Gynecologic Endoscopic Surgery Research Articles

Balanced opioid-free anesthesia with lidocaine and esketamine versus balanced anesthesia with sufentanil for gynecological endoscopic surgery: a randomized controlled trial

In this randomized controlled trial, 74 patients scheduled for gynecological laparoscopic surgery (American Society of Anesthesiologists grade I/II) were enrolled and randomly divided into two study groups: (i) Group C (control), received sufentanil (0.3 μg/kg) and saline, followed by sufentanil (0.1 μg/kg∙h) and saline; and (ii) Group F (OFA), received esketamine (0.15 mg/kg) and lidocaine (2 mg/kg), followed by esketamine (0.1 mg/kg∙h) and lidocaine (1.5 mg/kg∙h). The primary outcome was the 48-h time-weighted average (TWA) of postoperative pain scores. Secondary outcomes included time to extubation, adverse effects, and postoperative sedation score, pain scores at different time points, analgesic consumption at 48 h, and gastrointestinal functional recovery. The 48-h TWAs of pain scores were 1.32 (0.78) (95% CI 1.06–1.58) and 1.09 (0.70) (95% CI 0.87–1.33) for Groups F and C, respectively. The estimated difference between Groups F and C was − 0.23 (95% CI − 0.58 − 0.12; P = 0.195). No differences were found in any of the secondary outcomes and no severe adverse effects were observed in either group. Balanced OFA with lidocaine and esketamine achieved similar effects to balanced anesthesia with sufentanil in patients undergoing elective gynecological laparoscopic surgery, without severe adverse effects.Clinical Trial Registration: ChiCTR2300067951, www.chictr.org.cn 01 February, 2023.

Gynaecological endoscopic surgery in elderly women: which outcomes?

Gynaecological endoscopic surgery in elderly women: which outcomes?

Clinical relevance of vaginal natural orifice transluminal endoscopic surgery (vNOTES) in gynecology.

This study reviews the progress and recent advances in vaginal natural orifice transluminal endoscopic surgery (vNOTES) as a minimally invasive gynecologic procedure. The proposed advantages of vaginal natural orifice transluminal surgery include enhanced cosmesis due to a scarless procedure, better exposure compared with the pure vaginal approach, tolerable pain scores, fewer perioperative complications, and a shorter hospital stay. Recent advances in surgical instrumentation and technology have improved the feasibility of vNOTES as an innovative treatment option for gynecological conditions. However, technical challenges and training issues must be overcome before its widespread use. As a promising surgical innovation, further randomized comparative studies are required to clarify the safety and effectiveness of vNOTES in gynecology.

Pre-operative ureteric catherisation for major endoscopic gynaecological surgery.

Several strategies have been implemented to better identify the course of the ureters intra-operatively due of the morbidity associated with ureteric injuries especially during gynaecological surgery. We described our experience with pre-operative ureteric catherisation in women who underwent major endoscopic gynaecological surgery. A case-controlled study of 862 women who underwent major endoscopic gynaecological surgery sourced from two health institutionswere conducted. Two groups were compared: those who had pre-operative prophylactic ureteric catherisation (study group) and those who had routine cystoscopy performed immediately post surgery (control group). There were no intra-operative ureteric injuries or associated complications noted in the study group. When compared to the control group, length of hospital stay (2days vs 5days; p < 0.05) and overall mean time for cystoscopy (11min vs 35min; p < 0.05) was significantly shorter in the study group. There was no long-term morbidity recorded in the study group. Our experiences with prophylactic pre-operative bilateral ureteric catheterisation for major endoscopic gynaecological surgeries were favourable and are associated with low complication rates.Routine or adjunct use before major gynaecological and pelvic surgery combined with meticulous surgical technique can help reduce iatrogenic and unintentional ureteric injuries.

Natural orifice transluminal endoscopic surgery in gynecology

Natural orifice transluminal endoscopic surgery in gynecology

When Two Coincidences are a Clue: A Retrospective Cohort Study Regarding the Incidence of Ruptured Tubal Pregnancies in a Northern Italy Hospital During the COVID-19 Pandemic

Background: Undiagnosed ectopic pregnancies are among the main gynecological emergencies, and hemorrhage from an ectopic pregnancy is still the leading cause of maternal mortality in the first trimester. During the first lockdown period in Italy (March–April 2020) and in March 2021 restrictive measures were issued by the Italian government, but their impact on the incidence of ruptured tubal pregnancies remains unknown. Methods: The purpose of this study was to evaluate the impact of restrictive measures for the COVID-19 outbreak on the incidence of ruptured tubal pregnancies at our referral center for endoscopic gynecologic surgery. In particular, the primary outcome was the comparison of the incidence of ruptured tubal pregnancies between the lockdown phases and the other months of the pandemic. For this retrospective cohort study we considered all women examined for tubal ectopic pregnancy at our emergency unit from 1 January 2019 to 30 April 2021. We divided patients into three groups according to the period they were referred to our center: 10 March 2019–10 March 2020 (Pre-Covid period); 11 March–4 May 2020 and 6 March–30 April 2021 (Lockdown periods); 5 May 2020–5 March 2021 (COVID-19 pandemic period without restrictive policies). We compared data acquired during the lockdown phases with data collected both before the COVID-19 pandemic and during the restriction-free COVID-19 period. Results: 31 of 85 women were diagnosed with a ruptured tubal pregnancy. The proportion of ruptured ectopic pregnancies was higher during the lockdown period than the other two periods combined (62.5% vs 30.4%, p = 0.016). Mean gestational age and beta-HCG levels showed the same tendency (7.31 ± 1.25 weeks vs 5.99 ± 1.28 weeks, p &lt; 0.0001; 7392.56 ± 4337.50 mUI/mL vs 4188.36 ± 3235.95 mUI/mL, p = 0.001). There were no differences between the proportion of ruptured pregnancies during the whole COVID-19 pandemic and the months preceding it (45.7% vs 25.6%, p = 0.07). Conclusions: Our study demonstrated that restrictive lockdown policies for the containment of the COVID-19 outbreak are associated with an increased rate of ruptured extrauterine tubal pregnancies.

Tubal Infertility at The Yaounde Gynaecological Endoscopic Surgery and Human Reproductive Research Teaching Hospital

Introduction: Tubal infertility affects 25% of infertile couples in Cameroon and is the leading cause of female infertility. Methods: We carried out a case-control study at the Yaounde Gynaecological Endoscopic Surgery and Human Reproductive Research Teaching Hospital, from the period of March to May 2021. Women with tubal infertility were grouped as cases and women with no fertility problems were grouped as the controls. Data of interest were sociodemographic, reproductive, surgical, medical, paraclinical, and therapeutic. Chi-square and Fischer's exact tests were used to compare variables. Odds ratios were calculated to determine the association between variables. A p-value of less than 0.05 was considered significant. Logistic regression analysis was performed to eliminate confounding factors. Results: Of the 205 patients recruited for the study, 67 had tubal infertility representing the cases and 138 with no fertility problems, representing the controls. After multivariate analysis and logistic regression, tubal infertility was associated in our study, with a history of sexually transmitted infections (aOR: 9.4; 95% CI [3.2-27.8]; p&lt;0.001) and ectopic pregnancy (aOR: 13.5 95% CI [1.9-91]; p=0.009). The main diagnostic tools used were: hysterosalpingography alone (55.2%), hysterosalpingography followed by laparoscopy (40.3%). The main therapeutic approaches used were medically assisted reproduction (82.1%) and laparoscopic surgery (44.8%). Conclusion: The independent risk factors for tubal infertility were a history of sexually transmitted infections and ectopic pregnancy. The diagnosis was mainly by hysterosalpingography. Treatment was mainly by medically assisted reproduction.

Endoscopic surgery in gynecology: state and development prospects

In the clinical lecture the main principles of arranging endovideosurgical carein gynecology are substantiated on the basis of the material of 17,5 thousandslaparoscopies and 10 thousands hysteroscopies. The detailed analysis of possibilities of endoscopic methods in operative gynecology is given. The peculiarities of laparoscopys application are depicted in cases of tube-peritoneal infertility, uterine and ovarian tumors, pyoinflammatory diseases of uterine adnexa, ectopic pregnancy, maldevelopment of female genital organs, stress incontinence in women. Perspectives of endovideosurgical technologies in gynecological practice are also shown.

Modern aspects of endoscopic surgery in gynecology

133003 hysteroscopies (including3624 operative ones) and 8401 laparoscopic interventions were performed since 1996 to 2000. On the basis of rich experience the results of treating gynecologic pathology with the method of endoscopy were analyzed and the perspectives of its further development were determined.

Combined lumbar muscle block and perioperative comprehensive patient-controlled intravenous analgesia with butorphanol in gynecological endoscopic surgery.

BACKGROUNDLaparoscopic surgery has become a common surgical approach for the clinical treatment of intra-abdominal lesions in recent years. We hypothesized that lumbar block with postoperative patient-controlled intravenous analgesia (PCIA) by butorphanol after gynecological surgery under general anesthesia would be more effective than PCIA by butorphanol alone.AIMTo investigate the effect of lumbar block with PCIA by butorphanol after gynecological surgery under general anesthesia.METHODSThis study assessed 120 women scheduled for laparoscopic surgery at our hospital between May 2017 and May 2020. They were divided using a random number table into a research group (those who received quadratus lumborum block combined with PCIA analgesia by butorphanol) and a control group (those who received only PCIA analgesia by butorphanol), with 60 patients in each group. Demographic factors, visual analog scale scores for pain, serum inflammatory markers, PCIA compressions, Ramsay scores, and adverse events were compared between groups using a t-test, analysis of variance, or χ2 test, as appropriate.RESULTSThere were no significant differences in demographic factors between groups (all P > 0.05). The visual analog scale scores of the research group in the resting state 12 h and 24 h postoperatively were significantly lower than those of the control group (P < 0.05). Two hours after surgery, there were no significant differences in the levels of serum tumor necrosis factor-α, interleukin (IL)-6, or IL-8 between groups (P > 0.05). The serum tumor necrosis factor-α levels of the research group 24 h postoperatively were significantly lower than those of the control group (P < 0.05). The levels of serum IL-6 and IL-8 in the study group 24 h and 48 h postoperatively were significantly lower than those in the control group (P < 0.05).CONCLUSIONLumbar block with PCIA with butorphanol after gynecological surgery under general anesthesia significantly improves the analgesic effect and reduces the degree of inflammation, instances of PCIA compression, and adverse reactions.

Endometrial Micropoliposis, Hysteroscopic Manifestation of Chronic Endometritis

Study Objective Identify the relationship between hysteroscopic findings of micropoliposis and the histopathological result of chronic endometritis in a series of cases. Design Between 02/01/17 and 02/15/21, cases diagnosed with endometrial micropoliposis were analyzed through hysteroscopy and histopathology in the gynecological endoscopic surgery service of the Hospital “Lic. Adolfo López Mateos” ISSSTE. Setting Hysteroscopy in gynecological position, 2.7 mm outer diameter lens, 105 ̊ visual field angle, 4.5 mm outer diameter. Saline solution was used to dilate the uterine cavity. The anterior and posterior uterine walls were examined. Patients or Participants 42 patients undergoing hysteroscopy were included in which micropoliposis was reported. Interventions A biopsy was taken of the compatible lesions with micropoliposis by hysteroscopy, reporting inflammatory infiltration with plasma cells was reported in relation to endometritis. Measurements and Main Results The mean age was 28 years, 39 with abnormal uterine bleeding (92%), 1 with infertility (2%) and 2 with a bicornuate uterus with a non-communicating cavity (4%), no patient presented data of vaginal or pelvic infection, cultures: Mycoplasma hominis in 17 (40%), Ureaplasma urealyticum in 15 (35.7%), Chlamydia in 2 (4%), E. Coli in 4 (8%), Gardnerella vaginalis in 2 (4%) and 2 with Müllerian malformations and negative cultures (4%). All patients were treated according to antibiogram with a new culture after 3 months, the infection persisted in 3 patients (7%), having negative cultures with a second antibiotic scheme. All patients had improvement in bleeding, after the management of the Müllerian malformation, micropoliposis persisted 6 months after surgery. Conclusion Chronic endometritis can be manifested as micropoliposis by hysteroscopy, just with abnormal uterine bleeding without data of an active infectious process. Although chronic endometritis has been mentioned as an infertility factor, none of our patients had a desire for pregnancy. In the presence of endometrial micropoliposis by hysteroscopy, chronic endometritis should be suspected, and special cultures against Mycoplasmas and Chlamydia should be performed. Identify the relationship between hysteroscopic findings of micropoliposis and the histopathological result of chronic endometritis in a series of cases. Between 02/01/17 and 02/15/21, cases diagnosed with endometrial micropoliposis were analyzed through hysteroscopy and histopathology in the gynecological endoscopic surgery service of the Hospital “Lic. Adolfo López Mateos” ISSSTE. Hysteroscopy in gynecological position, 2.7 mm outer diameter lens, 105 ̊ visual field angle, 4.5 mm outer diameter. Saline solution was used to dilate the uterine cavity. The anterior and posterior uterine walls were examined. 42 patients undergoing hysteroscopy were included in which micropoliposis was reported. A biopsy was taken of the compatible lesions with micropoliposis by hysteroscopy, reporting inflammatory infiltration with plasma cells was reported in relation to endometritis. The mean age was 28 years, 39 with abnormal uterine bleeding (92%), 1 with infertility (2%) and 2 with a bicornuate uterus with a non-communicating cavity (4%), no patient presented data of vaginal or pelvic infection, cultures: Mycoplasma hominis in 17 (40%), Ureaplasma urealyticum in 15 (35.7%), Chlamydia in 2 (4%), E. Coli in 4 (8%), Gardnerella vaginalis in 2 (4%) and 2 with Müllerian malformations and negative cultures (4%). All patients were treated according to antibiogram with a new culture after 3 months, the infection persisted in 3 patients (7%), having negative cultures with a second antibiotic scheme. All patients had improvement in bleeding, after the management of the Müllerian malformation, micropoliposis persisted 6 months after surgery. Chronic endometritis can be manifested as micropoliposis by hysteroscopy, just with abnormal uterine bleeding without data of an active infectious process. Although chronic endometritis has been mentioned as an infertility factor, none of our patients had a desire for pregnancy. In the presence of endometrial micropoliposis by hysteroscopy, chronic endometritis should be suspected, and special cultures against Mycoplasmas and Chlamydia should be performed.

Study on the Influence of Nursing Intervention Strategy of Heat Preservation on Patients Undergoing Gynecological Endoscopic Surgery

Study on the Influence of Nursing Intervention Strategy of Heat Preservation on Patients Undergoing Gynecological Endoscopic Surgery

Vaginal natural orifice transluminal endoscopic gynaecological surgery: is it time to accept it as routine practice?

Natural orifice surgery is a novel surgical technique with increasing use across different medical disciplines (Pearl et al, Journal of Gastrointestinal Surgery12, no. 7 (2008): 1293-1300). In gynaecology, Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) offers alternative access to the intra-abdominal space eliminating the need for abdominal incisions with a better cosmetic outcome and less post-operative pain. This approach could be particularly helpful in women with high BMI or those with suspected abdominal rather than pelvic adhesions where laparoscopic abdominal entry is often difficult to achieve.

Intestinal endometriotic nodules with a length greater than 2.25 cm and affecting more than 27% of the circumference are more likely to undergo segmental resection, rather than linear nodulectomy.

To analyze the efficacy of intestinal ultrasonography with bowel preparation (TVUSBP) for endometriosis mapping in evaluating intestinal endometriosis to choose the surgical technique (segmental resection or linear nodulectomy) for treatment. Cross-sectional observational study. University Hospital-Center for Advanced Endoscopic Gynecologic Surgery from April 2010 to November 2014. One hundred and eleven women with clinically suspected endometriosis and intestinal endometriotic nodule or intestinal adherence in TVUSBP for endometriosis mapping. All patients with suspected endometriosis underwent TVUSBP for endometriosis mapping prior to videolaparoscopy for complete excision of endometriosis foci, including intestinal foci, using the linear nodulectomy or segmental resection techniques, depending on the characteristics of the intestinal lesion with confirmation of endometriosis on anatomopathological examination. Preoperative ultrasonographic assessment of the length of the intestinal nodule, circumference of the intestinal loop affected by the endometriotic lesion, distance from the anal verge and intestinal wall layers infiltrated by endometriosis, as well as other endometriosis sites. Of the 111 patients who participated in the study, 63 (56.7%) presented intestinal endometriotic nodules in ultrasonography, performed by a single examiner (A.L.A.N.), and underwent intestinal surgical treatment of deep endometriosis-linear nodulectomy or segmental resection. The analysis of the receiver operating characteristic (ROC) curve showed that a longitudinal length of the intestinal nodule of 2.25 cm and a loop circumference of 27% are cutoff points separating linear nodulectomy from segmental resection techniques for excising intestinal endometriosis. The information obtained by TVUSBP helps the surgeon and patient, in the preoperative period, to select the surgical technique to be performed for resection of intestinal endometriosis and plan the surgical procedure while taking into account postoperative morbidity.

Hysteroscopy in COVID-19 times

Objective: The coronavirus disease 2019 (COVID-19) pandemic is a global public health concern. Health Care Facilities in every country have to deal with a complete reorganization of labor and delivery unit, and resource management. Aim of this review is to summarize the available literature data about the impact of COVID-19 on hysteroscopic surgery. Mechanism: A search on PubMed and Medline databases was performed until March 2021. Findings in brief: Most of evidence agree on complete cancellation of elective endoscopic gynecologic surgery, and on its deferring until the pandemic has been contained. When hysteroscopy is performed, precautions should be observed to prevent COVID-19 infection. Conclusions: We summarized all best practice to perform safe and effective hysteroscopic surgery in COVID-19 times and in the slow restore of normal activities.

Recommendations for Gynecological Endoscopic Surgery during COVID-19 Pandemic

AbstractThe presence of coronavirus disease 2019 (COVID-19) continues to overwhelm health-care systems with numerous concerns around the safety of patients as well as health-care professionals. It is essential to allow for judicious use of resources and emphasize allotting maximum staff and resources to care for the affected. To this end, most centers are choosing to defer elective procedures and perform only emergency surgeries. The safety of all theater staff is of utmost importance, and the risks of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral transmission should be curbed when operating. In particular, there are concerns relating to the transmission of COVID-19 during gynecological laparoscopic surgery, arising from the possible generation of contaminated aerosols from gas leakage and the creation of smoke from the use of electrosurgical devices. The aim of this paper is to review the evidence available as of today for recommendations to follow while performing gynecological procedures.

Effects of menstrual cycle on nausea and vomiting after general anesthesia.

To investigate the impact of menstrual cycle on patients undergoing gynecological endoscopic surgery. 220 patients scheduled for gynecological endoscopic surgery under general anesthesia were selected. The patients were divided into three groups based on 3 phases of menstrual cycle which are the follicular phase (Group F), ovulatory phase (Group O) or luteal phase (Group L). It is based on their duration of menstruation and the last day of menstrual bleeding from the date of surgery. Primary outcomes were the incidences of early and late postoperative nausea and vomiting (PONV) in the three patient groups. Preoperative venous blood was taken to determine the estrogen and progesterone levels of the patients. A total of 207 patients were enrolled. The incidence of early PONV was highest in group O (22.22% vs 43.33% vs 17.86%, P < 0.01). Multivariate logistic regression showed that menstrual cycle (P < 0.01) and sufentanil dosage (P < 0.05) were independent risk factors for early PONV, menstrual cycle (P = 0.03) and intraoperative hypotension (P = 0.03) were independent risk factors for late PONV. After the propensity matching, the incidences of early and late PONV in group O were both higher than that in other two groups (19.23% vs 44.68% vs 16.90%, P < 0.01; 53.80% vs 72.34% vs 45.07%, P = 0.01). The incidence of PONV after gynecological endoscopic surgery was different in patients with different menstrual cycles, with the highest incidence in ovulation.

Critical Remarks to Endoscopic Surgery for Endometrial Cancer and Sarcoma, Cervical and Ovarian Cancer Diagnosis and Treatment

While endoscopic gynecological surgery as laparoscopy and hysteroscopy in all its variations of skills, like with single port entry, multiple port entry, conventional or robotically assisted has been universally completely accepted by the medical and patient community this is not at all yet a reality in oncological indications [1]. The article reviews the reality reality of Endoscopic surgery and its application in Gynecological Malignancy diagnosis and treatment focusing endometrial sarcoma, cervical and ovarian cancer.

Is Hysterectomy a Risk Factor for Urinary Retention? A Retrospective Matched Case Control Study

Compare the rates of urinary retention in patients undergoing endoscopic hysterectomy with those of patients undergoing nonhysterectomy endoscopic gynecologic surgery. Retrospective case control study matched by operative time. Academic medical center. All patients undergoing endoscopic gynecologic surgeries between January 2013 and December 2018. Outpatient endoscopic gynecologic surgery. A total of 200 endoscopic hysterectomy cases were matched to endoscopic nonhysterectomy gynecologic surgery controls in a 1:1 ratio. The differences in baseline and operative characteristics between the 2 groups included age (48.6 years vs 45.7 years, p = .04), perioperative opioid administration (morphine milligram equivalents, 11.6 mg vs 7.6 mg, p = .01), and estimated blood loss (64.1 mL vs 31.8 mL, p = .001). The rate of urinary retention in the hysterectomy group was double that in the nonhysterectomy group (26.5% vs 13%, p = .01). In the hysterectomy group, age, perioperative opioids, operative time, and estimated blood loss did not differ between those who failed and those who passed the void trial. In the nonhysterectomy group, only operative time was significantly longer in those who failed the void trial (108 minutes vs 94.3 minutes, p = .04). After adjusting for perioperative opioid use and operative time, the relative risk of urinary retention in the hysterectomy group was 2.3 (p = .002, 95% confidence interval, 1.38-3.98). Hysterectomy appears to be an independent and major factor contributing to postoperative urinary retention. When compared with nonhysterectomy gynecologic surgical controls with similar operative times, the rate of urinary retention in patients who underwent hysterectomy was doubled.

Preoperative Ultrasound Indications Determine Excision Technique for Bowel Surgery for Deep Infiltrating Endometriosis: A Single, High-Volume Center

To identify bowel nodule features of deep infiltrating endometriosis (DIE) measured through preoperative ultrasound scanning that influence laparoscopic surgical strategy. A retrospective study. Malzoni Clinic-Endoscopica Malzoni Department, Center for Advanced Endoscopic Gynecological Surgery, Avellino, Italy. Patients undergoing laparoscopic surgery between January 1, 2014, and December 31, 2018, for clinically suspected DIE with previous ultrasound evaluation ≤1 month before intervention. Use of sonographic measurements to determine laparoscopic excision technique (segmental bowel resection, discoid resection, shaving) for DIE with bowel involvement.``` MEASUREMENTS AND MAIN RESULTS: Of 5051 DIE surgeries, 4983 were included; 1494 (29.9%) bowel resections (512 bowel segmental resections and 982 nodulectomies [967 shaving and 15 discoid resections]) were performed, accounting for 34.3% and 65.7% of all bowel procedures, respectively. Preoperative sonographic findings and surgical reports were collected. Sensitivity and specificity of preoperative ultrasound evaluation for all types of DIE lesions were calculated, and sonographic measurements of bowel nodules and different surgical techniques were compared. According to preoperative sonographic measurements, most nodules excised by segmental resection had a longitudinal diameter of 3 to 7 cm, none were <3 cm; all nodules excised by nodulectomy (shaving or discoid resection) had a longitudinal diameter <3 cm. Mean thickness (maximum depth of muscular layer infiltration) of identified bowel nodules estimated through ultrasound scanning was 13.4 mm ± 4.8 mm (mean ± standard deviation) and 5.8 mm ± 2.7 mm for lesions removed by segmental resection and nodulectomy, respectively, and there was a statistically significant difference between them (p <.05). Of the 512 segmental resected bowel nodules, 143 (28%) had a maximum depth ≥9 mm, 354 (69%) had 7 to 9 mm, and 15 (3%) had <7 mm (6 mm, with length >4 cm). All shaved nodules had thickness ≤7 mm. The 15 nodules excised by discoid resection (1.5% of nodulectomies) were <25 mm, but thickness ranged from 7 to 9 mm. The need for segmental resection in DIE with bowel-infiltrating nodules depends on the degree of muscular layer infiltration and corresponding thickness (muscularis rule) in addition to nodule length and can be accurately identified by preoperative ultrasound evaluation.