Benign Gynecologic Conditions Research Articles

Diagnosing adenomyosis with MRI: a prospective study revisiting the junctional zone thickness cutoff of 12mm as a diagnostic marker.

To assess the diagnostic accuracy of a junctional zone (JZ) thickness of ≥ 12mm and morphological features of the JZ in MRI in diagnosing adenomyosis in a premenopausal study population. This single-center, prospective observational study consecutively enrolled 93 premenopausal women suffering from a benign gynecological condition, from September 2014 to August 2016. Institutional review board approval and written consent were obtained. All participants underwent MRI and hysterectomy with a histopathological examination. MR images were evaluated in a blinded fashion by two independent readers. The maximum junctional zone thickness (JZmax), presence of JZmax ≥ 12mm, and any irregular appearance of the JZ (defined as irregular outer or inner borders, focal thickening, presence of high-intensity signal foci, or fingerlike indentations at the inner border) were documented, and the diagnostic performance was evaluated with the AUC, chi-square test, and multiple regression. Adenomyosis was histopathologically confirmed in 57 (61%) of the women. JZmax was not positively correlated with adenomyosis diagnosis (AUC = 0.57, p = 0.26) and did not differ significantly between those with and without adenomyosis (10.3 vs 10.1mm, p = 0.88), nor was a cutoff of JZmax ≥ 12mm (n = 30/57 (53%) vs n = 16/36 (44%), p = 0.29). The presence of an irregular JZ showed the best association with adenomyosis among the evaluated signs (sensitivity 74% (95% CI, 60, 85); specificity 83% (95% CI, 67, 94) (p < 0.001)). JZmax was not correlated with adenomyosis in the present premenopausal study population, but direct signs of adenomyosis such as irregularities of the JZ provided a good diagnostic accuracy. • Measuring the junctional zone thickness is of limited value for diagnosing adenomyosis with MRI and should not be used for diagnosing adenomyosis in premenopausal women with moderate disease severity. • An irregular appearance of the junctional zone, the presence of myometrial cysts, and adenomyoma appear to provide the highest specificity for diagnosing adenomyosis. • A consensus for the definition and reading of the junctional zone is needed.

Transition from multiport to single-site surgery: A single institution experience in robotic supracervical hysterectomy for benign gynecological diseases

ObjectiveTo share our experience of transition from multiport to single-site robotic surgery for benign gynecological conditions as well as to assess the selection criteria of candidates for robotic single-site supracervical hysterectomy (RSSH). Materials and methodsA retrospective review was conducted on patients undergoing robotic supracervical hysterectomy by a single surgeon in a single institute between June 2014 and December 2017. Patients who underwent additional procedures along with supracervical hysterectomy and who had unexpectant corpus malignancy proved pathologically were excluded from comparisons between patients undergoing RSSH and robotic multiport supracervical hysterectomy (RMSH). ResultsBetween June 2014 and December 2017, we accomplished 26 RSSH and 57 RMSH. There were no conversions, intraoperative complications, and readmissions within 30 days after surgery. In the RSSH group, the mean uterine weight was 264.6 ± 140.9 g with mean docking time of 15.8 ± 5.5 min, mean console time of 61.1 ± 35.6 min and mean operative time of 140.3 ± 34.4 min. In comparison to the RMSH group, the percentage of overweight/obese patients was lower (p = 0.018) and the uterine size was smaller (p < 0.001) with adenomyosis diagnosed more frequently (p = 0.002) in the RSSH group. While the operative time in the RSSH group was significantly shorter (p = 0.002), the RSSH group took longer time in docking (p < 0.001) and comparable time in console (p = 0.254). In view of chronological change, docking time and console time in the RMSH group remained steady, whereas steep decreases were observed in the RSSH group. The intraoperative blood loss and hemoglobin drop were comparable. The length of hospital stay was significantly shorter in the RSSH group (p = 0.005). ConclusionTransition from multiport to single-site surgery can be smooth for a surgical team experienced in the conventional multiport robotic system. RSSH is safe and feasible in properly selected patients.

Metabolic Disposition of [Women 14 C] Ulipristal Acetate in Healthy Premenopausal

Introduction: Ulipristal acetate (UPA) is a novel selective progesterone receptor modulator for the treatment of benign gynaecological conditions such as uterine myoma. The disposition of [ 14 C] UPA was determined in five healthy premenopausal women after administration of a single oral dose of 20 mg (59 μCi). Materials and Methods: The single dose study allocated 5 healthy women of reproductive age to receive a single radio labelled dose of 20 mg (59 μCi) UPA. After dosing, blood, plasma, urine and faecal samples were collected for up to 11 days and analysed for concentrations of radioactivity. UPA metabolite profiles in plasma were determined by high-performance liquid chromatography with radioactivity flow detection; metabolite structures were confirmed by liquid chromatography-mass spectrometry. Results: UPA was rapidly absorbed, exhibiting a mean peak plasma concentration of 141 ng/mL at 0.7 hours post-dose. Plasma radioactivity maxima were observed 0.9 hours post-dose at 281ng equivalents/mL. The total mean recovery of the radioactive dose in excreta was 78.8%, with the majority recovered in faeces (72.5%) and only a small fraction (6.4%) in urine. UPA was extensively metabolised. Radio-chromatograms of plasma revealed that oxidative demethylation was the major metabolic pathway, most likely via cytochrome P450 isoenzyme3A4. At peak plasma radioactivity, the majority of circulating radioactivity was constituted by parent (58.0%), N-monodemethylated UPA (PGL4002 (20.5%)) and N-didemethylated UPA (PGL4004) eluting together with PGL4002+2H (8.3%). Unchanged UPA was not present in faeces, but PGL4002, hydroxylated PGL4004 and UPA +2H, UPA +2O -2H, as well as acetylated or glucuronidated UPA were identified. Conclusion: After oral administration in healthy premenopausal women, UPA was rapidly absorbed, extensively metabolized via oxidative demethylation, and excreted predominantly in faeces.

Optimizing Clinical Status and Quality of Life With Iron Dextran in Gynecologic Patients With Iron Deficiency Anemia [8L

INTRODUCTION: To assess improvement in quality of life (QoL) in women with iron deficiency anemia secondary to chronic blood loss from benign gynecological conditions. To concurrently assess clinical improvement in hematologic indices. METHODS: An IRB approved prospective observational and survey study of women in an urban-based healthcare system with hemoglobin (Hgb) <12 g/dL who were poor candidates for oral iron supplementation. These women received iron dextran and Health-related quality of life (HRQOL) survey and had labs drawn at treatment, 30-days and 90-days post-infusion. RESULTS: Clinical improvement was assessed with Ferritin, Iron profile, Retic count, Hemoglobin and Hematocrit. The questionnaire assessed quality of life with two categories 1) physical health score and 2) mental health score. 23 patients completed the baseline questionnaire and labs. 13 patients completed the 30-day questionnaire, 7 of which completed the labs. Eight completed the survey and labs at 90-days. At baseline, average physical health T-score was 41, mental health T-score of 44, hgb 9.0 g/dL, ferritin 8.47 ng/mL, iron 35 µg/dL and TIBC of 481 mcg/dL. At 30 days, average physical health T-score was 43, mental health T-score of 45, hgb 11.6 g/dL, ferritin 162 ng/mL, iron 76 µg/dL and TIBC 285 mcg/dL. At 90-days, the average physical health T-score was 43, mental health T-score of 42, hgb 12.2 g/dL, ferritin 72 ng/mL, iron 76 µg/dL and TIBC 323 mcg/dL. CONCLUSION: Our study portrays the efficacy of iron dextran in improving hematologic indices without significant change in patient's QoL, including physical and mental health. Nonetheless, intravenous iron may be a good option for patients who are not candidates for oral iron supplementation.

Applications of Tranexamic acid in benign gynecology.

Bleeding at the time of benign gynecologic surgery, as well as from benign gynecologic conditions, is a major source of morbidity for many women. Few nonhormonal medical options exist for the treatment of heavy menstrual bleeding, and to reduce surgical bleeding during major gynecologic surgery. Interest in Tranexamic acid (TXA) as a means to reduce surgical blood loss has been growing across many surgical specialties. This review focuses on applications for TXA as a means to reduce heavy menstrual bleeding (HMB) as well as to reduce surgical bleeding during benign gynecologic surgery. Tranexamic acid is an effective treatment to reduce the volume of bleeding during menstruation. Tranexamic acid was found to be superior to both placebo and oral progestins, and as good as combined oral contraceptives at reducing menstrual blood volume. Tranexamic acid has also been show to reduce the volume of bleeding during abdominal myomectomy as well as hysterectomy. There is a major need for prospective studies evaluating the utility of TXA for reducing blood loss during benign gynecologic surgery. Tranexamic acid has been found to be an excellent affordable nonhormonal treatment option for women with HMB and should be considered during major gynecologic surgery.

Urinary Tract Infection After Hysterectomy for Benign Gynecologic Conditions or Pelvic Reconstructive Surgery

(Abstracted from Obstet Gynecol 2018;132:1347–1357) About half of all women will experience at least 1 urinary tract infection (UTI) in their lifetimes, and the infection will recur in more than 10% of postmenopausal women. Pelvic surgery increases risk of UTI.

&lt;p&gt;&lt;em&gt;Chlamydia&amp;nbsp;trachomatis&lt;/em&gt; infection in primary fallopian tube and high-grade serous ovarian cancers: a pilot study&lt;/p&gt;

BackgroundThe aim of this study was to evaluate the association of Chlamydia trachomatis (CT) infection with primary tubal and high-grade serous ovarian cancers.MethodsThis is a cross-sectional, retrospective study conducted at Ain Shams University Maternity Hospital, Egypt, from February 2008 to October 2017. Sixty-seven paraffin archival blocks specimens were retrieved from cases who underwent staging laparotomy due to high-grade serous ovarian cancer (30 cases), primary tubal serous cancer (25 cases), and control specimens of (12) tubal specimens from cases of benign gynecological conditions. All samples were examined for CT DNA using semiquantitative qRT-PCR.ResultsCT DNA was detected in 84% of high-grade tubal serous cancer, 16.7% of high-grade serous ovarian cancer, and 13.3% in controls (P<0.0005). Mean CT DNA relative quantity was significantly high (256) in tubal carcinoma, in comparison to that in high-grade serous ovarian cancer and controls (13.5 and 0.28, respectively; P<0.0005).ConclusionTo the best of our knowledge, this is the first report on relation of CT to the tubal serous cancer, so the responsibility of CT tubal infection in the pathogenesis of primary tubal cancer needs to be considered.

Reduced α-2,6 sialylation regulates cell migration in endometriosis.

Is endometriosis associated with aberrant sialylation patterns and what is the potential impact of such anomalies on cell migratory properties? The reduced α-2,6 sialylation patterns in the peritoneal fluid of endometriosis-affected women and in stromal and epithelial cells from endometriotic lesions could be associated with enhanced cell migration. Endometriosis is considered to be a benign disease although, like cancer, it has the characteristic of being an invasive disease with cells that have an enhanced capacity to migrate. Aberrant sialylation has been reported in various malignancies and it has been linked to tumour invasion and metastasis. We conducted a prospective laboratory study in a tertiary-care university hospital. We investigated non-pregnant patients who were <42 years of age (n = 273) when they underwent surgery for a benign gynaecological condition. The study population consisted of 102 women with histologically proven endometriosis and 71 endometriosis-free controls, who underwent a complete surgical exploration of the abdominopelvic cavity. Peritoneal fluids were collected during the surgical procedures, and endometrial and endometriotic biopsies were performed on all of the patients to generate stromal and epithelial primary cell cultures. The expression of α-2,6-sialyltransferase (ST6GALNAC1) was studied in eutopic and ectopic endometria of endometriosis patients and in eutopic endometria of controls by reverse transcription followed by quantitative real-time polymerase chain reaction (RT-qPCR). The α-2,6 sialylation levels were measured by ELISA in the peritoneal fluids of patients and controls and by western-blot in primary endometrial and endometriotic cell cultures using Sambucus nigra agglutinin (SNA), an α-2,6 sialic acid-binding lectin. A transwell migration assay after incubation of the cells with neuraminidase was also performed to evaluate the impact of desialylation on eutopic endometrial stromal cell migration. ST6GALNAC1 gene expression was significantly lower in endometriotic lesions compared to that in eutopic endometrium of endometriosis-affected patients and healthy endometrium (16-fold for both; P < 0.01). We observed a significant reduction in SNA levels in the peritoneal fluids of endometriosis-affected women compared to control women (median optic density (OD), 0.257; range, 0.215-0.279 versus median OD, 0.278; range 0.238-0.285; P < 0.01), as well as in stromal (mean OD, 705 907; standard error of the mean (SEM), 141 549 versus mean OD, 1.16 × 106; SEM, 107,271; P < 0.05) and epithelial (mean OD, 485 706; SEM, 179 681 versus mean OD, 1.25 × 106; SEM, 232 120; P < 0.05) ectopic endometriotic cells compared to control eutopic cells, indicating reduced α-2,6 sialylation. Finally, in the transwell migration assay, the eutopic endometrial cells of endometriosis patients migrated significantly more into the lower chamber after incubation with neuraminidase, indicating enhanced migration by these cells after desialylation. N/A. Our control group involved patients operated for benign gynaecological conditions (e.g. tubal infertility, uterine fibroids or ovarian cysts) which may also be associated with altered sialylation patterns. The hyposialylation pattern of endometriotic cells appeared to be associated with enhanced migratory abilities, which might contribute to the establishment of early endometriotic implants. Further research is needed to confirm these findings, as this could lead to new potential therapeutic targets for this complex disorder. No external funding was received and there are no conflicts of interest.

Unexpected malignant uterine pathology: Incidence, characteristics and outcome in a large single-center series of hysterectomies for presumed benign uterine disease

ObjectiveHysterectomy is a frequently used therapeutic option for benign gynecological conditions. The purpose of this study was to investigate the incidence and characteristics of unforeseen malignant pathologies of the uterine corpus in a large population-based, single center cohort. MethodsPatients who underwent hysterectomy for presumed benign conditions between 2003 and 2016 were identified. In cases of unexpected malignancies of the uterine corpus (UUM), available tissue samples were collected and a specialized gynecopathological review was performed. ResultsA total of 10,756 patients underwent hysterectomy for benign indications. After chart and gynecopathological review, 45/10,756 (0.42%) cases of unexpected uterine malignancies were confirmed. 33/45 (73.3%) were endometrial carcinomas (UEC) and 12/45 (26.7%) were uterine sarcomas (UUS). 27/33 (81.8%) UEC were FIGO IA, 5/33 (15.2%) FIGO IB and 1/33 (3%) FIGO stage II disease. Endometrioid and serous histotype were present in 31/33 (93.9%) and in 2/33 (6.1%) cases, respectively. 8/12 (66.7%) USS were early stage (FIGO IA or IB); only 3/12 (25.0%) were diagnosed at an advanced stage (≥FIGO II). Fatal outcome was observed in 1 patient diagnosed with UEC and 3 patients diagnosed with UUS. ConclusionOur study shows that diagnosis of UUM is rare (0.42%). The majority of UUM tend to be early stage, making preoperative diagnosis difficult. In case of UEC, patient outcome is generally favorable. Nevertheless, the appropriate surgical approach for hysterectomy for a benign indication should be chosen carefully, taking all preoperative findings into account. Patients should always be informed about the residual risk of UUM.

Single-Incision Hysterectomy Outcomes With and Without Robotic Assistance

Objective:To evaluate the differences in operative time and postoperative complications for total laparoscopic hysterectomy (TLH) performed using conventional laparoendoscopic single-site surgery (LESS) versus a robotic-assisted LESS approach.Methods:A retrospective study was conducted of all cases of conventional LESS TLH (n = 47) and robotic LESS TLH (n = 129) for benign gynecologic conditions performed from November 2014 to October 2017. Patient characteristics, operative time for hysterectomy, estimated blood loss, duration of hospitalization, and short-term postoperative complications were compared using appropriate parametric and nonparametric statistical tests.Results:Conventional LESS TLH cases had a 16.36-minute longer mean operative time for hysterectomy (P < .01). No difference was found in uterine weight, estimated blood loss, hospitalization, or incidence of postoperative complications when LESS TLH was performed with or without robotic assistance. When comparing uterine weight < 100 g, conventional LESS TLH cases had significantly greater operative time than the robotic LESS TLH cases (78.10 ± 23.97 minutes vs. 59.97 ± 35.17 minutes, P < .01). When comparing uterine weight > 100 g, conventional LESS TLH cases again had significantly greater operative time than the robotic LESS TLH cases (98.73 ± 50.16 minutes vs. 80.00 ± 42.97 minutes, P < .01). There was no difference in postoperative complications.Conclusion:Robotic single-incision laparoscopy can result in decreased operative time compared to a conventional LESS approach. Robotic-assisted and conventional LESS are similar in rate of postoperative complications, if performed by surgeons with abundant LESS experience.

Extraperitoneal pelvic lymph node dissection with laparotomy in occult invasive cervical cancer found after a simple hysterectomy

Purpose of Investigation: To evaluate the authors’ experience and clinical outcomes of extraperitoneal pelvic lymph node dissection (EPLND) and subsequent radiotherapy with concomitant chemotherapy in 21 patients with invasive cervical cancer found in simple hysterectomy. Materials and Methods: The authors reviewed the data of patients with occult invasive cervical cancer (OICC) detected after simple hysterectomy carried out for benign gynecologic conditions or preinvasive cervical lesions from 2007 to 2017. Results: All patients were classified into three groups as low risk, high risk, and specially selected according to pathological reports and imaging methods. All patients were staged IA1 to 2B and all pathological reports revealed squamous cell carcinoma. There were 6, 13, and 2 patients in the high-risk group, low-risk group, and specially selected group; respectively. During a median follow-up of 39 months, patients did not show any recurrence. All adjuvant chemoradiation therapy was initiated at three weeks postoperatively without delay. There were two postoperative complications. The mean operation time regarding extraperitoneal lymph node dissection (ELND) was 33.66 ± 5.36 minutes and median postoperative hospital stay was two days. Conclusions: Optimal treatment plan can be made after pathological examination and interpretation of imaging methods in patients with OICC after simple hysterectomy (SH). EPLND may be considered as a safe and reliable first-line surgical option in the management of patients with OICC after SH.

Urinary Tract Infection After Hysterectomy for Benign Gynecologic Conditions or Pelvic Reconstructive Surgery.

To report rates and identify risk factors for urinary tract infection (UTI) after hysterectomy for benign conditions or combined with pelvic reconstructive surgery. This is a cohort study that included women who underwent hysterectomy either for benign gynecologic conditions or hysterectomy combined with pelvic reconstructive surgery from January 1, 2012, through June 30, 2014, at a single institution. The primary outcome was UTI within 8 weeks of surgery. Logistic regression modeling was used to develop a model for predicting UTI after surgery. Of 1,156 women included in the study, 136 (11.8%, 95% CI 10.0-13.8) developed UTI within 8 weeks. Women who underwent hysterectomy for a benign gynecologic condition that was not combined with pelvic reconstructive surgery had an overall UTI rate of 7.3% (95% CI 5.6-9.3) vs 21.7% (95% CI 17.6-26.4) after hysterectomy combined with pelvic reconstructive surgery. After adjusting for hormone therapy use, the following were independent variables associated with postoperative UTI: premenopausal status with an adjusted odds ratio (OR) of 1.80 (95% CI 1.11-2.99), anterior vaginal wall prolapse with an adjusted OR of 4.39 (95% CI 2.77-6.97), and postvoid residual greater than 150 mL with an adjusted OR of 2.38 (95% CI 1.12-4.36). Using this model, postoperative UTI rates ranged from 4.3% to 59.4% with high postvoid residual and presence of anterior prolapse having the strongest association. There are wide variations in the rate of UTI after hysterectomy for begin disease including pelvic reconstructive surgery. These variations can be explained with a model based on available preoperative data.

Benign gynecologic conditions are associated with ovarian cancer risk in African-American women: a case-control study.

The association between common benign gynecologic conditions and ovarian cancer remains under-studied in African Americans. Therefore, we examine the association between self-reported history of benign gynecologic conditions and epithelial ovarian cancer risk in African-American women. Data from a large population-based, multi-center case-control study of epithelial ovarian cancer in African-American women were analyzed to estimate the association between self-reported history of endometriosis, pelvic inflammatory disease (PID), fibroid, and ovarian cyst with epithelial ovarian cancer. Logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI) for the associations between individual and composite gynecologic conditions and ovarian cancer. 600 cases and 752 controls enrolled in the African American Cancer Epidemiology Study between 1 December 2010 and 31 December 2015 comprised the study population. After adjusting for potential confounders, a history of endometriosis was associated with ovarian cancer (OR 1.78; 95% CI 1.09-2.90). A non-significant association of similar magnitude was observed with PID (OR 1.33; 95% CI 0.82-2.16), while no association was observed in women with a history of fibroid or ovarian cyst. A positive trend was observed for an increasing number of reported gynecologic conditions (p = 0.006) with consistency across histologic subtypes and among both oral contraceptive users and non-users. A self-reported history of endometriosis among African-American women was associated with increased risk of ovarian cancer. Having multiple benign gynecologic conditions also increased ovarian cancer risk.

Alternative Treatment Utilization Before Hysterectomy for Benign Gynecologic Conditions at a Large Integrated Health System

To investigate rates of utilization of alternative treatments before hysterectomy for benign gynecologic indications within a large integrated health care system. Retrospective cohort study of patients who underwent hysterectomies for benign gynecologic conditions between 2012 and 2014 (Canadian Task Force classification II-2). Kaiser Permanente Northern California, a community-based integrated health system. Women who underwent hysterectomy for a benign gynecologic condition between 2012 and 2014. From an eligible cohort of 6892 patients who underwent hysterectomy, a stratified random sample of 1050 patients were selected for chart review. Stratification was based on the proportion of indications for hysterectomy. The primary outcome was the use of alternative treatments before hysterectomy. Alternative treatments included oral hormone treatment, leuprolide, medroxyprogesterone intramuscular injections, a levonorgestrel intrauterine device, hormonal subdermal implants, endometrial ablation, uterine artery embolization, hysteroscopy, and myomectomy. Of the 1050 charts reviewed, 979 (93.2%) met the criteria for inclusion in this study. The predominant indication for hysterectomy was symptomatic myomas (54.4%), followed by abnormal uterine bleeding (29.0%), endometriosis (5.8%), pelvic pain (3.1%), dysmenorrhea (3.4%), and other (4.3%). The major routes of hysterectomy were laparoscopy (68.7%) and vaginal hysterectomy (13.4%). Before hysterectomy, 81.2% of patients tried at least 1 type of alternative treatment (33.8% with 1 treatment and 47.4% with at least 2 treatments), and 99.3% of patients were counseled regarding alternative treatments. Compared with younger women age <40 years, women age 45 to 49 years were less likely to use alternative treatments before hysterectomy (adjusted odds ratio, 0.41; 95% confidence interval, 0.21-0.76). There were no variations in treatment rates by socioeconomic status or between major racial and ethnic groups. The final pathological analysis identified myomas as the most common pathology (n = 637; 65.1%); 96 patients (9.8%) had normal uterine pathology. More than 80% of patients received alternative treatments before undergoing hysterectomy for a benign gynecologic condition. Additional investigation is warranted to assess alternative treatment use as it relates to preventing unnecessary hysterectomies.

Effects of abdominal and vaginal hysterectomy on anorectal functions along with quality of life of the patient.

Hysterectomy is the most commonly performed major gynecological operation for both benign and malign gynecologic conditions. After hysterectomy, although some investigators have declared an increased incidence of urinary and anorectal dysfunction, some others could not show any connection. The voluntary patients were divided in two groups: abdominal hysterectomy (Group 1) and vaginal hysterectomy (Group 2). Anal manometry and all the other examinations of the patients were performed at the Department of General Surgery Endoscopy Unit of Ankara University, Faculty of Medicine. When the quality of life of the patients was assessed before the operation and on the 12th post-operative month via the SF-36 form; it can be seen that body pain parameters of the patients in Group 1 had significantly improved and there is no statistical difference in other parameters. When the effect of hysterectomy on the quality of life of the patients was evaluated by the "Cleveland Clinic Global Quality of Life" form, the statistically significant improvement in the quality of life of the patients in Group 2 was observed. If the type of operation (vaginal or abdominal) is performed due to benign causes, it does not affect the urinary and anorectal functions of the patients. Depending on the decrease of complaints of the patients, it has a positive effect on the quality of life.

The role of appendectomy at the time of laparoscopic surgery for benign gynecologic conditions.

The risk-benefit ratio of concurrent appendectomy at the time of gynecologic surgery has long been debated and remains controversial. However, emerging data on the appendix's role in chronic pain syndromes point to a previously unrecognized link between gynecologic disorders and appendicular pathology. In this article, we review the indications for appendectomy at the time of laparoscopic gynecologic surgery for the treatment of endometriosis and chronic pelvic pain. The incidence of appendiceal endometriosis is highly variable depending on the patient population selected. Although rare in patients undergoing appendectomy for acute appendicitis, women with endometriosis may experience rates as high as 9.3-39.0%, especially when suffering from deep infiltrative endometriosis. Appendectomy may also significantly reduce pain in women with unexplained chronic pelvic pain. Despite lack of prospective data, retrospective studies suggest that appendectomy during gynecologic procedures for chronic pelvic pain and severe endometriosis may be beneficial and necessary to fully address the treatment of these complex gynecologic conditions. In these clinical scenarios, the benefits of laparoscopic appendectomy at the time of the primary gynecologic procedure may outweigh the risks and cost, and should be discussed with patients preoperatively.

Raman spectroscopic techniques to detect ovarian cancer biomarkers in blood plasma

Robust diagnosis of ovarian cancer is crucial to improve patient outcomes. The lack of a single and accurate diagnostic approach necessitates the advent of novel methods in the field. In the present study, two spectroscopic techniques, Raman and surface-enhanced Raman spectroscopy (SERS) using silver nanoparticles, have been employed to identify signatures linked to cancer in blood. Blood plasma samples were collected from 27 patients with ovarian cancer and 28 with benign gynecological conditions, the majority of which had a prolapse. Early ovarian cancer cases were also included in the cohort (n = 17). The derived information was processed to account for differences between cancerous and healthy individuals and a support vector machine (SVM) algorithm was applied for classification. A subgroup analysis using CA-125 levels was also conducted to rule out that the observed segregation was due to CA-125 differences between patients and controls. Both techniques provided satisfactory diagnostic accuracy for the detection of ovarian cancer, with spontaneous Raman achieving 94% sensitivity and 96% specificity and SERS 87% sensitivity and 89% specificity. For early ovarian cancer, Raman achieved sensitivity and specificity of 93% and 97%, respectively, while SERS had 80% sensitivity and 94% specificity. Five spectral biomarkers were detected by both techniques and could be utilised as a panel of markers indicating carcinogenesis. CA-125 levels did not seem to undermine the high classification accuracies. This minimally invasive test may provide an alternative diagnostic and screening tool for ovarian cancer that is superior to other established blood-based biomarkers.

Risk Factors for Recurrence of Ovarian Endometriosis in Chinese Patients Aged 45 and Over.

Background:When considering the issue of recurrence, perimenopausal women may have more dilemma during management comparing with young women, for example, whether to retain the uterus and ovary during surgery, whether it is necessary to add adjuvant medicine treatment after operation, and there is no evidence for reference about using of gonadotropin-releasing hormone agonist. This study aimed to study the risk factors for the recurrence of ovarian endometriosis (EM) in patients aged 45 and over.Methods:This is a retrospective nested case-control study. We reviewed the medical records of patients aged over 45 years who underwent surgical treatments for ovarian EM from 1994 to 2014, in Peking Union Medical College Hospital of Chinese Academy of Medical Sciences. By following up to January 2016, 45 patients were found to have relapses and regarded as the recurrence group. The patients with no recurrence during the same follow-up period were randomly selected by the ratio of 1:4 as the nonrecurrence group (180 patients in total). Stratified Cox regression was used to analyze the risk factors of the recurrence.Results:Univariate analysis showed that there was a significant difference in the postoperative treatment (the percentage of patients who received postoperative treatment in non-recurrence group and recurrence group, 23.9% vs. 40.0%, χ2 = 4.729, P = 0.030) and ovarian preservation (the percentage of patients who received surgery of ovarian preservation in non-recurrence group and recurrence group, 25.0 % vs. 44.4%, χ2 = 19.462, P < 0.001) between the nonrecurrence group and the recurrence group. There was no correlation between recurrence and the following factors including patient's age, menarche age, gravidity, parity, CA125 level, ovarian lesions, menopausal status, combined benign gynecological conditions (such as myoma and adenomyoma) and endometrial abnormalities, and surgical approach or surgical staging (all P > 0.05). Multivariate analysis indicated that whether to retain the ovary was the only independent risk factor of recurrence for patients aged 45 years and over with ovarian EM (odds ratio: 5.594, 95% confidence interval: 1.919–16.310, P = 0.002).Conclusion:Ovarian preservation might be the only independent risk factor of recurrence for patients aged 45 years and over with ovarian EM.

Relationship between Race/Ethnicity and Hysterectomy Outcomes for Benign Gynecologic Conditions

Study ObjectiveTo examine the association between race/ethnicity, route of hysterectomy, and risk of inpatient surgical complications. DesignCross-sectional analysis (Canadian Task Force classification III). SettingInpatient hospitals in the United States. Patients and InterventionsThere were 114 719 women aged 18 and older from the Nationwide Inpatient Sample who underwent an elective hysterectomy for benign indications using International Classification of Diseases codes. Measurements and Main ResultsMultivariable logistic regression was performed to examine the association between race/ethnicity and route of hysterectomy and surgical complications, after adjusting for patient characteristics, clinical factors, and hospital characteristics. Analyses were weighted to provide national estimates of prevalence. The rate of minimally invasive hysterectomy was 55.0% in white women, 28.6% in black women, 50.1% in Hispanic women, and 45.6% in other race/ethnic categories. Compared with white women, black women had a .55 odds (95% confidence interval, .52–.59) of undergoing minimally invasive hysterectomy, after adjusting for patient, clinical, and hospital characteristics. This finding remained consistent across quartiles of median household income of residence, primary payer, and diagnosis of myomas. Among women who had an elective hysterectomy, 6091 experienced a complication, representing an estimated 30 455 women nationwide. The rate of surgical complications was 5.3% in white women, 5.9% in black women, 4.6% in Hispanic women, and 5.1% in women of other racial/ethnic groups. There was no difference in odds of experiencing a surgical complication between white and black women (odds ratio, 1.03; 95% confidence interval, .93–1.13) after adjusting for patient, clinical, and hospital characteristics. This finding remained consistent across quartiles of median household income of residence, primary payer, and route of hysterectomy. ConclusionAmong women undergoing an elective hysterectomy, black women were less likely to receive minimally invasive hysterectomy compared with white women. However, the rate of inpatient surgical complications did not vary significantly by race/ethnicity. Further research is encouraged to identify and address the influential factors behind the disparity in minimally invasive hysterectomy use among black women in the United States.

The current status and indications of robotic surgery in the setting of benign and malignant gynaecological conditions

Objective . Robotic surgery has gained ground in recent years in benign and malignant gynecological interventions. The purpose of this article is to present the main indications of robotic surgery, to identify the advantages and disad­van­tages of this surgical technique and to present our ex­pe­rience in this field. Materials and method. An analysis of ar­ti­cles published in literature to observe the in­di­ca­tions of robotic surgery in gynecology, both for be­nign and ma­lig­nant interventions. Comparison of li­te­rature data with the main surgical indications found in the pa­tient group selected by us who received robotic sur­ge­ry. Results . The integration of robotic technology is a significant advance in the minimal invasive treatment techniques of the gynecological pathology used to treat both benign and malignant conditions. The advantages of robotic surgery are: 3D view of the operator field, superior dexterity, seven degrees of freedom for the movement of the brushes, superior capability of stitches and knots, superior ergonomics, elimination of the effect of the rebound, movement of the movements and reduction of tremor. The disadvantages of surgery are: the high cost of surgery, the lack of tactile feedback and the increased size of the device. Conclusions . Robotic surgery is an effective, safe and feasible method for the treatment of benign and malignant gynecological disorders. The optimal knowledge of trocars (adapted to the body mass index of each patient) is important in order to benefit from all the advantages of robotic surgery. Regarding the robotic surgical treatment group in which the feasibility of this procedure was observed, there are: oncological interventions, endometriosis, in reproductive medicine and in obese patients.