Vaginal hysterectomy in patients with pelvic organ prolapse: An eight-year experience from a tertiary care center.

Perioperative Outcomes of vNOTES Versus Vaginal Hysterectomy in Obese Women.

Health outcomes following oophorectomy during benign hysterectomy in those who are in postmenopausal ages: a population-based study.

Introduction Adnexal masses are among the most frequently encountered gynecological conditions and may require surgical intervention when symptomatic or suspicious for malignancy. With advances in minimally invasive techniques, laparoscopy has emerged as an alternative to conventional laparotomy, offering potential benefits in terms of perioperative morbidity and recovery. The study aimed to compare laparoscopic adnexal surgery and open adnexal surgery for adnexal masses with respect to intraoperative and postoperative outcomes. Materials and methods This randomized controlled trial was conducted in the Department of Obstetrics and Gynecology, Shri B. M. Patil Medical College, Vijayapura, Karnataka, India, from March 2024 to October 2025. Sixty women with adnexal masses requiring surgical management were randomly allocated into two groups: laparoscopic surgery (n=30) and open surgery (n=30). Outcomes assessed included postoperative complications (primary outcome)and secondary outcomes such as duration of surgery and anesthesia, intraoperative blood loss, postoperative hemoglobin levels, analgesic requirement, need for blood transfusion, and duration of hospital stay.Data were analyzed using appropriate statistical tests, and a p-value <0.05 was considered statistically significant. Results Both groups were comparable with respect to baseline demographic characteristics. Laparoscopic surgery was associated with significantly lower intraoperative blood loss (p<0.001), reduced postoperative analgesic requirement (p<0.001), shorter hospital stay (p<0.001), and better preservation of postoperative hemoglobin levels (p=0.021). None of the patients in the laparoscopic group required blood transfusion, whereas five (16.7%)patients in the open surgery group did (p=0.018). Although laparoscopic procedures required a longer duration of surgery and anesthesia, complication rates were comparable between the two groups, with only one wound infection reported in the open surgery group.However, the low incidence of complications limits a definitive comparison of safety outcomes. Conclusion Laparoscopic surgery for adnexal masses offers significant advantages over open surgery in terms of reduced blood loss, faster recovery, and lower postoperative morbidity. It represents a favorable surgical option for improving short-term perioperative outcomes; however, larger studies are required to establish definitive conclusions regarding comparative safety.

The Current State of AAGL-Fellowship in Minimally Invasive Gynecologic Surgery: Surgical Volume and Case Types.

To determine whether hysterectomy for benign diseases is associated with the risk of dementia in middle-aged women. We conducted a retrospective cohort study using data from the Korean National Health Insurance Service database (2002-2020). Women aged 40-59 years who underwent hysterectomy for benign indications (n=16,818) were propensity score-matched (1:1) to controls who had not received hysterectomy. Subjects were followed up until the diagnosis of dementia, death, or the end of the study period (2020). Dementia (all types), Alzheimer's disease (AD), and vascular dementia (VaD) were identified by International Classification of Diseases, 10th revision codes. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for dementia associated with hysterectomy. Median follow-up was 11.4 years. Dementia occurred in 302 (1.8%) women who did not undergo hysterectomy and 257 (1.5%) women who underwent hysterectomy (P=0.061). Cox analysis revealed that hysterectomy was not significantly associated with all-cause dementia (HR, 0.865; 95% CI, 0.724-1.033), with a non-significant trend towards reduced risk. Subgroup analysis also failed to identify any significant association; AD (HR, 0.696; 95% CI, 0.463-1.048) and VaD (HR, 0.625; 95% CI, 0.284-1.377) were not significantly associated with an increased hazard. In this large Korean cohort, hysterectomy for benign diseases in women aged 40-59 years was not associated with a significant change in the subsequent risk of dementia. Collectively, our results indicate that hysterectomy was not associated with an increased incidence of dementia, including in analyses stratified by adnexal surgery.

A significant civilian casualties due to gunshot wounds with orbital injuries, being a particularly devastating type of trauma, were incurred during the July Revolution of 2024 in Bangladesh. Those injuries resulted in complex ophthalmic and craniofacial damage that required specialised care. This study aims to describe the pattern of injuries, management procedures, and visual outcomes of orbital gunshot injuries treated in the National Institute of Ophthalmology &amp; Hospital (NIOH), Dhaka, Bangladesh, a specialized, tertiary-level eye care hospital in the country. This cross-sectional study was conducted between July and December of 2024. A total of 612 patients were included in this study among total 1002 firearm trauma presentations. Detailed information about the patients' surgical interventions, visual outcomes, and imaging findings were documented. Among 1002 gunshot injury patients, 612(61.1%) had orbital involvement, predominantly unilateral (93.6%). Radiological evaluation revealed the presence of metallic foreign bodies (68.5%) and fractures (52.3%). About 82.4% of cases with orbital injuries need ocular and adnexal surgery. Approximately 64% of the procedures involved vitreoretinal surgery. Postoperatively, 73% of patients experienced some improvement in vision; however, those with bilateral injuries showed poorer outcomes, with 51.5% experiencing further vision loss. These findings highlight the severe ocular morbidity from conflict-related orbital trauma. Conclusion: Vision loss is the most frequent morbidity from orbitofacial injuries caused by gunshots. Bilateral cases tend to exhibit the most severe outcome. These findings emphasise the essential need for updated trauma strategies, protective gear, and improved eye care in conflict zones to preserve vision and reduce disability. CBMJ 2026 January: vol. 15 no. 01 P:67-73

Articulated laparoscopic instruments such as Artisential® offer enhanced dexterity compared with conventional tools, but evidence for their use in benign gynecologic surgery remains limited. This multicenter, prospective, non-randomized comparative study evaluated the feasibility and perioperative safety of Artisential® instruments using contemporaneous controls. Consecutive patients undergoing laparoscopic surgery for benign adnexal disease between December 2022 and August 2024 were enrolled in Korea, Taiwan, and Japan. Patients who consented underwent surgery using Artisential®, while those who declined were treated with conventional laparoscopic instruments and included as retrospectively collected controls. Propensity score matching was performed based on age, body mass index, history of previous abdominal surgery, and type of surgery. Outcomes included operation time, estimated blood loss, postoperative hospital stay, and Clavien–Dindo–graded complications. A total of 184 patients were analyzed, and 112 matched patients were included after matching. No significant differences were observed between groups in operative outcomes. No conversions or transfusions occurred, and postoperative complications were infrequent and limited to grade I superficial port-site issues. These findings support the feasibility and short-term safety of Artisential® instruments in benign adnexal surgery, although randomized trials are needed to further evaluate ergonomic and economic benefits.

Adnexectomy during Vaginal Hysterectomy for Benign Non-prolapse Indications: A National NSQIP Analysis of Practice Patterns and Perioperative Outcomes.

Hysterectomy is a common gynecological surgery, but its long-term impact on ovarian cancer risk remains unclear, particularly in Asian populations. To evaluate the association between hysterectomy (with or without concomitant adnexal surgery) and the risk of ovarian cancer in South Korean women. We conducted a retrospective cohort study using the Korean National Health Insurance Service (NHIS) database (2002-2020). After 1:1 propensity score matching, 13,059 women who underwent hysterectomy for benign indications (aged 40-59) were compared with 13,059 women without hysterectomy. The primary outcome was incident ovarian cancer, defined by three or more medical visits with a C56.xx diagnosis code. Cox proportional hazards models were used to estimate hazard ratios (HRs) for ovarian cancer, adjusting for demographic and clinical confounders. Over a median follow-up of 11.5 years, ovarian cancer incidence was 18 per 100,000 person-years in the hysterectomy group and 13 per 100,000 person-years in the non-hysterectomy group. Hysterectomy was associated with an imprecise estimate of ovarian cancer risk (HR 1.42, 95% CI 0.79-2.56), compatible with both a clinically meaningful decrease and increase in risk; therefore, the findings are inconclusive. There were no statistically significant differences between the two groups across various decades of life, including females below or above 50 years of age. This study found no statistically significant association between hysterectomy and ovarian cancer risk, but the wide confidence intervals and limited number of events indicate that the findings remain inconclusive.

To compare the long-term risk of subsequent abdominopelvic surgery in women who underwent hysterectomy with ovarian conservation (H-OC) versus referent women, and in women who underwent abdominal H-OC versus vaginal H-OC. We conducted a population-based cohort study in Olmsted County, Minnesota, USA including 1573 women who underwent H-OC for a benign indication at age 18-44 years between January 1, 1980, and December 31, 2002, and 1573 age-matched (±1 year) referent women who had not undergone hysterectomy or any oophorectomy as of the matching date. For both the H-OC women and the referent women, we defined the index date as the H-OC or matching date plus 6 months. The index date served as the starting point for follow-up. Overall, we found an increased risk of subsequent lysis of adhesions in women who underwent H-OC compared to referent women (hazard ratio [HR], 1.57 [95% confidence interval [CI]: 1.09-2.27]). Women undergoing H-OC also had an increased risk of subsequent gastrointestinal tract procedures (HR, 1.18 [95% CI: 1.05-1.31]) compared to referent women. When comparing surgical route of H-OC, we identified an increased risk of subsequent adnexal surgeries in women undergoing abdominal compared with vaginal H-OC (HR, 1.91 [95% CI: 1.40-2.61]). Women who underwent H-OC have an increased risk of subsequent abdominopelvic surgeries compared to referent women. In addition, women who underwent abdominal H-OC have an increased risk of subsequent adnexal procedures compared to women who underwent vaginal H-OC.

This study aimed to evaluate the association between hysterectomy and the risk of thyroid cancer and benign thyroid disorders in South Korean women. A retrospective cohort study was conducted using Korean National Insurance data from 2002 to 2020. Women aged 40 to 59 who underwent hysterectomy for benign conditions were matched with controls using propensity score matching. The participants were followed for a median of 11.4 years. Cox proportional hazards regression analyses were performed to assess the risk of thyroid conditions. Women who underwent hysterectomy showed a significantly higher risk of developing thyroid cancer (hazard ratio [HR] 1.351, 95% confidence interval [CI] 1.17–1.559) as well as increased incidence of goiter and non-toxic thyroid nodules. This elevated risk was observed across the age group 40–59 years and was independent of whether adnexal surgery was performed. No significant differences were found for other thyroid disease categories. These findings demonstrate an association between hysterectomy and increased risk of thyroid cancer. Further research is needed to elucidate the underlying mechanisms.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-22424-1.

Antimicrobial prophylactic strategies in vNOTES: No consensus, but what do we know?

Objectives: This study aims to determine the necessity of obtaining a basic metabolic panel (BMP) and/or comprehensive metabolic panel (CMP) prior to minor laparoscopic gynecological surgery by looking at intraoperative anesthetic or surgical complications in patients with electrolyte abnormalities found on routine testing. Methods: The electronic medical record (Epic Systems Corporation) was queried for patients who had received minor laparoscopic gynecological surgery at Jeanes Hospital or Temple University Hospital in Philadelphia, Pennsylvania, between January 1, 2018, and December 31, 2022. Patients included underwent laparoscopic adnexal surgeries or exploratory laparoscopy. Patients included had complete blood count (CBC), BMP, or CMP performed within 4 months of their surgery. Patients who had BMP or CMP were included as cases. Patients with only CBC were used as the control group, resulting in 117 cases and 121 controls. Charts were then analyzed for either anesthetic or intraoperative surgical complications. Anesthesia complication was defined as any complication as documented by anesthesia ( i.e. , arrhythmias, significant desaturations). Surgical complication was defined as documentation of complication noted by the surgeon in the operative note ( i.e. , uterine perforation, instrument malfunction, laparotomy). Continuous data were analyzed using the Wilcoxon test, while categorical data were analyzed using the chi-square or Fisher’s test. A p -value of &lt;0.05 was considered statistically significant. Results: Among 117 cases, 47 patients (40.2%) had no electrolyte abnormalities on routine preoperative labs, and a total of 70 cases (59.8%) had some form of electrolyte abnormality preoperatively. Only one case received preoperative repletion based on labs collected in the Emergency Room, despite normal preoperative laboratories. Of the 70 cases with an abnormality, 4 had an anesthetic or surgical complication (0.05%) as compared with 1 patient out of 47 who had no electrolyte abnormalities (0.02%). There was no significant difference in anesthetic or surgical complications between cases with or without an electrolyte abnormality ( p = 0.52). There was no significant difference in anesthetic or surgical complications between cases and controls ( p = 0.91). No life-threatening anesthetic or surgical complications were noted within this study group. Conclusions: The majority of cases had some form of electrolyte abnormality; however, few had any form of preoperative intervention, and the case proceeded as planned. Additionally, there was no significant difference in the number of anesthetic or surgical complications between the two study groups. This study suggests that routine BMP or CMP prior to minor gynecological laparoscopic surgery does not change outcomes for patients and may be an unnecessary step, potentially saving the patient and hospital both time and money prior to surgery. Further research is needed to investigate the necessity of metabolic panel in a more age-diverse population prior to minor and major gynecological laparoscopic surgeries for increased applicability.

ObjectiveTo estimate the learning curve of laparoscopic articulated instrument (LAI) surgery by analyzing data from a multi-institutional gynecologic surgery cohort using surgical time as the primary metric for evaluation.MethodsA total of 400 patients scheduled to undergo gynecologic surgery (adnexal surgery, myomectomy, hysterectomy, and cancer surgery) using LAI were prospectively enrolled at 14 institutes in the Republic of Korea between November 2021 and April 2022 (KGOG 4002). After excluding patients who did not undergo surgery with LAI (n=43), those in whom LAI was rarely used (n=11), and those operated on by surgeons with prior LAI experience (n=147), 199 patients were included in the analysis. Changes in surgical time according to the surgery index were evaluated using linear regression analysis.ResultsFifty-four adnexal surgeries, 40 myomectomies, 68 hysterectomies, and 37 cancer surgeries were performed by 24 surgeons. Each surgeon performed between one and 24 surgeries. Surgical time did not decrease as the surgery index increased for any type of surgery. Among surgeons who performed ≥10 surgeries, surgical time similarly showed no decrease with increasing surgery index.ConclusionIn gynecologic surgery using LAI, surgical time did not decrease despite accumulating surgical experience.

Vaginal NOTES adnexal surgery: Results of a retrospective cohort study in The Netherlands

Background: Laparoscopic gynecologic surgery is widely favored for its minimally invasive nature, offering reduced postoperative pain, shorter hospital stays, and faster recovery. However, despite its advantages, postoperative complications—ranging from minor infections to major injuries—remain a concern. Identifying patient- and procedure-specific risk factors is critical to enhancing surgical safety and outcomes. Objective: To evaluate the incidence and predictors of postoperative complications in gynecologic laparoscopic surgeries and identify high-risk patient and procedural factors using a large, retrospective dataset. Methods: This retrospective cohort study included 15,308 patients who underwent laparoscopic gynecologic procedures at tertiary care hospitals in Pune, India, between January 2023 and October 2024. Patients were categorized by procedure type: adnexal surgery, myomectomy/uterine lesion surgery, LAVH/TLH, and malignancy surgery. Data on demographics, prior surgical history, comorbidities, and surgical details were collected. Complications were classified as major (e.g., bowel or ureteral injury, hemorrhage requiring reoperation) or minor (e.g., infection, transient fever). Multivariate logistic regression identified independent risk factors for major complications. Results: The overall major complication rate was 0.51%, and the minor complication rate was 4.64%. Surgeries for malignancy had the highest major complication rate. Independent risk factors for major complications included age 31–60 years (aOR: 2.88; 95% CI: 1.89–7.88), age &gt;60 years (aOR: 2.92; 95% CI: 1.67–5.65), prior abdominal surgery (aOR: 3.58; 95% CI: 1.38–6.54), obesity (aOR: 2.52; 95% CI: 1.39–7.28), and higher surgical complexity (e.g., malignancy surgery vs. adnexal: aOR: 7.62; 95% CI: 3.61–13.63). Conclusion: Although complication rates in laparoscopic gynecologic surgery remain low, advanced age, obesity, previous abdominal surgery, and complex procedures significantly increase the risk of major complications. These findings underscore the need for thorough preoperative assessment, individualized surgical planning, and targeted risk mitigation strategies to optimize patient outcomes.

PurposeDespite numerous previous studies, the relationship between hysterectomies and breast cancer risk remains unclear. This study aimed to assess whether hysterectomies are significantly associated with a reduced risk of breast cancer in Korean women using data from the National Health Insurance Service database of South Korea.MethodsWe conducted a retrospective cohort study of South Korean women aged 40–59 years who underwent hysterectomies for benign reasons or underwent a health check-up between 2003 and 2011. To minimize confounding factors, a 1:1 propensity score matching (PSM) was used to balance the groups based on key covariates. The participants were followed up until December 31, 2020. Stratified Cox proportional hazards regression analysis was performed to assess the association between hysterectomies and breast cancer risk.ResultsAfter 1:1 PSM, 13,148 women were assigned to the hysterectomy or non-hysterectomy groups. Breast cancer occurred in 242 (1.8%) and 233 (1.8%) women in the non-hysterectomy and hysterectomy groups, respectively (p = 0.711). After adjusting for confounders, hysterectomy with or without adnexal surgery was not significantly associated with breast cancer risk (hazard ratio [HR], 0.937; 95% confidence interval [CI], 0.775–1.132 for hysterectomy with/without adnexal surgery; HR, 0.957; 95% CI, 0.779–1.176 for hysterectomy without adnexal surgery; and HR, 0.833; 95% CI, 0.513–1.353 for hysterectomy with adnexal surgery). No significant association was found when analyzing surgical methods or age at natural menopause.ConclusionOur study found no association between hysterectomies and breast cancer risk, which is consistent with previous studies that reported a null association.

Background and Objectives: Regional anesthesia is a key component of multimodal analgesia following minimally invasive gynecologic surgery. However, single-port laparoscopic adnexal surgery differs anatomically and physiologically from multiport or open approaches, particularly in terms of incision site, tissue handling, and pain characteristics. Despite its increasing use, evidence supporting procedure-specific regional analgesic protocols for this approach remains limited. This study aimed to compare the analgesic efficacy of quadratus lumborum block (QLB) and rectus sheath block (RSB) in this surgical context. Materials and Methods: In this randomized controlled trial, 68 patients undergoing single-port laparoscopic adnexal surgery were randomly assigned to receive either QLB or RSB at the end of surgery. Four patients were excluded due to missing patient-controlled analgesia (PCA) data, resulting in 64 patients analyzed (QLB group: n = 32; RSB group: n = 32). The primary outcome was cumulative opioid consumption over the first 24 postoperative hours. Secondary outcomes included interval-based opioid consumption, time to first PCA bolus, postoperative pain scores, and incidence of postoperative nausea and vomiting (PONV). Results: The RSB group demonstrated significantly lower cumulative opioid consumption at 24 h postoperatively (132.9 [61.3, 338.4] µg vs. 453.0 [253.1, 811.0] µg, p < 0.001). This trend persisted across most postoperative time points up to 48 h. Interval-based opioid consumption was also lower in the RSB group during 0–24 h and 32–48 h intervals (each comparison p < 0.05). The time to first PCA bolus was significantly longer in the RSB group (56.5 [41.0, 340.3] minutes vs. 40.5 [33.3, 68.8] minutes; p = 0.014), and Kaplan–Meier analysis confirmed a delayed first bolus request in the RSB group (log-rank p = 0.007). Pain scores and postoperative nausea and vomiting incidence were comparable between groups. Conclusions: Compared with QLB, RSB provided similar pain relief with significantly lower opioid consumption following single-port laparoscopic adnexal surgery. These findings highlight the potential advantages of RSB in enhancing analgesic efficiency and support the development of procedure-specific regional analgesia protocols tailored to this surgical approach.

INTRODUCTION: International guidelines recommend follow-up imaging and gynecologic oncology referral for patients with Ovarian-Adnexal Reporting and Data System (O-RADS) 4/5 lesions. We examined factors associated with guideline-concordant follow-up of these lesions in our health system. METHODS: The university IRB exempted this retrospective cohort study of patients with O-RADS 4/5 lesions on ultrasound (US) or magnetic resonance imaging (MRI) from July 1, 2020, to December 31, 2023. Patients with adnexal surgery within 120 days of detection were excluded (n=253). We performed descriptive statistics of our final cohort (n=172). RESULTS: 59.9% were not referred to gynecologic oncology (103/172, 59.9%). 65.7% had a documented pelvic examination after initial detection (113/172, 65.7%), 48.8% had generalist follow-up (84/172, 48.8%), and 15.7% had both generalist and gynecologic oncology follow-ups (27/172, 15.7%). 13.4% had ongoing lesion surveillance at data collection (23/172). 55.0% of the remaining (82/149, 55.0%) had benign follow-up imaging. 9.4% received surgery for persistent abnormalities (14/149, 9.4%) with three cancers diagnosed (3/149, 2.0%). Black compared to White patients had higher rates of incomplete or no follow-up imaging (14/40, 35.0% versus 18/91, 19.8%), follow-up pelvic examinations (30/40, 75.0% versus 62/91, 68.1%), and generalist visits (23/40, 57.5% versus 47/91, 51.6%), with lower rates of gynecologic oncology follow-up (13/40, 32.5% versus 43/91, 47.3%). Insured patients had higher rates of completed follow-up imaging (80/156, 51.3% versus 2/6, 33.3%). CONCLUSIONS/IMPLICATIONS: 22.7% (39/172) of patients with O-RADS 4/5 lesions had no or incomplete follow-up imaging. Higher rates of guideline discordant care among Black and uninsured patients suggest opportunities for care optimization.