Continued improvement to imaging diagnosis and treatment triage of endometriosis: The role of the multi-disciplinary conference.

Patient-centered endometriosis management tailored to the individual patient's subset of symptoms often requires highly sensitive and specific preoperative imaging. In the setting of a present ongoing learning curve among radiologists who interpret pelvis ultrasounds and MRIs for diagnosis of endometriosis, we have found that routine feedback between minimally invasive gynecology surgeons and radiologists, based on pre-operative imaging and postoperative laparoscopic findings, is essential for the continual improvement of imaging-based staging of endometriosis and empower pre-operative imaging as an important pillar of endometriosis management. We share illustrative patient cases, which, after collaborative discussion during our routine multi-institutional, multi-disciplinary conferences (MDCs) have led to improved patient counseling, better pre-surgical planning, and therefore improved patient satisfaction.

Impact of Race and Ethnicity on Perioperative Outcomes During Hysterectomy for Endometriosis.

Study Objective: To assess whether complications incurred during hysterectomy for the treatment of endometriosis differ among racial-ethnic groups.

Design: Retrospective cohort study.

Setting: American College of Surgeons National Surgical Quality Improvement Program database from 2014 to 2019.

Intraoperative Factors Associated with More Postoperative Opioid Use after Laparoscopic Hysterectomy.

Background And Objectives: To identify intraoperative factors during laparoscopic hysterectomy associated with postoperative opioid use and increased pain scores during the acute postoperative period.

Methods: This is a prospective survey-based cohort study at two teaching hospitals in the Boston metropolitan area. A total of 125 patients undergoing laparoscopic hysterectomy were enrolled.

Incidental Bladder Cancer at the Time of Routine Cystoscopy following Laparoscopic Hysterectomy.

Three patients with abnormal uterine bleeding underwent uncomplicated minimally invasive total hysterectomy with routine cystoscopy. At time of cystoscopy, the patients had unexpected findings of bladder masses and postoperatively were expeditiously referred to urology. Final pathology for all revealed low-grade urologic carcinoma.

International Consensus Statement for Recommended Terminology Describing Hysteroscopic Procedures.

Objective: To develop a consensus statement of recommended terminology to use for describing different aspects of hysteroscopic procedures that can be uniformly used in clinical practice and research.

Design: Open forum discussion followed by online video meetings.

Setting: International community of hysteroscopy experts PATIENTS: Not applicable.

Patient-reported menstrual and obstetric outcomes following hysteroscopic adhesiolysis for Asherman syndrome.

Objective: Review the menstrual and obstetric outcomes among Asherman syndrome patients when stratified by disease severity.

Design: Retrospective cohort study.

Setting: A community teaching hospital affiliated with a large academic medical center.

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.

A Systematic Review of Adenomyosis: It Is Time to Reassess What We Thought We Knew about the Disease.

Objective: To summarize and update our current knowledge regarding adenomyosis diagnosis, prevalence, and symptoms.

Data Sources: Systematic review of PubMed between January 1972 and April 2020. Search strategy included: "adenomyosis [MeSH Terms] AND (endometriosis[MeSH Term OR prevalence study [MeSH Terms] OR dysmenorrhea[text word] OR prevalence[Text Word] OR young adults [Text Word] OR adolesce* [Text Word] OR symptoms[Text Word] OR imaging diagnosis [Text Word] OR pathology[Text Word].

Physiomimetic Models of Adenomyosis.

Adenomyosis remains an enigmatic disease in the clinical and research communities. The high prevalence, diversity of morphological and symptomatic presentations, array of potential etiological explanations, and variable response to existing interventions suggest that different subgroups of patients with distinguishable mechanistic drivers of disease may exist. These factors, combined with the weak links to genetic predisposition, make the entire spectrum of the human condition challenging to model in animals.

Endometrial thickness measurements among Asherman syndrome patients prior to embryo transfer.

Study Question: Is there an association between endometrial thickness (EMT) measurement and clinical pregnancy rate among Asherman syndrome (AS) patients utilizing IVF and embryo transfer (ET)?

Summary Answer: EMT measurements may not be associated with successful clinical pregnancy among AS patients undergoing IVF.

What Is Known Already: Clinical pregnancy rate after IVF is significantly lower in patients with a thin endometrium, defined as a maximum EMT of <7 mm. However, AS patients often have a thin EMT measurement due to intrauterine scarring, with a paucity of data and no guidance on what EMT cutoff is appropriate when planning an ET among these patients.

Effects of Asherman Syndrome on Maternal and Neonatal Morbidity with Evaluation by Conception Method.

Study Objective: Create a comprehensive summary of maternal and neonatal morbidities from patients previously treated for Asherman syndrome and evaluate for differences in perinatal outcomes based on conception method.

Design: Retrospective cohort.

Setting: Community teaching hospital affiliated with a large academic medical center.

Concomitant Adenomyosis among Patients with Asherman Syndrome.

Study Objective: To characterize obstetric outcomes for concomitant Asherman syndrome and adenomyosis.

Design: A retrospective cohort study.

Setting: A community teaching hospital affiliated with a large academic medical center.

Novel Technology to Capture Objective Data from Patients' Recovery from Laparoscopic Endometriosis Surgery.

Study Objective: To assess the feasibility of a noncontact radio sensor as an objective measurement tool to study postoperative recovery from endometriosis surgery.

Design: Prospective cohort pilot study.

Setting: Center for minimally invasive gynecologic surgery at an academically affiliated community hospital in conjunction with in-home monitoring.

Opioid use after laparoscopic hysterectomy: prescriptions, patient use, and a predictive calculator.

Background: In the setting of America's opioid epidemic, judicious postoperative opioid prescribing is important. Gynecologists lack standard guidelines about postoperative opioid prescriptions.

Objectives: The objectives of the study were to describe opioid prescribing practices by a group of minimally invasive gynecologic surgeons, to measure postoperative opioid use after minimally invasive hysterectomy, and to identify preoperative factors that could predict whether a patient will be a low or high postoperative opioid user.

Into the void: a review of postoperative urinary retention after minimally invasive gynecologic surgery.

Purpose Of Review: Postoperative urinary retention (POUR) is a common occurrence after minimally invasive gynecologic surgery (MIGS). This review discusses the definition, incidence, evaluation, diagnosis, and treatment of POUR after MIGS.

Recent Findings: Reported incidence of POUR after MIGS ranges from 0.

Total Laparoscopic Hysterectomy and Bilateral Salpingo-Oophorectomy for a 6095-g Myomatous Uterus in a Patient of the Jehovah's Witness Faith.

Study Objective: To demonstrate techniques for addressing the unique challenges for a minimally invasive approach to hysterectomy presented by a massive myomatous uterus.

Design: Technical video of an operation demonstrating the methods used to perform hysterectomy in this setting, highlighting such aspects as port placement (Fig. 1), uterine manipulation (Fig.

Reducing the spread of occult uterine sarcoma at the time of minimally invasive gynecologic surgery.

Purpose: This review covers the most recent evidence to discuss the incidence of occult uterine sarcoma, whether morcellation increases tumor dissemination or mortality, and whether there is a difference between different types of morcellation. We will also discuss techniques to reduce the spread of an undiagnosed uterine sarcoma.

Method: A comprehensive literature search was made in Pubmed, Medline, the Cochrane Library, and Google Scholar for articles related to the incidence of occult uterine sarcoma after morcellation.

Tissue Extraction Techniques for Leiomyomas and Uteri During Minimally Invasive Surgery.

Fragmented tissue extraction (morcellation) of uterine and leiomyoma tissue in gynecologic surgery has been performed for decades, but recent years have seen a vast expansion of techniques to address risks associated with tissue dispersion. Use of power, or electromechanical, morcellation has largely been replaced by manual morcellation with a scalpel. Morcellation can take place through a laparoscopic incision, a minilaparotomy incision, or through a colpotomy.

Managing Postoperative Pain After Minimally Invasive Gynecologic Surgery in the Era of the Opioid Epidemic.

In this review, we examine the evidence behind nonopioid medication alternatives, peripheral nerve blocks, surgical techniques, and postoperative recovery protocols that can help minimize and effectively treat postoperative pain after minimally invasive gynecologic surgery (MIGS). Because of the depth and heterogeneity of the data, a narrative review was performed of reported interventions. A comprehensive review was performed of PubMed, Embase, and the Cochrane Database with a focus on randomized controlled trials.

Laparoscopic hysterectomy with morcellation vs abdominal hysterectomy for presumed fibroids: an updated decision analysis following the 2014 Food and Drug Administration safety communications.

Previous decision analyses demonstrate the safety of minimally invasive hysterectomy for presumed benign fibroids, accounting for the risk of occult leiomyosarcoma and the differential mortality risk associated with laparotomy. Studies published since the 2014 Food and Drug Administration safety communications offer updated leiomyosarcoma incidence estimates. Incorporating these studies suggests that mortality rates are low following hysterectomy for presumed benign fibroids overall, and a minimally invasive approach remains a safe option.