Benign Gynecologic Conditions Research Articles

Robotic Surgery in Gynaecology: A Retrospective Evaluation of an Experience at a Single Centre.

The aim of this research was to assess the role of robotics and its outcome in gynaecology both in benign and malignant cases in a single centre and provide a critical evaluation of possible advantages of robot assisted surgeries from surgeons' point of view. A single centre, retrospective observational study. All women who underwent robotic gynaecological surgeries between 2015 and 2022. The Da Vinci Si™ robotic system was used for these surgeries performed by all surgeons at our quaternary care centre, and data were acquired retrospectively through electronic medical records. Descriptive statistical analysis of data was done. Main outcome measures included operative time, estimated blood loss, hospital stay, complications and conversion rates in all cases. Age was analysed as a demographic data. A total of 211 robotic cases wereperformed including 172 hysterectomies, 20 myomectomies and 19 cases for other gynaecological indications. The mean operating time or hysterectomy and myomectomy was 113 and 129min, respectively, and haemoglobin drop was 1.34 and 1.2g/dl, respectively. No conversions to laparotomy were observed in either of the groups. The surgeries for 19 benign gynaecological conditions included ovarian cystectomy, cesarean scar repair and chronic cornual ectopic. Robotic surgical system helps accomplish several procedures with exceptional laparoscopic skills. Robotic surgery is safe in all types of gynaecological procedures and is a promising alternative for comprehensive gynaecologic surgical care.

The global burden of disease due to benign gynecological conditions: A call to action.

Focusing on low- and middle-income countries (LMICs), this article uses data from the Global Burden of Disease (GBD) database to highlight the burden of morbidity due to benign gynecological conditions (BGCs). We analyzed 2019 morbidity data for all BGCs, measured as years lost to disability (YLDs). Disease burden was calculated for individual conditions, BGCs overall, and percentages of overall disease burden from all conditions. The same data extraction was performed for malaria, tuberculosis, and HIV/AIDS for comparison. The data were subcategorized by age and World Bank income level. BGCs are major causes of disease morbidity worldwide. For women aged 15 years and over in high-income countries (HICs), 3 588 157 YLDs (3.94% of all YLDs) were due to BGC. In LMICs, 18 242 989 YLDs (5.35% of all YLDs) were due to BGCs. The highest burden of BGCs is seen during the reproductive years where conditions driven or exacerbated by reproductive hormones are the major causes of morbidity. In LMICs, for women aged 15-49, 14 574 100 YLDs (7.75% of all YLDs) were due to BGCs, declining to 3 152 313 YLDs (3.04%) in women aged 50-69 and 529 399 YLDs (1.06%) in women age 70+. These data demonstrate a huge burden of morbidity due to BGCs. There is an urgent need for international stakeholders to prioritize the treatment and prevention of BGCs.

Vaginal Hysterectomy Compared With Laparoscopic Hysterectomy in Benign Gynecologic Conditions

OBJECTIVE: To compare surgical efficacy outcomes and complications after laparoscopic hysterectomy and vaginal hysterectomy performed for benign gynecologic conditions. DATA SOURCES: We performed an online search in major databases, including PubMed, Scopus, Web of Science, ClinicalTrials.gov, and the Cochrane Library from 2000 until February 28, 2023. METHODS OF STUDY SELECTION: We searched for randomized controlled trials (RCTs) that compared vaginal hysterectomy with laparoscopic hysterectomy in benign gynecologic conditions. We located 3,249 articles. After reviewing titles and abstracts, we identified 32 articles that were eligible for full-text screening. We excluded nine articles as not-RCT or not comparing vaginal hysterectomy with laparoscopic hysterectomy. Twenty-three articles were included in the final systematic review, with 22 articles included in the meta-analysis. TABULATION, INTEGRATION, AND RESULTS: Twenty-three eligible RCTs included a total population of 2,408, with 1,105 in the vaginal hysterectomy group and 1,303 in the laparoscopic hysterectomy group. Blood loss and postoperative urinary tract infection rates were lower in the vaginal hysterectomy group than in the laparoscopic hysterectomy group (mean difference −68, 95% CI −104.29 to −31.7, P<.01, I 2=95% and odds ratio 1.73, 95% CI 0.92–3.26, P=.03, I 2=0%, respectively). Vaginal hysterectomy was associated with less total operative time, less recovery time, and greater postoperative pain on the day of surgery. Other complications, including conversion to laparotomy, visceral organ damage, or wound dehiscence, were uncommon. Because of insufficient data, we were not able to stratify by surgical indication. CONCLUSION: Vaginal hysterectomy had a shorter total operative time and recovery time but greater postoperative pain on day of surgery compared with laparoscopic hysterectomy. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42023338538.

Kallikrein-Related Peptidase 4 Promotes Proliferation, Migration, Invasion, and Pro-Angiogenesis of Endometrial Stromal Cells via Regulation of Brain-Derived Neurotrophic Factor Production in Endometriosis

Endometriosis is a common benign gynecologic condition. Endometriosis lesions are associated with endometrial cell proliferation, migration, invasion, and neovascularization, while the specific molecular mechanisms are still elusive. Transcriptome sequencing has been used for the identification of diagnostic markers in endometriosis. Here, transcriptome profiling revealed that kallikrein-related peptidase 4 (KLK4) expression was up-regulated in ectopic endometrium (EC) tissues of patients with endometriosis. KLK4 mediates the degradation of extracellular matrix proteins, and its proteolytic activity activates many tumorigenic and metastatic pathways via tumor invasion and migration. Nevertheless, whether KLK4 serves as an important regulatory factor in endometriosis remains unclear. This study confirmed that KLK4 was highly expressed in ectopic endometrial stromal cells (EC-ESCs). KLK4 overexpression promoted proliferation and suppressed apoptosis of EC-ESCs, induced cell migration and invasion, and enhanced angiogenesis invivo. Mechanistically, KLK4 overexpression mediated the protein cleavage of pro-brain-derived neurotrophic factor in EC-ESCs. Finally, brain-derived neurotrophic factor was a vital downstream substrate of KLK4 maintained the proliferation, metastasis, and pro-angiogenesis abilities and inhibited apoptosis of ESCs through a rescue study. Together, these findings demonstrate the promotive role of KLK4 in endometriosis development. In addition, the study provides a new insight that KLK4 might be a potential therapeutic target and prognostic marker for patients with endometriosis.

Hysteroscopic management of subfertility in cases with suspected endometrial polyps

Endometrial polyps (EPs) are a common benign gynecologic condition associated with abnormal uterine bleeding (AUB), infertility and recurrent pregnancy loss. Transvaginal ultrasound (TVU) provides an excellent diagnostic technique to identify the size and the anatomic location of endometrial polyps. Its accuracy increases when color Doppler, 3D investigation and saline-infused sonohysterography are used. However, hysteroscopy showed the highest diagnostic accuracy in infertile patients with suspected endometrial polyps and provides a safe and feasible opportunity for EPs removal. Objectives. This study aims to demonstrate the effectiveness of hysteroscopic polyps’ removal in infertile young female patients. Methodology. This study, conducted over a period of one year, included women who addressed our clinic for infertility. These patients were clinically examined and evaluated using transvaginal ultrasound (TVUS). Hysteroscopy was performed on all cases where TVUS raised the suspicion of endometrial polyps. Additionally, the incidence of pregnancies obtained within the first 12 months after the hysteroscopic removal of endometrial polyps was recorded. Results. Out of the cohort of 97 infertile patients, endometrial polyps were suspected in 33 patients. Before hysteroscopy, seven patients additionally underwent a sonohysterography (SHG) procedure. Abnormal uterine bleeding was the primary clinical manifestation (21 cases; 63.63%). EPs were histologically confirmed in 31 cases, and leiomyoma, in two cases. Of the 31 EPs cases, in 20 cases (64.51%) the localization was at the utero-tubal junction. Out of the 30 patients diagnosed with EPs and where the follow-up was possible, 18 individuals, constituting 60% of the group, successfully attained intrauterine pregnancies within the initial 12 months following their hysteroscopic procedure. Conclusions. Our study revealed a significant improvement in reproductive outcomes within the first year following EP resection. The prevalence of endometrial polyps has increased due to improved ultrasound techniques. SHG can potentially increase the ultrasound detection of endometrial polyps, especially in cases where the imagistic information is unclear. Nonetheless, hysteroscopy, known for its high diagnostic accuracy, remains the gold standard. Our research supports the importance of hysteroscopy for uterine cavity assessment and lesion management, and it highlights the increased chances of pregnancy after the lesion’s removal.

9773 Vaginal Hysterectomy Versus Laparoscopic Hysterectomy in Benign Gynecological Conditions: An Updated Meta-Analysis of RCTs for 2023

9773 Vaginal Hysterectomy Versus Laparoscopic Hysterectomy in Benign Gynecological Conditions: An Updated Meta-Analysis of RCTs for 2023

Feasibility and safety of vNOTES for gynecological procedures in obese patients

IntroductionThis study aimed to determine the feasibility and safety of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) to treat benign and malign gynecological conditions in obese patients. Material and methodsWe analyzed data from 79 obese patients with a body mass index (BMI) > 30 Kg/m2 operated by vNOTES for gynecological conditions between May 2020 and April 2023. The primary outcome was the feasibility of performing the surgery as initially planned. Data were presented for subgroups of patients with obesity class I (BMI 30.1 - 34.9 Kg/m2), class II (BMI 35.0 – 39.9 Kg/m2), and class III (BMI ≥ 40.0 Kg/m2). ResultsPatients presented obesity class I in 39 cases (49.4 %), class II in 27 cases (34.2 %), and class III in 13 cases (16.4 %). Fifty-two patients (65.8 %) underwent vNOTES hysterectomy, 26 patients (32.9 %) underwent procedures limited to the adnexa, and 1 patient (1.3 %) underwent myomectomy. The conversion rate was 0 %, 11.1 %, and 7.7 % in obesity class I, II, and III, respectively. Intraoperative bladder injury was observed in 1 case (1.3 %) and rectal serosal tear in 2 cases (2.5 %). Postoperatively, we observed 3 cases (3.8 %) of wound infection, 2 cases (2.5 %) of cystitis, and 1 case (1.3 %) of deep vein thrombosis. DiscussionThis study demonstrated the feasibility and safety of performing gynecological vNOTES procedures in obese patients. However, obesity could be associated with longer and more complex interventions, especially in obesity class II and III patients.

Effects of localization of uterine adenomyosis on clinical features and pregnancy outcome

The purpose of this study was to implore the association among clinical features, long-term fertility outcomes and the anatomical location of adenomyosis identified by ultrasound. We collected data of non-pregnant patients between 20 and 40 years old who had undergone surgical exploration for benign gynecological conditions at our institution between January 2010 and December 2017. A total of 158 women met the inclusion criteria and were allocated into three groups according to the ultrasound-determined adenomyosis anatomical location: anterior (Group A), posterior (Group B), both posterior and anterior (Group C). 44.3% (70/158) adenomyosis was located at the posterior side. History of miscarriage and parity were significantly higher in Group C (p = 0.036 and 0.001 respectively). Group C also had a higher concurrence rate of ovarian endometrioma (OEM) (80.4%, p = 0.002), pelvic adhesion (80.4%, P = 0.003) and the revised American Fertility Society (rAFS) Score (median64, range2-100, P < 0.001), while a significantly lower rate of concurrent peritoneal endometriosis (P = 0.01). Group B showed a relative higher rate of coexistent heavy menstrual bleeding (28.6%, p = 0.04) and oviduct obstruction (24.3%, P = 0.038). Group A had a higher proportion of coexistent leiomyoma (53.1%, P = 0.002). There were no significant differences between group A, B, and C in terms of pain symptoms, endometrial polyps, operation time, and endometriosis fertility index score and other basic characters (p > 0.05). During the follow-up, 59.2% (61/103) patients had clinical pregnancies, and 26.2% (16/61) of them experienced pregnancy loss. Total in vitro fertilization and embryo transfer pregnancy rate was 64.6% (42/65) and spontaneous pregnancy rate was 50.0% (19/38). The Kaplan–Meier curves demonstrated significant lower cumulative pregnancy rate in Group C than Group A and Group B (p = 0.01). Severe obstetric complications such as placenta previa, placenta accreta, preeclampsia, and preterm birth were only found in women with adenomyosis located in the posterior side. In conclusion, types of adenomyosis based on sonographic location had different clinical features and pregnancy outcome. Patients with adenomyosis lesion in both anterior and posterior sides had higher combination of OEM, pelvic adhesion and rAFS score.

LAparoscopic Versus Abdominal hysterectomy (LAVA): protocol of a randomised controlled trial

IntroductionThere is uncertainty about the advantages and disadvantages of laparoscopic hysterectomy compared with abdominal hysterectomy, particularly the relative rate of complications of the two procedures. While uptake of laparoscopic hysterectomy...

Predictive risk factors of vaginal cuff infection and vaginal cuff dehiscence in Egyptian female patients undergoing total laparoscopic hysterectomy for benign gynecological conditions

Predictive risk factors of vaginal cuff infection and vaginal cuff dehiscence in Egyptian female patients undergoing total laparoscopic hysterectomy for benign gynecological conditions

Salpingectomy and the Risk of Ovarian Cancer in Ontario

A body of pathological and clinical evidence supports the position that the fallopian tube is the site of origin for a large proportion of high-grade serous ovarian cancers. Consequently, salpingectomy is now considered for permanent contraception (in lieu of tubal ligation) or ovarian cancer prevention (performed opportunistically at the time of surgical procedures for benign gynecologic conditions). To evaluate the association between salpingectomy and the risk of invasive epithelial ovarian, fallopian tube, and peritoneal cancer. This population-based retrospective cohort study included all women aged 18 to 80 years who were eligible for health care services in Ontario, Canada. Participants were identified using administrative health databases from Ontario between January 1, 1992, and December 31, 2019. A total of 131 516 women were included in the primary (matched) analysis. Women were followed up until December 31, 2021. Salpingectomy (with and without hysterectomy) vs no pelvic procedure (control condition) among women in the general population. Women with a unilateral or bilateral salpingectomy in Ontario between April 1, 1992, and December 31, 2019, were matched 1:3 to women with no pelvic procedure from the general population. Cox proportional hazards regression models were used to estimate the hazard ratios (HRs) and 95% CIs for ovarian, fallopian tube, and peritoneal cancer combined. Among 131 516 women (mean [SD] age, 42.2 [7.6] years), 32 879 underwent a unilateral or bilateral salpingectomy, and 98 637 did not undergo a pelvic procedure. After a mean (range) follow-up of 7.4 (0-29.2) years in the salpingectomy group and 7.5 (0-29.2) years in the nonsurgical control group, there were 31 incident cancers (0.09%) and 117 incident cancers (0.12%), respectively (HR, 0.82; 95% CI, 0.55-1.21). The HR for cancer incidence was 0.87 (95% CI, 0.53-1.44) when comparing those with salpingectomy vs those with hysterectomy alone. In this cohort study, no association was found between salpingectomy and the risk of ovarian cancer; however, this observation was based on few incident cases and a relatively short follow-up time. Studies with additional years of follow-up are necessary to define the true level of potential risk reduction with salpingectomy, although longer follow-up will also be a challenge unless collaborative efforts that pool data are undertaken.

Which combination cause less inflammatory response during laparoscopic hysterectomy? Ligasure plus monopolar cautery or harmonic plus bipolar cautery?

We aimed to compare the inflammatory response with alterations in hemogram parameters, in patients who underwent laparoscopic hysterectomy and bilateral salpingo-oophorectomy for benign gynecologic conditions with ligasure plus monopolar cautery or harmonic plus conventional bipolar cautery. Patients who underwent Laparoscopic hysterectomy with bilateral salpingo-oophorectomy between January 2017 and January 2022 for benign gynecologic pathology were identified. Patients were divided into two group, according to instruments used during surgery. Instruments were used according to surgeons preference. Preoperative and postoperative in the first 24 hours hematocrit (HCT), WBC, trombocyt, neutrophil- lymphocyte (NLR), platelet-lymphocyte (PLR) ratio, mean platelet volume- lymphocyte ratio (MPVLR) and red cell distribution width- platelet ratio (RPR) values were compared. During study period, a total of 462 patients underwent hysterectomy for benign gynecologic pathology. After exclusion, 212 patients were included in the study. İn the study group, 147 patients were operated with ligasure plus monopolar electrocauter and 65 with harmonic scalpel plus bipolar electrocautery. İn the postoperative period, regardless of the procedure, WBC and RPR count increase, hematocrit and trombocyt decrease in both group but the inflammatory markers lymphocyte count, neutrophyl, NLR, PLR and MPVLR count changed less in the harmonic plus bipolar cautery group which shows less inflamatuar response in this group. Ligasure plus monopolar cautery group compared with harmonic plus bipolar cautery group cause more inflammatory changes in complete blood count values. However, further studies are needed to show whether these changes in laboratory findings affect clinical situations.

Pregnancy Outcomes With Donor Oocyte Embryos in Patients Diagnosed With Adenomyosis Using the Morphological Uterus Sonographic Assessment Criteria

(Abstracted from Fertil Steril 2023;119(3):484–489) Adenomyosis is a benign gynecologic condition that causes endometrial glands and stroma to be found in the myometrium. Although the criterion-standard diagnosis of adenomyosis remains histology after hysterectomy, ultrasound diagnosis has allowed earlier detection, but no standard definition of imaging-based diagnosis exists.

P-359 The prevalence of benign coexisting gynaecological conditions with endometriosis: a systematic review and meta-analysis

Abstract Study question What is the prevalence of other benign gynaecological conditions in women with endometriosis. Are women with endometriosis at a higher risk of these conditions? Summary answer Women with endometriosis are at a higher risk of coexisting adenomyosis and endometrial polyps. What is known already Endometriosis is a chronic and debilitating condition with a prevalence of ∼10% in women of reproductive age. Over recent years, associations between endometriosis and other gynaecological and non-gynaecological conditions have been speculated but data on the prevalence of benign gynaecological conditions coexisting with endometriosis is limited. Furthermore, whether women with endometriosis are at an increased risk of other gynaecological conditions is unclear, particularly, when some of those conditions share a hormonally driven pathway to endometriosis. Understanding the risk of coexistence with endometriosis is crucial in establishing an association, providing insights into disease pathophysiology, informing clinical surveillance, and improving patient care. Study design, size, duration The review was prospectively registered in PROSPERO (id: CRD42022307527). MEDLINE and Embase was searched from inception to June 2022 with no restrictions. Experimental and population-based observational studies were included. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria was used to rate the quality of evidence with the risk of bias in non-randomized studies of interventions (ROBINS-I) tool incorporated. A random effects model was used to pool the odds ratio (OR) data. Participants/materials, setting, methods Coexisting gynaecological conditions included were adenomyosis, fibroids, endometrial polyps (EP), polycystic ovarian syndrome (PCOS), benign ovarian cysts (BOC) or pelvic inflammatory disease (PID). All conditions were diagnosed by surgery, imaging or ICD coded medical records. Comparison groups were women with and without endometriosis. Outcome was prevalence expressed as a fraction. All prevalence estimates were either drawn from original papers or calculated. Meta-analysis was carried out if at least two studies were available. Main results and the role of chance 7137 studies were screened, and fifty-five studies reported on the prevalence of a coexisting gynaecological condition with endometriosis. Of these, 21 studies compared the prevalence in women without endometriosis and was included in the meta-analysis. The prevalence of coexisting adenomyosis (n = 34 studies; 11.0-91.9%.), fibroids (n = 16; 1.9-67.3%), EP (n = 14;1.6-68.4%.), PCOS (n = 3; 4.35-73.6%), BOC (n = 2;10.9-15.1%) and PID (n = 3;1.29-4.42) showed considerable variation between studies. Compared to women without endometriosis, women with endometriosis had a significantly higher prevalence of adenomyosis (OR 3.65, 95% CI 1.94-6.88, P &amp;lt; 0.001) and EPs (OR 4.04, 95% CI 2.85-5.74, P &amp;lt; 0.001) but not fibroids (OR 1.16, 95% CI 0.76-1.78, P = 0.5). There was insufficient comparative data for PCOS, BOC and PID. Overall, the quality of evidence for the prevalence estimate rated as low or very low on the GRADE criterion scale. The major factors associated with downgrading an outcome for quality was limitations in the study design and execution (risk of bias) and imprecision. The factors associated with increasing the quality of evidence was large effect sizes or sample sizes. Limitations, reasons for caution The wide variance in prevalences may be due to the differences in study design, study population, mode of diagnosis and criteria used to define the coexisting condition. The quality of evidence for prevalence effect estimates were low to very low quality, due to inherent biases associated with observational studies. Wider implications of the findings The wide variation in the prevalence of benign gynaecological conditions suggests over or under diagnosis. In our review endometriosis is associated with a significantly higher risk of adenomyosis and endometrial polyps. Clinicians may need to be mindful of this coexistence, but future high-quality studies are required to make robust conclusions. Trial registration number not applicable

Robotic Hysterectomy with Ureter Identification and Uterine Artery Ligation for Benign Gynecological Conditions: An Early-Year Single-Center Experience.

The use and application of robotic systems with a high-definition, three-dimensional vision system and advanced EndoWrist technology have become widespread. We sought to share our clinical experience with ureter identification and preventive uterine artery ligation in robotic hysterectomy. The records of patients undergoing robotic hysterectomy between May 2014 and December 2015, including patient preoperative characteristics, operative time, and postoperative outcomes, were analyzed. We evaluated the feasibility and safety of using early ureteral identification and preventive uterine artery ligation in robotic hysterectomy in patients with benign gynecological conditions. Overall, 49 patients diagnosed with benign gynecological conditions were evaluated. The mean age of the patients and mean uterine weight were 46.2 ± 5.3 years and 348.7 ± 311.8 g, respectively. Robotic hysterectomy achieved satisfactory results, including a short postoperative hospital stay (2.7 ± 0.8 days), low conversion rate (n = 0), and low complication rate (n = 1; 2%). The average estimated blood loss was 109 ± 107.2 mL. Our results suggest that robotic hysterectomy using early ureteral identification and preventive uterine artery ligation is feasible and safe in patients with benign gynecological conditions.

Disparities in Women With Endometriosis Regarding Access to Care, Diagnosis, Treatment, and Management in the United States: A Scoping Review.

Endometriosis is a benign gynecological condition that elicits chronic pain in 2-10% of reproductive-age women in the United States and exists in approximately 50% of women with infertility. It creates complications such as hemorrhage and uterine rupture. Historically, the gynecologic symptoms of endometriosis have been associated with economic strain and inferior quality of life. It is suspected that endometriosis diagnosis and treatment are affected by health disparities throughout gynecological care. The goal of this review was to collate and report the current evidence on potential healthcare disparities related to endometriosis diagnosis, treatment, and care across race, ethnicity, and socioeconomic status. This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and searched the Excerpta Medica Database (EMBASE), Medline Ovid, Cumulated Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and PsycInfo databases for relevant articles on the topic. Eligibility was established a priori to include articles written in English, published between 2015-2022, and reported on cohort, cross-sectional, or experimental studies conducted in the United States. Initially, 328 articleswere found, and after screening and quality assessment, four articles were retained for the final review.Results indicated that White women had higher rates of minimally invasive procedures versus open abdominal surgeries than non-White women. White women also had fewer surgical complications compared to all other races and ethnicities. Black women had higher rates of perioperative complications, higher mortality, and spent more time in the perioperative stage than any other race or ethnicity. In the management of endometriosis, the limited research available showed that all non-White women encountered an increased risk of perioperative and postoperative complications compared to White women. More research is needed to explore diagnostic and treatment disparities beyond surgical management, socioeconomic barriers, andimproved representation of racial and ethnic minority women.

Radiofrequency Ablation for Adenomyosis.

Adenomyosis is a common benign gynecologic condition characterized by ectopic endometrial glands and stroma in the myometrium causing pain (dysmenorrhea) and abnormal uterine bleeding. New interventional techniques have been introduced over recent years. This study evaluates the treatment success and side effects of radiofrequency ablation. An electronic literature search in the PubMed, Scopus, and ScienceDirect databases was carried out on the outcomes of pain reduction and, secondarily, on abnormal uterine bleeding, reintervention, reproductive outcome, imaging outcome, and complications. There was a mean decrease in dysmenorrhea pain scores by -63.4 ± 9.0% at 12 months. Data on other outcome parameters were sparse. No major complications were reported. Radiofrequency ablation represents a promising minimally invasive and organ-preserving treatment in patients with symptomatic adenomyosis. It is associated with clinically meaningful improvement of adenomyosis-related pain in the short term.

Uterine Transcriptome: Understanding Physiology and Disease Processes.

In recent years, transcriptomics has enabled us to gain a deeper understanding of fundamental reproductive physiology, including the menstrual cycle, through a more precise molecular analysis. The endometrial mRNA transcript levels fluctuate during the normal menstrual cycle, indicating changes in the relative recruitment and abundance of inflammatory cells, as well as changes in the receptivity and remodeling of the endometrium. In addition to providing a more comprehensive understanding of the molecular underpinnings of pathological gynecological conditions such as endometriosis, leiomyomas, and adenomyosis through RNA sequencing, this has allowed researchers to create transcriptome profiles during both normal menstrual cycles and pathological gynecological conditions. Such insights could potentially lead to more targeted and personalized therapies for benign gynecological conditions. Here, we provide an overview of recent advances in transcriptome analysis of normal and pathological endometrium.

The clinical applications of interventional radiological techniques in obstetrics and gynaecology

Key content Uterine artery embolisation can be used as a minimally invasive technique for the management of benign gynaecological conditions refractory to other medical treatments. The Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Radiologists (RCR) recommend the use of interventional radiology (IR) techniques for the prophylaxis and management of postpartum haemorrhage. Interventional radiologists can percutaneously drain post‐operative collections or tubo‐ovarian abscesses. Interventional radiology plays a role in the management of early pregnancy complications such as ectopic pregnancy and gestational trophoblastic disease. Interventional radiology can aid the care of patients with gynaecological malignancies. Learning objectives To understand the various IR techniques applicable to obstetrics and gynaecology To understand the risk and benefit profiles of these techniques To understand when the techniques could be appropriate and how they compare to surgical alternatives Ethical issues There are limited data regarding the use of some IR procedures owing to the ethical issues of using experimental techniques to treat pregnant women or women who wish to conceive. The availability of IR procedures is hospital specific so treatment is not available to all who may benefit.

Single centre experience in India for benign gynecological robotic surgery with da Vinci Si system: A real world data analysis of one decade

Objective: To analyse real time data over a decade of robotic surgery for benign Gynecological conditions using the da Vinci Si system.Methods: This is a retrospective analysis of prospectively collected data of da Vinci Si robotic surgery between August 2012 and July 2021 at single medical centre by a single surgeon.Results: Of the total 452 cases, the procedures were broadly categorised into myomectomy (RM-204), hysterectomy (RH-150), endometriosis excision (RE-80). The mean age of 46.12±6.77 and the mean BMI 28.89±5.02 kg/m2 in RH group was higher in RH group when compared to RM and RE groups. The mean docking time over 10 years was 10.59 minutes and mean console time was 96.35±47.77 minutes and both were significantly lower in the last 5 years when compared to first 5 years. 49.9% patients did not require intravenous analgesics beyond 24 hours and only 7.2% needed beyond 48 hours. 44.7% had less than 24 hours of hospital stay and 1.1% stayed beyond 48 hours. The mean hemoglobin drop was 1.109±0.7531 g%, significantly higher in RM group. The mean specimen weight in RM group was 323.8 g (200–1,372 g) and 84 cases had multiple leiomyomas. The commonest indication of robotic surgery was fibroid uterus.Conclusion: Robotic surgery for benign gynecologic surgery feasible and safe. It has equivalent outcomes when compared to laparoscopic surgery and superior when compared with laparotomy. Using robots to reduce open and repeat surgery for injury corrections could translate to reductions in the over-all economic burden of treatment.