of 2D TVS and 2D/3D TVS for adenomyosis were 0.55 and 0.72, respectively. Conclusions: Both 2D and 3D TVS reflect the challenge of depicting a wide spectrum of sonographic findings of adenomyosis from microscopic myometrial implants to more extensive involvement of the transmural myometrium. The use of both 2D and 3D TVS has a greater preoperative sensitivity for sonographically diagnosing adenomyosis compared to 2D TVS alone. Potential improvements for enhanced TVS detection might include elastography and vascularity assessment.

Neoadjuvant imatinib treatment, followed by complete transvaginal removal, presents a feasible option for large rectal gastrointestinal tumors located on the anterior wall of the rectum and protruding into the vagina. The use of Martius flap interposition is convenient and can be employed to prevent rectovaginal fistula.

Aim: Natural orifice specimen extraction (NOSE) is an alternative to conventional transabdominal retrieval. We aimed to compare outcomes following transvaginal specimen extraction (TVSE) and transabdominal specimen extraction (TASE) in minimally invasive abdominal surgery. Methods: An electronic database search of PubMed, Embase and CENTRAL was performed from inception until March 2023. Comparative studies evaluating TVSE versus TASE in adult female patients were included. Studies involving transanal NOSE, endoluminal surgery, or TVSE with concomitant hysterectomy were excluded. Weighted mean differences (WMD) and odds ratio were estimated for continuous and dichotomous outcomes respectively. Primary outcomes were postoperative day 1 (POD1) pain and length of stay (LOS). Secondary outcomes were operative time, rescue analgesia, morbidity, and cosmesis. A review of sexual, oncological, and technical outcomes was performed. Results: Thirteen studies (2 randomised trials, 11 retrospective cohort studies), involving 1094 patients (TASE 583, TVSE 511), were included in the analysis. Seven studies involved colorectal disease and six assessed gynaecological conditions. TVSE resulted in significantly decreased POD1 pain (WMD 1.08, 95% CI: 0.49, 1.68) and shorter LOS (WMD 1.18 days, 95% CI: 0.14, 2.22), compared to TASE. Operative time was similar between both groups, with fewer patients requiring postoperative rescue analgesia with TVSE. Overall morbidity rates, as well as both wound-related and non-wound related complication rates were better with TVSE, while anastomotic morbidity rates were comparable. Cosmetic scores were higher with TVSE. TVSE did not result in worse sexual or oncological outcomes. Conclusion: TVSE may be feasible and beneficial compared to TASE when performed by proficient laparoscopic operators, using appropriate selection criteria. Continued evaluation with prospective studies is warranted. [ABSTRACT FROM AUTHOR]

Abstract Transvaginal small bowel evisceration is a life-threatening condition, which is usually seen in postmenopausal women with a history of gynecological surgery. Cervical loop electrosurgical excision procedure (LEEP) is widely used in the treatment of cervical intraepithelial neoplasia (CIN), and its surgical risk and postoperative complications are relatively low because of the simplicity of the operation. However, improper operation may result in perforation of the uterus, which can cause prolapse of the small bowel into the vagina. We here reported an extremely rare case of a young woman with transvaginal small bowel evisceration after cervical LEEP, achieving a good prognosis after the prolapsed bowel was reduced. The patient underwent cervical LEEP as a treatment for CIN III, but the LEEP resulted in a laceration of about 4.0 cm × 3.5 cm on the peritoneum of the uterovesical peritoneal reflection and a laceration of about 2.0 cm × 1.5 cm on the anterior wall of the cervical canal. Through the two lacerations, the pelvic cavity is connected to the vagina and the small intestine prolapsed into the vagina. Due to aggressive surgical intervention, the patient achieved a favorable prognosis after successfully reducing the prolapsed bowel.

Abstract Objectives This study's aim is to evaluate the long‐term quality of life and functional outcomes following cystoscopic excision of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) mesh extruded into the urinary tract in women. Patients and Methods A retrospective chart review was performed of all cases of cystoscopic removal of extruded mesh at our high‐volume tertiary care centre between April 2013 and August 2021. Postoperative patient‐reported outcomes were collected via questionnaires: Urogenital Distress Inventory Short Form (UDI‐6), EQ‐5D‐5L Visual analogue scale, ICIQ‐Satisfaction (ICIQ‐S) and additional questions regarding postoperative sexual function. Results During the study period, 27 women with a median age of 61 years (45–87) underwent cystoscopic mesh removal surgery using either Ho‐YAG laser (56%) or bipolar loop resection (44%). The most common presentation of mesh extrusion was recurrent urinary tract infections (67%). Other presenting complaints were pain (41%), urinary urgency ± incontinence (41%) and voiding difficulties (18%). Long‐term follow‐up outcomes from 20 patients (median follow‐up: 24 months) showed that mesh removal was rated successful by 80%, and 100% would choose to have the surgery again if in the same situation. Recurrent SUI was reported by 45% of respondents, and urinary urge incontinence was found in 50%. For patients who answered the sexual function questions, 50% reported improved sexual function postmesh removal (6/12). Conclusions Cystoscopic removal of extruded female SUI and POP mesh is associated with high patient satisfaction and low morbidity in appropriately selected patients at 2‐year median follow‐up. A patient‐centred shared decision‐making process is essential in counselling patients regarding options and expected outcomes following mesh removal surgery.

The optimal surgical method of vesicovaginal fistula (VVF) remains uncertain. Minimally invasive surgical approaches have become highly popular in line with technological advancements, namely, laparoscopic, robotic, and transvaginal techniques. However, these techniques still require invasiveness. This is the first case report that described a novel “zero-incision” technique for natural orifice transvaginal single-port laparoscopy used to repair a recurrent and high-position VVF. The patient underwent transvaginal single-port laparoscopic repair of a VVF. Methylene blue was used to locate the VVF, and a needle electrode was used to thoroughly remove the scar tissue of the VVF. In addition, this technique for transvaginal single-port laparoscopy provides more working space to expose and repair fistulas conveniently and adequately. One year after surgery, the patient remained asymptomatic and had no fistula recurrence. Minimally invasive transvaginal single-port laparoscopy provides a clear surgical field, is safe and feasible. This novel technique has promising as an additional personalized treatment option for VVF repair.

Objective: The goal of this research was to determine the efficacy of fractionated carbon dioxide (CO2) laser therapy for reducing symptoms of vulvar lichen sclerosus (LS). Materials and Methods: This was a prospective case series. The study participants were 23 women with active vulvar LS, confirmed via biopsy, who were abstaining from topical and systemic treatments for at least 4 weeks before enrollment. Subjects received 3–5 treatments with the CO2 laser, based on symptom improvements. The primary endpoint was a reduction by >50%, as shown by a composite examination-based and symptom-based score at 6 months post-treatment. A secondary endpoint was changes in the Vulvar Quality of Life Questionnaire and patient-supplied Patient Global Impression of Improvement (PGI) scores. A t-test was used to contrast pre-treatment and post-treatment changes in symptoms Results: From 2015 to 2020, 23 women participated in the study. The primary endpoint of >50% reduction in the composite symptom score was not significant; p = 0.08, although a reduction was significant at that time point; p = < 0.01. At 12 months a >50% reduction was significant; p = 0.03. Secondary outcomes were remarkable for significant reductions in symptoms that did not meet the >50% threshold at 6 and at 12 months. Mean satisfaction was 2.47 ± 0.61 on a 3-point scale and significantly positive PGI scores through the post-treatment follow-up time point. Conclusions: Exploration of fractionated CO2 for treating vulvar LS should be continued. (J GYNECOL SURG 39:295) [ABSTRACT FROM AUTHOR]

Objectives: To assess transvaginal (TV) and transabdominal (TA) cervical length (CL) measurements' variability and patient factors associated with TA CL accuracy. We hypothesized that patient factors would affect the accuracy of TA CL. Methods: This was a prospective cohort study. During anatomy ultrasound, TA and TV CL measurements were obtained, distance from placental edge to internal cervical os assessed, and demographic questionnaires completed. Patients between 18 to 22 weeks and 6 days were included and those <18 year old or with a twin gestation were excluded. TA CL >0.5 cm different from TV length was considered inaccurate. Results: A total of 530 patients were included. Exactly 18.7% had a prior cesarean, 9.8% a preterm birth, and 2.2% a cervical procedure. Mean age and BMI were 31.1 years and 27.8 kg/m2. Median number of living children was one. Median TA and TV CL were 3.42 and 3.53 cm. Exactly 36% (95% CI: 32–40%) of TA CL measurements were inaccurate. CL of 3.4 cm corresponded to a mean difference of zero between TA and TV CL. TA ultrasound had a sensitivity of 25% and a specificity of 98.5% to detect TV CL <2.5 cm. On multivariable analyses, Hispanic ethnicity was associated with inaccurate TA measurement (OR 0.48, 95% CI: 0.24–0.96, P =.04). Conclusions: On average, TA CL underestimates TV CL when TV CL >3.40 cm and overestimates TV CL when TV CL <3.40 cm. Additional co‐variates did not impact accuracy. TA ultrasound has low sensitivity to predict short cervix. Relying solely on TA CL to identify those who need intervention may miss diagnoses. It may be reasonable to develop protocols in which TV CL is used for TA CL <3.4 cm. Access the CME test here and search by article title. [ABSTRACT FROM AUTHOR]

To describe transvaginal radiofrequency ablation of myomas (TRAM) in 10 key steps. Video article. University hospital. A 38-year-old woman presented with menometrorrhagia and consequent chronic anemia (hemoglobin 8.5 g/dL) caused by a cervical myoma measuring 51 cm3. Initially, a cervicovaginal embolization was performed, but without any improvement in symptoms. Given the complex position of the myoma (close proximity to the uterine arteries), as well as the patient's desire for future pregnancies, a TRAM was proposed. Not applicable. Volume of myoma and menometrorrhagia 6 months after treatment. Not applicable. Transvaginal radiofrequency ablation of myomas is a quick, simple, minimally invasive, and easily reproducible technique. It could be an interesting alternative to the conventional laparoscopic and open-surgical treatments of myomas. There is a lack of high-quality data establishing TRAM safety in infertility and pregnancy. The only available radiofrequency ablation device in the United States has specific language stating that this procedure is not recommended for women considering future pregnancy. [ABSTRACT FROM AUTHOR]

Ureteral injury is a known complication of gynecologic surgery with potential long-term sequelae. Traditional management of significant ureteral injury recognized at the time of transvaginal pelvic organ prolapse repair is a transabdominal re-implantation procedure using a transabdominal open or laparoscopic approach. We present a case describing a transvaginal approach for ureteroneocystostomy. During a transvaginal pelvic organ prolapse repair, a ureteral transection was noted. A transvaginal ureteroneocystostomy was performed. There was primary healing of the ureteroneocystostomy without sequelae during a 6-month follow-up period.

Transvaginal small bowel evisceration is a life-threatening condition, which is usually seen in postmenopausal women with a history of gynecological surgery. Cervical loop electrosurgical excision procedure (LEEP) is widely used in the treatment of cervical intraepithelial neoplasia (CIN), and its surgical risk and postoperative complications are relatively low because of the simplicity of the operation. However, improper operation may result in perforation of the uterus, which can cause prolapse of the small bowel into the vagina. We here reported an extremely rare case of a young woman with transvaginal small bowel evisceration after cervical LEEP, achieving a good prognosis after the prolapsed bowel was reduced. The patient underwent cervical LEEP as a treatment for CIN III, but the LEEP resulted in a laceration of about 4.0 cm × 3.5 cm on the peritoneum of the uterovesical peritoneal reflection and a laceration of about 2.0 cm × 1.5 cm on the anterior wall of the cervical canal. Through the two lacerations, the pelvic cavity is connected to the vagina and the small intestine prolapsed into the vagina. Due to aggressive surgical intervention, the patient achieved a favorable prognosis after successfully reducing the prolapsed bowel. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to compare the diagnostic performance of magnetic resonance imaging (MRI) and transvaginal ultrasound (TVS) for detecting myometrial invasion (MI) in patients with low‐grade endometrioid endometrial carcinoma. Methods: A comprehensive search of MEDLINE (Pubmed), Web of Science, Embase and Scopus (from January 1990 to December 2022) was performed for articles comparing TVS and MRI in the evaluation of myometrial infiltration in low‐grade (grade 1 or 2) endometrioid endometrial carcinoma in the same group of patients. We used QUADAS‐2 tool for assessing the risk of bias of studies. Results: We found 104 citations in our extensive research. Four articles were ultimately included in the meta‐analysis, after excluding 100 reports. All articles were considered low risk of bias in most of the domains assessed in QUADAS‐2. We observed that pooled sensitivity and specificity for detecting deep MI were 65% (95% confidence interval [CI] = 54%–75%) and 85% (95% CI = 79%–89%) for MRI, and 71% (95% CI = 63%–78%) and 76% (95% CI = 67%–83%) for TVS, respectively. No statistical differences were found between both imaging techniques (p > 0.05). We observed low heterogeneity for sensitivity and high for specificity regarding TVS; and moderate for both sensitivity and specificity in case of MRI. Conclusions: The diagnostic performance of TVS and MRI for the evaluation of deep MI in women with low‐grade endometrioid endometrial cancer is similar. However, further research is needed as the number of studies is scanty. [ABSTRACT FROM AUTHOR]

This paper is to explore the clinical effect of transvaginal single-port laparoscopic appendectomy, a minimally invasive technique for acute appendicitis. The clinical data of 8 lady cases with acute simple appendicitis undergoing transvaginal single-port laparoscopic appendectomy from May 2019 to September 2020 were analyzed. The process of the procedure and details were recorded, and its safety and feasibility are retrospectively analyzed. The operation of all 8 cases was successfully completed, with no case required conversion to routine laparoscopic or open surgery. The average operation time was (50.27 SD8.66) min. The average intraoperative bleeding was (2.77 SD0.90) ml. The average intestinal function recovery time was (8.87 SD3.94) h. The average hospitalization time was (3.86 SD0.74) day. And the average hospitalization cost was (1.28 SD0.10) thousand yuan. Besides, 24-h postoperative pain score, CRP and IL-6 were (2.66 SD0.89) mg/l, (40.93 SD5.56) mg/l, and (68.66 SD15.19) pg/ml, respectively. No postoperative complications were observed during hospital stay, but two patients developed complications after discharge, including one abdominal infection and one poor healing of the wound. Patients' satisfaction with their incision accounted for 87.5% after 1-month follow-up. And none of the patients had discomforts after 6-month follow-up, especially for sexual life. At the same time, patients' self-confidence was improved greatly. Traditional single-port laparoscopic approach is a safe and feasible method for transvaginal appendectomy, which broadens the path of appendectomy and avoids the drawbacks of transabdominal surgery. Besides, it is more minimally invasive, without scars on the skin, and has accurate cosmetic effect. Therefore, it is considered to be a feasible approach for lady patients with appendicitis and higher cosmetic requirements. [ABSTRACT FROM AUTHOR]

Gartner’s duct cyst (GDC) is a remnant of the mesonephric (Wolffian) duct in females. The GDC is formed from the persistence of some portions of the mesonephric duct in adult females resulting in small-sized cysts usually in the anterolateral vaginal wall but could be found elsewhere along the tract of the duct. The case of a 33-year-old para 5+1 (three alive) woman who had GDC is reported. The patient presented with incidental findings of a vaginal mass during gynecological evaluation and subsequently had dyspareunia. A provisional diagnosis of GDC was made and this was confirmed by transvaginal ultrasound. The patient had transvaginal excision of the cyst and histological confirmation of a benign cystic lesion with the diagnosis of GDC. GDC is a rare entity and clinical examination revealing a cystic vaginal wall mass with or without symptoms should raise a high suspicion of this condition.

Background: According to estimates, about 30 and 40 % of implanted conceptions result in spontaneous abortions throughout the first trimester, the majority of which happen at an extremely early stage. Most massive losses occur relatively early in the gestational period, but after the heart activity of the embryo has appeared, the spontaneous abortion rate steadily falls to 2-5%.Aim of the Work: To assess the yolk sac's value in terms of pregnancy outcome prediction.Patients and Methods: This prospective observational study has been performed on 100 healthy women with singleton pregnancies and gestational ages ranging from 5 to 10 weeks. The internal YS diameter, the mean gestational sac diameter, and the crown-rump length [CRL] were all measured using electronic calipers through transvaginal ultrasound. These data were correlated with pregnancy outcome.Results: Yolk sac regularity was lower in missed abortion cases at different weeks, the differences statistically were significant between 6 and 10 weeks of gestation. Yolk sac diameter higher in missed abortion cases at different weeks, the differences statistically were significant in weeks 8 to 10.Conclusion: The ultrasonography measurement of yolk sac diameter and shape during the first trimester of gestation has proven to be a valuable, useful, and noninvasive technique in the examination, diagnosis, and follow-up of pregnant women in their early stages of gestation. In our study, the irregular shape of the yolk sac was found to be a significant predictor of the outcome of pregnancy.

Abstract Background This study aimed to evaluate cosmetic outcomes and feasibility of transvaginal natural orifice specimen extraction (NOSE) in patients who underwent laparoscopic or robotic surgery for the treatment of benign or malignant diseases of the kidney, liver, stomach, adrenal gland, and bladder. Methods This prospective study was conducted at a tertiary hospital between March 2015 and May 2020. The main outcome was cosmetic outcomes of scars assessed using the Patient and Observer Scar Assessment Scale (POSAS) 1 and 8 weeks after surgery. The secondary outcomes were postoperative pain, operating time, and complications. Sexual function was assessed using the Female Sexual Function Index (FSFI) questionnaire 6 months after surgery in 17 patients who were sexually active at the time of surgery. Results A total of 38 transvaginal NOSE procedures were performed for the extraction of 33 kidneys, 2 livers, 1 stomach, 1 adrenal gland, and 1 bladder. Observers rated pigmentation and relief scores as most deviant from normal skin (2.9 ± 1.7, 3.0 ± 2.1 at postoperative 1 week; 3.6 ± 1.9, 3.5 ± 2.2 at postoperative 8 weeks, respectively), but the overall scores of each item were low. The patients’ overall satisfaction with postoperative scars was high, and the mean scores for pain and itching were low, with significant improvement from the first week to the eighth week (P = 0.014 and P = 0.006, respectively). Patients also reported low scores on vaginal assessment items, indicating better symptoms, and bleeding improved significantly between the two time points (P = 0.001). Postoperative pain was reduced from moderate during the first 24 h after surgery to mild after 24 h. The mean operative time of the transvaginal NOSE procedure was 28.3 ± 13.3 min. No postoperative complications were associated with the procedure. The mean FSFI total score was 21.2 ± 8.7 (cutoff score for dysfunction is 21), with higher scores indicating better sexual functioning. Conclusion Transvaginal NOSE seems to be a feasible procedure with promising cosmetic benefits, for patients who undergo minimally invasive surgery for large organs including the kidney, liver, stomach, adrenal gland, and bladder. A prospective randomized clinical trial is needed to provide solid evidence to support transvaginal NOSE. Trial registration: This trial is registered at ClinicalTrials.gov (NCT05113134).

Pelvic pain and vaginal bleeding are common symptoms in postpartum women presenting to the emergency room (ER). Pelvic ultrasonography plays a crucial role in evaluating symptomatic postpartum patients by allowing a rapid diagnosis and treatment initiation. The main goal of imaging is to distinguish between causes of pelvic pain and vaginal bleeding that may be managed conservatively and those requiring emergent intervention. This pictural essay focuses on the ultrasonographic features of common postpartum conditions for which patients may present to the ER with vaginal bleeding and pelvic pain, including retained products of conception, endometritis, uterine arteriovenous malformation, uterine artery pseudoaneurysm, ovarian vein thrombosis, bladder flap hematoma, and uterine dehiscence/rupture.

Adnexal masses in the third trimester of pregnancy may obstruct the pelvic outlet precluding labor induction and vaginal delivery. Expectant versus surgical management of adnexal cysts in pregnancy must carefully weigh maternal–fetal benefits and risks. Simple benign appearing cysts with low likelihood of malignancy may be amenable to percutaneous drainage as a bridge to interval postpartum laparoscopic cystectomy. We demonstrated posterior culdocentesis as a safe, minimally invasive technique to decompress a simple benign appearing left adnexal cyst obstructing the pelvic outlet in the third trimester at the time of labor induction to facilitate vaginal delivery and prevent primary cesarean delivery. Detailed sonographic cyst evaluation and counseling on underlying risk of malignancy must be considered to guide shared decision-making.

Background: Both objective and subjective transvaginal sonography (TVS) methods are used to assess the degree of myometrial invasion (MI). Subjective TVS assessment of MI (50%) may be as good or better than any objective measurement technique. The aim of this study is to examine the ultrasound characteristics of endometrial cancer (EC) in two groups of patients; with myometrial invasion less and greater than 50%. Methods: This is a prospective cohort study included 60 female patients with pathohistologically (PHD) proven endometrial cancer. Patients were divided into two groups, after surgery and PHD assessment of MI degree, into those with less and more than 50% MI. The degree of MI was performed by subjective assessment (50%). Results: The frequency of anteroposterior (AP) diameter of EC greater than 2 cm was statistically significantly higher in the group of subjects with MI >50% (p < 0.00001). The volume of EC in the group of patients with MI >50% is statistically significantly higher, with a difference of 10.48 milliliters compared to the group of subjects with MI 50% has a good diagnostic value: accuracy = 0.87; sensitivity = 0.77; specificity = 0.94; positive predictive value = 0.91; negative predictive value = 0.84; positive likelihood ratio = 13.08; negative likelihood ratio = 0.25. According to the subjective method of TVS, the degree of MI was overestimated in 5.9% of respondents, underestimated in 23.1%. Conclusions: The three dimensions, as well as the volume of endometrial cancer, obtained by TVS, are significantly higher in subjects with >50% myometrial invasion; there is also a significantly higher frequency of EC diameter greater than 2 cm in the group of subjects with >50% myometrial invasion.

Background: it is estimated that approximately 30% to 40% of implanted pregnancies resulted in spontaneous abortion during the first trimester, most of which occur in very early stage. Significant number of losses predominantly occurs very early in gestation, but once the embryonic heart activity appears the rate of spontaneous abortion gradually decreases to 2-5% . Methods: the present study was conducted at the Department of Obstetrics and Gynecology,6october Hospital during the period between February 2020 and august 2020 .46 cases at 5 weeks of pregnancy were subjected to transvaginal ultrasound and yolk sac size and shape were determined . Records of pregnant women were registered at 6, 9, 12 weeks of pregnancy. Aim Of The Work: to evaluate the value of yolk sac in prediction of pregnancy outcome . Results: Abnormal Shape of yolk sac was found in 11 cases, the mean YSD at 6 weeks in aborted cases was 3.5±1.8 and cases who continued pregnancy was 2.2 ±0.4 and this difference is statistically significant and cut off point at 6 weeks was 2.8 while there was no significant difference between YSD in aborted cases and in those who continued pregnancy at 9,12 weeks respectively. Conclusion: large size of yolk sac at 6 weeks of pregnancy and abnormal shape of yolk sac are predictor of poor pregnancy outcome.

Abstract Background Pelvic organ prolapse (POP) is greatly affecting the quality of life (QOL) of women. There are some surgical techniques for POP repair, for example, transvaginal mesh surgery (TVM), laparoscopic sacrocolpopexy (LSC), and robot-assisted sacrocolpopexy (RSC). In the United States and Europe, the number of TVM has rapidly decreased since 2011 due to complications and safety concerns and has shifted to LSC/RSC. In Japan, RSC has increased after the insurance coverage of RSC in 2020. Therefore, we compared the surgical outcomes of TVM and RSC in POP surgery. Methods We retrospectively collected POP surgery underwent TVM or RSC at our hospital and compared the operative time, blood loss, postoperative hospital stay, postoperative complications, and preoperative and postoperative stress urinary incontinence (SUI) of two groups. Preoperative and postoperative SUI were classified into 3 groups: “improved preoperative SUI”, “persistent preoperative SUI” and “de novo SUI”, which occurred for the first time in patients with no preoperative SUI, and compared incidence rate. The Mann–Whitney U test and Fisher’s exact test were used to compare the two groups, and P

Purpose Methods Results Discussion Conclusion To assess the effects of bladder fullness and lower uterine contractions ultrasound on transabdominal and transvaginal cervical length measurements at the mid‐trimester fetal anomaly scan (FAS).Transabdominal and transvaginal cervical length measurements from 925 mid‐trimester FAS examinations were retrospectively analysed. Images were assessed for lower uterine contraction and bladder fullness using a novel qualitative assessment. Bland–Altman plots and single‐score interclass correlation (ICC) were used to determine correlation between transabdominal and transvaginal measurements. Sensitivity and specificity of transabdominal cut‐offs were calculated.Transabdominal and transvaginal measurements of the cervix correlated poorly (ICC 0.306). An overfilled bladder and lower uterine contractions on average increased the length of transabdominal cervical length measurements. Removing these variables did not significantly improve correlation between transabdominal and transvaginal measurements of the cervix but resulted in an improved sensitivity of transabdominal assessment to detect a clinically relevant short cervix.Resolving the confounding factors of an overfilled bladder and lower uterine contractions can help improve the our ability to detect a short cervix on transabdominal ultrasound. Our data set supported a two‐stage approach to cervical length screening which would allow 100% sensitivity when a cut‐off of ≤35 mm is used on transabdominal ultrasound and would limit the need for transvaginal scanning to approximately 39% of patients. This cut‐off is in line with the findings of other studies. The low prevalence of short cervix in our study did however make it difficult to extrapolate reliable calculations.Although transabdominal measurements correlate poorly with transvaginal measurements of the cervix, we demonstrated an improved sensitivity for detecting a short cervix using a transabdominal approach when no contractions or overfilled bladder is present. This potential could be explored in a future study with a larger sample size. [ABSTRACT FROM AUTHOR]

BackgroundThe transvaginal route for specimen extraction is considered ideal for colorectal surgery, but its safety is still questioned. There has been little research on transvaginal natural orifice specimen extraction surgery (NOSES) in the right hemicolectomy. As a result, we conducted a study comparing transvaginal NOSES to traditional transabdominal specimen extraction surgery.Patients and methodsData on female patients who underwent radical right hemicolectomy at the First Affiliated Hospital of Nanchang University between January 2015 and December 2020 were collected retrospectively. A total of 847 patients were compliant, with 51 undergoing the transvaginal specimen extraction surgery (NOSES) group and 796 undergoing the transabdominal specimen extraction surgery (TISES) group. A propensity score matching method (1:2) was used to balance the clinicopathological characteristics of the two groups.ResultsFinally, 138 patients were enrolled in our study, with 46 in the NOSES group and 92 in the TISES group. Compared to the TISES group, the NOSES group had less intraoperative blood loss (p = 0.036), shorter time to first flatus (p < 0.001), shorter time to first liquid diet (p < 0.001), lower postoperative white blood cell counts (p = 0.026), lower C-reactive protein levels (p = 0.027), and lower visual analog scale (VAS) scores (p < 0.001). Regarding the quality of life after surgery, the NOSES group had better role function (p < 0.01), emotional function (p < 0.001), and improved symptoms of postoperative pain (p < 0.001) and diarrhea (p = 0.024). The scar satisfaction was significantly higher in the NOSES group than in the TISES group. Overall survival and disease-free survival in two groups were similar.ConclusionThe short-term results of transvaginal NOSES were superior to conventional transabdominal specimen extraction surgery. At the same time, transvaginal NOSES could improve the abdominal wall appearance and quality of life. The long-term survival was similar in the two surgical approaches. Therefore, transvaginal NOSES is worthy of our implementation and promotion.

Purpose: To evaluate diagnostic yield, safety profile, and specific technical considerations of transvaginal ultrasound (TVUS) guided biopsy/aspiration. Materials/methods: TVUS guided biopsy (core, FNA) procedures with pre-procedure CT/MRI imaging at a single institution between 2001 and 2021 were reviewed. Relevant patient demographic data was extracted via the Electronic Health Record (EMR), technical details of the biopsy procedure were collected, and distance to target via transvaginal and transabdominal biopsy approach was measured on pre-procedure imaging. Surgical pathology was reviewed and assessed for concordance. Complications were assessed. Statistical analysis was performed using SPSS. Results: 96 TVUS procedures (mean age, 58.7 ± 15.2 years; mean BMI, 27.4) were reviewed. TVUS guided approach decreased the distance to target (mean, 1.1 cm vs 8.6 cm transabdominal; p < 0.0001) and created a safe path not otherwise available in two patients. Average lesion size was 4.0 ± 2.1 cm (IQR 2.5, 5.2 cm) and targets at or above the vaginal cuff (0.9 ± 1.5 cm) and up to 0.5 ± 1.0 cm above the acetabular roof were accessible. 75 (78%) cases were core biopsies (18G; median, 2 passes) and 21 were FNA. Conscious sedation was used in 84.4% (n = 81) of cases and local anesthetic was also used in 84.4% (n = 81) of cases. Overall diagnostic yield was 98.9% (n = 94) with 94.7% (n = 89) cases confirmed as concordant diagnoses, including 57.4% (n = 54) malignant. Complications occurred in eight patients (8.3%), all minor. No post-biopsy infections were encountered regardless of administration of pre-procedure antibiotics (n = 14, 14.6%,), documentation of sterile prep (n = 92, 95.8%), or speculum use (n = 19, 19.8%). 50% (n = 48) had a prior hysterectomy, with no association with adequacy or complications (p = 0.9). Conclusion: Transvaginal biopsy of pelvic lesions offers excellent diagnostic yield and favorable safety profile, and can dramatically decrease distance to target. Clinical relevance: Ultrasound-guided transvaginal approach offers a safe and effective way to biopsy pelvic lesions in women. [ABSTRACT FROM AUTHOR]

Pelvic organ prolapse (POP) is a common pelvic floor disorder (PFD) that affects quality of life (QoL) in millions of women in the United States and around the world. The normal position of pelvic organs relies on both the pelvic floor muscles/levator ani muscle and the connective tissue support for the uterus and vagina. Known risk factors for POP include age, parity, family history, genetic predisposition, and chronic straining. The diagnosis of POP depends mainly on history and clinical examination. After diagnosis, progression is slow, and regression is more common than expected. Treatment starts with patient education about the disorder and available treatments. It is important to note that "doing nothing" is always an option. If patient has troublesome symptoms, there are nonsurgical and surgical options. Nonsurgical options include pelvic floor muscle training and pessary therapy. Surgery is an option for patients with POP who decline nonsurgical options or for whom those options fail. Management of women with POP and other PFDs requires a multidisciplinary team to evaluate and formulate individualized plans to address the specific health and QoL issues facing each patient. (J GYNECOL SURG 39:3) [ABSTRACT FROM AUTHOR]

Purpose: To compare the first-time success rate and prognosis of repairing vesicovaginal fistula (VVF) by transvaginal and transvesical approaches, and to highlight a modified transvaginal repair technique which only require single layer closure of an annular vaginal flap. Methods: Retrospective analysis of 57 consecutive patients who underwent VVF repair between 2007 and 2021. Fistula characteristics, operative factors, post-surgical complications and outcomes were analyzed. Results: A total of 57 women with a median age of 50.4 (27–75) years were included. The history ranged from 7 days to 8 years, with an average of 20 months. 56 cases (98.2%) of VVFs were caused by pelvic surgery, and only one resulted from difficult labour. 11 cases (19.3%) had a history of surgical repair failure. All 57 cases of surgery were smoothly completed. Among them, 17 patients underwent transvaginal repair, whereas 40 (70.2%) women had transvesical repair. Transvaginal approach had a significantly shorter operative time, less intraoperative blood loss, reduced postoperative hospital stay, less hospitalization cost and lower minor complication rates than transvesical group (p < 0.05). No serious complications occurred in the two groups. No cystostomy was performed in the transvaginal group, but 12 cases (30%) in the transvesical group. The average follow-up time was 18.5 (3–48) months. The first-time success rates of transvaginal and transvesical techniques were 82.3 and 75%, respectively. Conclusion: VVF repair with single layer closure of an annular vaginal flap is a technically feasible, simple and successful approach with significantly better operative parameters and lower complications rates. [ABSTRACT FROM AUTHOR]

Natural orifice surgery has been used with increasing frequency in colon surgeries since the early 2000's. Our aim was to examine the patients retrospectively who underwent Natural Orifice Specimen Excision (NOSE) following laparoscopic colorectal resection. A total of 102 patients 2013 and 2018 were evaluated. The demographic characteristics, intra-operative and post-operative findings, pathology results, pain, incontinence, sexual dysfunction and cosmetic scores were examined. Mean age was 57.0 ± 14 and 52 of them (51%) were female. Specimen extraction was transanal in 72 (70%) (eventration technique in 10 patients) and transvaginal in the remaining 30 patients. The mean operating time was 272 ± 108 (median 240, range 120–540) minutes, and the mean blood loss was 92 ± 87 ml (median 54, range 5–400). The mean hospital stay was 7.0 ± 4.7 days (median 6, range 3–30). The main pain scores (visual analog score) on days 1-2-3 were 3.9 ± 2.0 (median 4, range 1–9), 3.1 ± 1.7 (median 3, range 0–8), 1.9 ± 1.5 (median 1.5, range 0–7), respectively. The mean cosmetic scores were 9.1 ± 1.5 (median 10, range 3–10). The median Wexner Incontinence score was 0 (0–9). Hospital mortality was 1% and unrelated with the NOSE. The 5-year overall survival and disease-free survival rates for cancer patients were 77.2–63.3%, respectively. NOSE has advantages in laparoscopic colorectal resections. It increases patient comfort and decreases incision related complications. Clinical trials: www.clinicaltrials.gov (NCT04394988). [ABSTRACT FROM AUTHOR]

Transvaginal natural orifice transluminal endoscopic surgery (vNOTES), as a minimally invasive surgery technique, applies CO2 for creating pneumoperitoneum, and uses a closed system to through smoke evacuation from a dedicated outlet or port. It has the potential to generate aerosol in the operation room, which can lead to an increased risk of transmission of SARS-CoV-2. This technical note introduces a new technique of gasless pure vNOTES to hysterectomy using silicone face mask as a modified vNOTES port.

Background: The correct diagnosis of placenta previa is a crucial task to prevent associated complications. Ultrasound is considered the gold standard technique. However, the appropriate technique, with 100% sensitivity is not yet determined.The aim of the work: The current study aimed to compare the transabdominal 3D versus transvaginal 2D ultrasound in the assessment of placental invasion in women with placenta previa with previous uterine scar.Patients and Methods: The study included sixty patients with confirmed ultrasound placenta previa. Each patient was evaluated by the full history taking, clinical examination. Finally, ultrasound was performed for all women. The placenta was examined while the bladder is partially full [about 300 ml] for adequate visualization and precise localization. A complete US scan had been performed and included 2D vaginal ultrasound, and 3D abdominal ultrasound. At delivery, intraoperative definitive diagnosis of abnormally invasive placenta was made. Data compared to the previous ultrasound diagnosis.Results: The hematocrit value was significantly decreased after the operation compared to preoperative values [27.16 ± 2.51 vs 30.92 ± 2.78, respectively, p = 0.024]. The sensitivity of 3D transabdominal ultrasound was 53.3%, 65.0%, 88.3% and 73.3% for the detection of retroplacental clear zone, myometrial thinning, uterovesical vascularity and bladder wall interruption, successively. Otherwise, the 2D transvaginal ultrasound sensitivity was 75%, 71.6%, 83.3% and 7.7% for the same conditions. The 3D transabdominal US was 72.5% sensitive, 90% specific, 84.1% PPV, 60.9% NPV and 76.7% accuracy. The 2D transvaginal US revealed 87.4% sensitivity, 73.7% specificity, 93.3% PPV, 41.6% NPV and 89.3% accuracy.Conclusion: 2D vaginal ultrasound is more sensitive compared to the 3-D abdominal sonography in detecting placenta previa. However, the 3D transabdominal US higher sensitivity in detecting some radiological signs of this lesions like uterovesical vascularity.

BackgroundSacrospinous ligament fixation (SSLF) is a minimally invasive and effective procedure for the treatment of apical prolapse. Because intraoperative exposure of the sacrospinous ligament is difficult, SSLF is difficult. The aim of our article is to determine the safety and feasibility of single-port extraperitoneal laparoscopic SSLF for apical prolapse.MethodsThis single-center, single-surgeon case series study included 9 patients with pelvic organ prolapse quantification (POP-Q) III or IV apical prolapse who underwent single-port laparoscopic SSLF. Additionally, transobturator tension-free vaginal tap (TVT-O) was performed in 2 patients, and anterior pelvic mesh reconstruction was performed in 1 patient.ResultsThe operative time ranged from 75 to 105 (mean, 88.9 ± 10.2) min, and blood loss ranged from 25 to 100 (mean, 43.3 ± 22.6) ml. No serious operative complications, blood transfusions, visceral injuries, or postoperative gluteal pain were reported for these patients. After 2–4 months of follow-up, no recurrence of POP, gluteal pain, urinary retention/incontinence, or other complications was observed.ConclusionTransvaginal single-port SSLF is a safe, effective, and easy-to-master operation for apical prolapse.

Uterine leiomyomas, also known as uterine fibroids, are the most common benign tumors found in the female reproductive system. Transvaginal prolapsed submucosal leiomyomas are a rare complication of uterine fibroids during the postpartum period. Due to the lack of sufficient published evidence on these rare complications and their uncommon appearance, they often result in diagnostic and treatment difficulties for clinicians. This case report presents a primigravida with no special prenatal examination developed recurrent high fever and bacteremia following an emergency cesarean section. On the 20th day after delivery, a vaginal prolapsed mass was observed, which was initially misdiagnosed as bladder prolapse before being corrected to a diagnosis of vaginal prolapse of submucosal uterine leiomyoma. This patient was able to retain fertility by prompt use of powerful antibiotics and transvaginal myomectomy rather than undergoing a hysterectomy. For parturient women with hysteromyoma and recurrent fever after delivery where the source of infection cannot be found, the infection of the submucous leiomyoma of the uterus should be highly suspected. It can be helpful to perform an imaging examination to diagnose a disease, and transvaginal myomectomy should be the first choice for treating prolapsed leiomyoma in cases with no obvious blood supply or if pedicle can be achieved.

Background: This study aimed to evaluate cosmetic outcomes and feasibility of transvaginal natural orifice specimen extraction (NOSE) in patients who underwent laparoscopic or robotic surgery for the treatment of benign or malignant diseases of the kidney, liver, stomach, adrenal gland, and bladder.Methods: This prospective study was conducted at a tertiary hospital between March 2015 and May 2020. The main outcome was cosmetic outcomes of scars assessed using the Patient and Observer Scar Assessment Scale (POSAS) 1 and 8 weeks after surgery. The secondary outcomes were postoperative pain, operating time, and complications. Sexual function was assessed using the Female Sexual Function Index (FSFI) questionnaire 6 months after surgery in 17 patients who were sexually active at the time of surgery.Results: A total of 38 transvaginal NOSE procedures were performed for the extraction of 33 kidneys, 2 livers, 1 stomach, 1 adrenal gland, and 1 bladder. Observers rated pigmentation and relief scores as most deviant from normal skin (2.9 ± 1.7, 3.0 ± 2.1 at postoperative 1 week; 3.6 ± 1.9, 3.5 ± 2.2 at postoperative 8 weeks, respectively), but the overall scores of each item were low. The patients' overall satisfaction with postoperative scars was high, and the mean scores for pain and itching were low, with significant improvement from the first week to the eighth week (P = 0.014 and P = 0.006, respectively). Patients also reported low scores on vaginal assessment items, indicating better symptoms, and bleeding improved significantly between the two time points (P = 0.001). Postoperative pain was reduced from moderate during the first 24 h after surgery to mild after 24 h. The mean operative time of the transvaginal NOSE procedure was 28.3 ± 13.3 min. No postoperative complications were associated with the procedure. The mean FSFI total score was 21.2 ± 8.7 (cutoff score for dysfunction is 21), with higher scores indicating better sexual functioning.Conclusion: Transvaginal NOSE seems to be a feasible procedure with promising cosmetic benefits, for patients who undergo minimally invasive surgery for large organs including the kidney, liver, stomach, adrenal gland, and bladder. A prospective randomized clinical trial is needed to provide solid evidence to support transvaginal NOSE.Trial Registration: This trial is registered at ClinicalTrials.gov (NCT05113134). [ABSTRACT FROM AUTHOR]