Hybrid Hysterectomy Versus Laparoscopic and Open Approaches: A Propensity Score-Matched Comparison of Outcomes.

Study Objective: To evaluate the surgical outcomes of hybrid hysterectomy for enlarged uteri, compared to laparoscopic and open approaches.

Design: Matched case-control study SETTING: Tertiary-care academic medical center.

Patients: Patients who underwent hybrid hysterectomy between January 1, 2010, and December 31, 2021, were included.

Impact of lifestyle and dietary modifications for endometriosis development and symptom management.

Purpose Of Review: Management of endometriosis is often complex and poorly studied. Patients with endometriosis have interest in how their lifestyle may affect their diagnosis. Self-management and lifestyle changes are often used as adjunct therapy, but best practices are not concrete in treatment guidelines.

Evolving best practices in the surgical management of endometriosis - examining the evidence and expert opinion.

Purpose Of Review: Endometriosis is a common and often debilitating condition, with multiple theories of pathogenesis. Despite the prevalence of endometriosis, the optimal surgical management remains unclear.

Recent Findings: Laparoscopy is the gold standard for the diagnosis of endometriosis, with biopsy confirmation more accurate than visual diagnosis alone.

Current Methods of Tissue Extraction in Minimally Invasive Surgical Treatment of Uterine Fibroids.

Background And Objectives: Since the 2014 Food and Drug Administration communication regarding the use of power morcellation, gynecologists have adopted alternative tissue extraction strategies. The objective of this study is to investigate the current techniques used by gynecologic surgeons for tissue extraction following minimally invasive hysterectomy or myomectomy for fibroids.

Methods: An online survey was distributed to all AAGL members and responses were collected between March 26, 2019 and April 17, 2019.

Minimally invasive management of retained products of conception and the adherent placenta.

Purpose Of Review: Retained products of conception (POC) may occur independently or as a consequence of placenta accreta spectrum (PAS). Managing these conditions depends on the clinical scenario, and in some cases, can involve the use of minimally invasive techniques. This review presents the role of hysteroscopy and laparoscopy in the treatment of retained POC and the adherent placenta.

Superior Hypogastric Plexus Block to Reduce Pain After Laparoscopic Hysterectomy: A Randomized Controlled Trial.

Objective: To assess whether a superior hypogastric plexus block performed during laparoscopic hysterectomy reduces postoperative pain.

Methods: We conducted a multicenter, randomized, single-blind, controlled trial of superior hypogastric plexus block at the start of laparoscopic hysterectomy. Women undergoing a laparoscopic hysterectomy for any indication and with any other concomitant laparoscopic procedure were eligible.

Diagnosing endometriosis before laparoscopy: radiologic tools to evaluate the disease.

Purpose Of Review: The current gold standard for diagnosing endometriosis is laparoscopy with tissue biopsy. This review presents new evidence regarding advanced imaging for more optimal clinical assessment and preoperative evaluation for endometriosis.

Recent Findings: A systematic approach to the imaging evaluation of endometriosis using transvaginal ultrasound and magnetic resonance imaging has been proposed by expert groups and societies.

Factors Associated with Negative Patient Experiences with Essure Sterilization.

Study Objective: The objective of the study was to identify factors associated with negative patient experiences with Essure.

Design: This was a retrospective cohort study and follow-up survey.

Setting: The study was conducted in an academic setting.

Laparoscopic abdominal cerclage: a highly effective option for refractory cervical insufficiency.

Laparoscopic abdominal cerclage is emerging as the preferred treatment option for patients with refractory cervical insufficiency. Laparoscopic abdominal cerclage reduces second-trimester loss and preterm birth with success rates similar to open abdominal cerclage. Increasing evidence also suggests improved neonatal survival rates with abdominal cerclage compared with repeat vaginal cerclage in patients who delivered prematurely despite a vaginal cerclage.

Laparoscopic treatment of endometriosis and predictors of major complications: A retrospective cohort study.

Introduction: Patients with advanced endometriosis may be at an increased risk of surgical complications following laparoscopic treatment of endometriosis; however, this relationship has not been examined. We sought to identify predictors of major complications following laparoscopic treatment of endometriosis.

Material And Methods: A retrospective cohort study of women who underwent laparoscopic treatment of suspected endometriosis between 2009 and 2016 within the Division of Minimally Invasive Gynecologic Surgery at Brigham and Women's Hospital, Boston, MA, USA.

Important considerations for women in the late reproductive and perimenopausal years desiring myomectomy.

Purpose Of Review: To review important considerations in the counseling and management of women over the age of 40 desiring a myomectomy for symptomatic fibroids.

Recent Findings: Women in the late reproductive and perimenopausal years may choose a myomectomy over a hysterectomy for reasons of fertility preservation or a personal desire to retain their uterus. Data suggest that laparoscopic myomectomy is a low-risk procedure that can be offered to older women, though the age-related risk of uterine malignancy must be evaluated.

Perioperative Antibiotic Use and Associated Infectious Outcomes at the Time of Myomectomy.

Objective: To report the frequency of perioperative antibiotic use at time of myomectomy and associated risk of infectious outcomes.

Methods: We conducted a retrospective cohort study including all women who underwent any route of myomectomy from 2009 to 2016 at two academic hospitals in Boston, Massachusetts. Cases involving chromopertubation or conversion to hysterectomy were excluded from further analysis.

A Novel Technique for Essure Reversal.

Background And Objectives: An increasing number of women are seeking removal of the Essure sterilization device due to symptoms including pelvic pain, abnormal bleeding, and allergic reaction. A fraction of these women also desire a future pregnancy and request sterilization reversal at the time of device removal. We present a novel technique for Essure reversal in addition to our experience with three cases.

Perioperative Outcomes of Myomectomy for Extreme Myoma Burden: Comparison of Surgical Approaches.

Study Objective: To describe the perioperative outcomes of various modes of myomectomy (abdominal [AM], laparoscopic [LM], or robotic [RM]) in cases of extreme myoma burden.

Design: Retrospective cohort study (Canadian Task Force classification II-2).

Setting: A tertiary academic center in Boston, Massachusetts.

Surgical skills assessment tools in gynecology.

Purpose Of Review: The purpose of this review is to outline surgical skills assessment tools for the purpose of training and competency evaluation, with a focus on recent literature in gynecology.

Recent Findings: Objective standardized surgical skills assessment tools are increasingly being explored in multiple surgical disciplines including gynecology. Several small studies in gynecology have validated procedure-specific checklists, global rating scales, and other surgical proficiency examinations in their ability to differentiate trainee skill level or correlate with other standardized tests.

Prospective Evaluation of Manual Morcellation Techniques: Minilaparotomy versus Vaginal Approach.

Study Objective: To compare the number of days required to return to daily activities after laparoscopic hysterectomy with 2 tissue extraction methods: manual morcellation via colpotomy or minilaparotomy. Secondary outcomes were additional measures of patient recovery, perioperative outcomes, containment bag integrity, and tissue spillage.

Design: Multicenter prospective cohort study and follow-up survey (Canadian Task Force classification II-2).

Incisional Outcomes of Umbilical vs Suprapubic Mini-laparotomy for Tissue Extraction: A Retrospective Cohort Study.

Study Objective: To compare outcomes following umbilical minilaparotomy and suprapubic minilaparotomy for tissue extraction.

Design Classification: Retrospective cohort study (Canadian Task Force classification II-2).

Setting: Two large academic medical centers.

Opioid Prescription and Patient Use After Gynecologic Procedures: A Survey of Patients and Providers.

Study Objective: To describe opioid distribution and patient use after gynecologic procedures.

Design: Survey study (Canadian Task Force classification III).

Setting: An urban academic tertiary care hospital.

The menstrual cycle and blood loss during laparoscopic myomectomy.

Introduction: Operative morbidity of laparoscopic myomectomy largely relates to the potential for intraoperative blood loss. We sought to determine whether blood loss varies according to the menstrual cycle.

Material And Methods: A retrospective study of 268 women who underwent a laparoscopic myomectomy from 2007 to 2012.

Impact of a Fellowship-Trained Minimally Invasive Gynecologic Surgeon on Patient Outcomes.

Background And Objectives: As the performance of minimally invasive hysterectomy has increased in the United States, the need to apply outcomes measures has also increased. This study was conducted to determine the impact of a fellowship-trained minimally invasive gynecologic surgery (MIGS) specialist on patient outcomes after laparoscopic hysterectomy (LH) in a gynecology department.

Methods: This is a retrospective review of 218 patients who underwent a laparoscopic hysterectomy for benign indications at a suburban academic-affiliated tertiary care hospital with a broad patient base from 2010 to 2014.

Review of Sterilization Techniques and Clinical Updates.

Sterilization is the most common form of contraception used worldwide and is highly effective in preventing unintended pregnancy. Each of the available sterilization methods has unique advantages and disadvantages that influence the choice of approach for each individual patient. Salpingectomy for sterilization has become more popular in recent years, with mounting evidence suggesting a protective effect against ovarian cancers originating in the fallopian tube.

Tissue Extraction Techniques During Laparoscopic Uterine Surgery.

Morcellation allows minimally invasive approaches to surgery even in the presence of large uteri or myomas. Recent restrictions in the use of power morcellation, as well as concerns regarding the potential for morcellation to disseminate malignant tissue, have initiated investigation and innovation to find safer methods. This review examines current techniques for tissue extraction during uterine surgery, with a focus on contained power morcellation and contained manual morcellation via mini-laparotomy or colpotomy.

Independent Roll-Down Ring for Contained Tissue Extraction.

An independent roll-down ring can be used to improve exposure during contained tissue extraction. We have used this technique in approximately 50 cases to date with good success. In this article we briefly describe our technique.