Gynecologic Surgery Research Articles

Early prediction of intraoperative hypothermia in patients undergoing gynecological laparoscopic surgery: A retrospective cohort study.

Intraoperative hypothermia is one of the most common adverse events related to surgery, and clinical practice has been severely underestimated. In view of this, this study aims to build a practical intraoperative hypothermia prediction model for clinical decision-making assistance. We retrospectively collected clinical data of patients who underwent gynecological laparoscopic surgery from June 2018 to May 2023, and constructed a multimodal algorithm prediction model based on this data. For the construction of the prediction model, all data are randomly divided into a training queue (70%) and a testing queue (30%), and then 3 types of machine learning algorithms are used, namely: random forest, artificial neural network, and generalized linear regression. The effectiveness evaluation of all predictive models relies on the comprehensive evaluation of the net benefit method using the area under the receiver operating characteristic curve, calibration curve, and decision curve analysis. Finally, 1517 screened patients were filtered and 1429 participants were included for the construction of the predictive model. Among these, anesthesia time, pneumoperitoneum time, pneumoperitoneum flow rate, surgical time, intraoperative infusion, and room temperature were independent risk factors for intraoperative hypothermia and were listed as predictive variables. The random forest model algorithm combines 7 candidate variables to achieve optimal predictive performance in 2 queues, with an area under the curve of 0.893 and 0.887 and a 95% confidence interval of 0.835 to 0.951 and 0.829 to 0.945, respectively. The prediction efficiency of other prediction models is 0.783 and 0.821, with a 95% confidence interval of 0.725 to 0.841 and 0.763 to 0.879, respectively. The intraoperative hypothermia prediction model based on machine learning has satisfactory predictive performance, especially in random forests. This interpretable prediction model helps doctors evaluate the risk of intraoperative hypothermia, optimize clinical decision-making, and improve patient prognosis.

Clinical Practice Guideline: Recommendations for the Perioperative Management of Pancreatic and Colorectal Cancer Patients.

Colorectal and pancreatic carcinoma are the most common cancers of the gastrointestinal tract. Their surgical treatment carries a high morbidity: Complications arise in 25% to 30% of cases, often prolonging recovery times and delaying the initiation of adjuvant therapy, leading, in turn, to worse oncological outcomes. The goal of multimodal perioperative management (mPOM) is to lower the postoperative complication rate through a combination of perioperative measures. This guideline on the perioperative management of gastrointestinal tumors (POMGAT) meets all requirements for an S3 guideline as specified by the Association of the Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF). These include a systematic literature search, quality assessment of the included publications, an evaluation of the reliability of the evidence according to the GRADE approach, and a structured consensus process. Meta-analyses have shown that mPOM lowers the complication rates of both pancreatic and colorectal resections (RD 0.96 with 95% confidence interval [0.92; 0.99] and RR 0.66 [0.54; 0.80], respectively). This shortens the hospital stay after pancreatic resections by a median of 2.33 days [-2.98; -1.69] and after colorectal resections by a median of 2.59 days [-3.22; -1.97]. Adherence to the POMGAT-S3 guideline for pancreatic and colorectal cancer surgery is associated with improved recovery, which can lead to a faster return to intended oncological treatment (RIOT) and thus to better long-term outcomes. These recommendations are not restricted to gastrointestinal cancer surgery; they can also be applied to visceral surgery for benign conditions, as well as to gynecological and urological operations.

An open comparative randomized prospective study: Direct trocar insertion vs Veress needle technique in laparoscopic surgeries.

Laparoscopy is a minimally invasive technique utilized for both diagnostic and surgical approaches. Minimally invasive procedures compared to laparotomy offer the advantages of reduced hospital stay, lower morbidity, decreased pain, and faster recovery. Common methods for laparoscopic entry include Veress needle insertion (VNI), direct optical trocar entry, direct trocar insertion (DTI), and the Hasson technique. This study aims to compare the efficacy and safety of VNI and DTI in laparoscopic gynecological surgeries. An open comparative randomized prospective study was conducted involving 200 women aged 18 to 70 years, scheduled for laparoscopic surgery at 2 tertiary centers. Participants were randomized into 2 groups: 1 using VNI and other using DTI. The groups were homogeneous regarding age, parity, and body mass index. The mean age of the VNI group is 45.22 ± 11.65 and the DTI group is 44.89 ± 10.5 (P = .833). There were no statistical significance in terms of the presence of chronic diseases and history of previous abdominal surgery between the groups (P = .802 and P = .510, respectively). Entry time to the abdomen, the decrease in hemoglobin values, and hospitalization length were found to be statistically significant between the entry methods (P < .001, P = .002, and P < .001, respectively). Entry time, the decrease in hemoglobin value, and hospitalization length were higher in the VNI group. In conclusion, although there is no definitive consensus on the optimal laparoscopic entry technique, direct trocar entry is an effective alternative to the Veress needle insertion technique. Direct trocar entry is associated with shorter entry times, fewer perioperative complications, less reduction in hemoglobin levels, and shorter hospitalization duration compared to VNI.

Fear, anxiety, and knowledge levels of women who underwent gynecologic surgery during the COVID-19 pandemic.

The objective of this study was to evaluate the fear, anxiety, and knowledge level in women who underwent gynecological surgical procedures during the COVID-19 pandemic. This cross-sectional study was conducted on 188 women who underwent a gynecologic surgical operation in Muğla, Turkey. Data were collected by using demographics and obstetric detail form, questionnaire on knowledge, attitudes, and practice toward COVID-19, and State-Trait Anxiety Inventory-I (STAI-I). Most of the women perceived their surgical process as very urgent. Women felt fear mostly for being infected with the virus, and they were afraid of transmitting COVID-19 to another one. The COVID-19 knowledge scores of women who had undergone cancer surgery were statistically significantly higher than others (p=0.017). The STAI-I scores of women increased as their COVID-19 knowledge scores increased (p<0.05). This study demonstrated that women were afraid of COVID-19 infection during gynecological operation and due to hospitalization, sociodemographic characteristics affected the knowledge levels about COVID-19 infection, and the anxiety levels of the women. Planning appropriate interventions to decrease the fear and anxiety of women who undergo gynecological surgery during the pandemic is important to ensure that women adhere to their treatment and follow-up in the postoperative period.

Predictors and potential risk factors of iatrogenic ureteral injury following common obstetric and gynecological surgeries: A single-center retrospective study

Objectives: As iatrogenic ureteral injury carries a high burden and is associated with increased postoperative morbidity and mortality, the purpose of this study is to determine the incidence and potential risk factors of iatrogenic ureteral injury following common obstetric and gynecological surgeries in King Abdulaziz Medical City. Methods: This was a single-center retrospective cohort study based on data extracted from an electronic hospital information system conducted in King Abdulaziz Medical City, Riyadh, Saudi Arabia. Three thousand four hundred and sixty-four cases of cesarean section (C-section) and hysterectomy from January 1, 2021, to December 31, 2022, were reviewed. All cases of C-section and hysterectomy in which the urology department was consulted for suspected iatrogenic ureteric injuries were included in the study. All cases other than C-sections and hysterectomy in which the urology department was consulted for suspected iatrogenic ureteric injuries were excluded from the study. Results: A total of 45 patients for whom urology was consulted for suspected ureteral injury were included in this study. Approximately (35.6%) one-third of the patients had positive findings of ureteral injury following common obstetric and gynecological surgeries. About 41.2% of these patients had previous gynecological surgeries. Other potential risk factors were tested such as age and body mass index. Older patients were slightly at higher risk of iatrogenic ureteral injury (P &lt; 0.05). Conclusion: Ureteral injury in obstetric and gynecological surgeries is rare yet serious complication. The findings of this study suggest that the incidence of iatrogenic ureteral injury was relatively associated with older age.

An Appraisal of Anaesthesia Practices for Obstetric and Gynaecologic Surgeries in a Tertiary Health Center in Zaria, North Western Nigeria

Abstract Background: Anaesthesia is a critical aspect of every surgical procedure. Various options exist depending on the type of procedure, nature and the clinical state of the patient. This study reviewed the anaesthesia practices for Obstetric and Gynaecologic surgeries at Ahmadu Bello University Teaching Hospital, Zaria. Materials and Methods: It was a retrospective cross-sectional descriptive study conducted at Ahmadu Bello University Teaching Hospital, Zaria. Obstetric and Gynaecologic surgeries performed from 1 November 2022 to 31 October 2023 were included in the study. Relevant data for the study were obtained from the anaesthesia register in the theatre. The data were analysed with SPSS 20. Results: The mean age ± SD of patients who had surgery was 32.1 ± 9.1 years. A total of 547 cases were reviewed, of which 273 (49.9%) were elective cases and 274 (51.1%) were emergency cases. Out of these, 254 (46.4%) were obstetric emergencies, 20 (3.7%) were gynaecologic emergencies, 149 (27.2%) were elective gynaecologic cases, and 124 (22.7%) were elective obstetric cases. The majority of the cases, 407 (74.4%), were American Society of Anaesthesiologists II. Spinal anaesthesia was the commonest type of anaesthesia used in obstetric surgeries 336 (91.8%), while general anaesthesia was the commonest type of anaesthesia used in gynaecologic surgeries 89 (79.5%). Senior registrars gave anaesthesia in 457 (83.5%) cases. Heavy Bupivacaine (0.5%) was the commonest agent used for spinal anaesthesia in 327(89.3%) cases, while plain bupivacaine (0.5%) was the least agent used in 39(10.7%). Propofol was the most common agent used for the induction of general anaesthesia in 72 (64.3%) cases, while ketamine was the least used agent in 40 (35.7%). Anaesthesia complications were recorded in only 24 (4.4%) of cases. The complications were recorded in 13 (54.2%) procedures done under neuraxial anaesthesia and 11 (45.8%) cases done under general anaesthesia. Cardiovascular instability was the most common complication recorded in 10 (41.7%) cases. Conclusion: Spinal anaesthesia was the most common technique of anaesthesia in Obstetric surgeries, while general anaesthesia was the most common in Gynaecologic surgeries during the period under review. Complications of anaesthesia were uncommon.

Omental incarceration secondary to uterine perforation after dilatation curettage: Conservative approach in sub-saharan Africa.

Complications of uterine perforation and herniation of intra-abdominal organs into the perforated area may occur after gynecological operations. They can be treated with a conservative approach, especially in cases whose vital signs are stable, laboratory values are within normal limits and their general condition is suitable. We aim to present the conservative treatment without using surgical and medical methods as it is the first case in the literature. Uterine perforation is a rare but potentially serious complication of curettage for gynecologic or obstetric reasons especially during and after operative procedures and the application of intrauterine contraceptive devices. The incidence of uterine perforation during gynecological operations is between 0.002-1.7. A 30-year-old multiparous case with a 7-week 4-day pregnancy was diagnosed with incomplete abortion at an external center due to vaginal bleeding. The case underwent suction curettage. After 24 h, revision suction curettage was performed due to the finding of rest in the endometrium during the ultrasonographic control, and the case was diagnosed with uterine perforation and omental herniation due to this. We highlighted the importance of a thorough gynecological assessment following a dilated suction curettage (D&C) procedure that includes a careful clinical examination and a detailed ultrasound evaluation.

Feasibility and Safety of ArtiSential for Minimally Invasive Surgery in Early-stage Gynecologic Cancer: Results from the KGOG 4002/GYANT Study

Objectives: The objective is to evaluate the feasibility and safety of ArtiSential for performing minimally invasive surgeries for gynecological cancers. Materials and Methods: We conducted a prospective observational study at 10 Tertiary Institutional Hospitals in Korea between November 2021 and April 2022. Eligible patients were 18 years or older and planned to undergo minimally invasive surgery for gynecologic cancer. We collected baseline characteristics, surgical information, and postoperative outcomes. The primary endpoint was to compare the operation time required for gynecologic cancer surgery using ArtiSential with the reported operation time for surgery using conventional laparoscopic instruments or robots. The secondary endpoints were to evaluate the surgical outcomes of gynecologic cancer surgery using ArtiSential compared to conventional laparoscopic instruments or robots and collect operator feedback on equipment improvements during surgery. Results: Forty patients were enrolled in this study, including 19 with endometrial cancer, 15 with cervical cancer, and 6 with ovarian cancer. The average operation time was 187.0 ± 49.2 min, with no complications encountered during surgery. Pelvic lymph nodes were assessed in 34 patients, with the ArtiSential device utilized in 22 (64.7%) of these patients, at an average assessment time of 40.3 ± 19.4 min. Most surgeons using the ArtiSential device reported that it performed slightly better than conventional laparoscopic instruments. Conclusion: The use of the ArtiSential device in minimally invasive surgery has been demonstrated to be both feasible and safe for the treatment of early-stage gynecologic cancer.

Acupuncture and Moxibustion in the Treatment of Gynecological Perioperative Anxiety: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis aims to investigate the effectiveness and safety of acupuncture and moxibustion in managing perioperative anxiety during gynecological surgery. Relevant studies published from the establishment of the databases to March 20, 2023, were searched in PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, VIP, and CBM. Literature screening and data extraction were independently conducted by two investigators. The Cochrane risk-of-bias tool 2.0 was utilized to assess the risk of bias in the included studies. Data analysis was carried out using Stata 15.1 software. The analysis included a total of 3254 patients from twenty studies. It was found that acupuncture and moxibustion therapy resulted in a reduction of postoperative State-Trait Anxiety Inventory (STAI-S) scores (mean difference [MD] = -3.50, 95% confidence interval [CI] [-6.93 to -0.07], P = 0.046), as well as both preoperative and postoperative Visual Analogue Scale-Anxiety (VAS-anxiety) and Self-Rating Anxiety Scale (SAS) scores (pre-operation: SMD = -1.04, 95% CI [-1.73 to -0.35], P = 0.003; post-operation: SMD = -0.78, 95% CI [-1.21 to -0.35], P < 0.001) in comparison to the control group. Nonetheless, no significant variances were noted between the two groups with regards to preoperative and intraoperative STAI-S scores (pre-operation: MD = -3.38, 95% CI [-9.58 to 2.82], P = 0.286; intraoperative: MD = -1.09, 95% CI [-7.32 to 5.13], P = 0.730), and intraoperative VAS-anxiety and SAS scores (SMD = -0.44, 95% CI [-1.51 to 0.64], P = 0.427). During the perioperative period of gynecological surgery, acupuncture and moxibustion therapy show potential in alleviating anxiety in patients. It is noteworthy that the current level of evidence is limited by the small sample size. Therefore, further validation of these findings is necessary.

Prospective Observational Study Of Surgical Site Infections In Obstetrics And Gynaecological Operations In Teaching Hospital

Background: Surgical site infections (SSI) are defined as infections occurring upto 30 days after surgery or (upto one year in patients receiving implants) and affecting either the incision or deep tissue at the operative site. SSIs are potential complications associated with any type of surgical procedure. Even though SSIs are among the most preventable hospital acquired infections, they still symbolize a significant burden in terms of patient’s morbidity and mortality leading to prolonged hospital stay and increase the patient susceptibility to other nosocomial infections affecting the financial condition of patients. Risk factors for SSIs are grouped as patient related, preoperative or pre pregnancy, intraoperative or intrapartum, and postoperative. SSI causes a substantial risk to patients and financial loses for health system because the multi-factorial causes achieving a measurable and sustained reduction in SSIs. In this context it becomes important to determine the prevalence of SSI, assess the magnitude of problem and provide a rationale to set priorities in infection control in the hospitals. Materials and Methods: The present prospective observational study was conducted on 200 patients in the Department of Obstetrics and gynaecology, at Dr B R Ambedkar Medical College and Hospital for a period of 12 months. Prior to the initiation of the study, Ethical and Research Committee clearance was obtained from Institutional Ethical Committee. Results: There was a significant statistical difference in the incidence of SSIs basing on the body mass index of subjects (pvalue:&lt;0.001). SSI incidence was high in morbidly obese subjects. There was a highly significant statistical difference in the incidence of SSIs basing on the history of previous surgeries of subjects (p-value: &lt;0.0001). SSI incidence was low in subjects with no history of previous surgeries. There was a highly significant statistical difference in the incidence of SSIs basing on the type of surgery (p-value: 0.48). SSI incidence was high in caesarean and low in tubectomy surgeries. There was a significant no statistical difference in the incidence of SSIs basing on the type of incision (p-value: 0.70). There was a highly significant statistical difference in the incidence of SSIs basing on the methods of skin closure (p-value: 0.002). SSI incidence was high in mattress method of skin closure and low in subcuticular method of skin closure. There was a highly significant statistical difference in the incidence of SSIs basing on the class of wound (p-value: 0.00001). SSI incidence was high in dirty wounds and low in clean wounds of skin closure. Conclusion: Although several preoperative risk factors (e.g., age, morbid obesity, ability to pursue a minimally invasive approach, type of gynaecologic surgery, type of incision, methods of skin closure, class of wound) may not be within the surgeon’s control, several evidence based interventions can limit the incidence of SSIs.

Perioperative management of oncological gynaecological robotic surgery patients (application of the ERAS protocol): a narrative literature review

Perioperative management of oncological gynaecological robotic surgery patients (application of the ERAS protocol): a narrative literature review

Evaluation of different methods for optic port entry in the umbilical region in gynecologic laparoscopic operations

Background Scarring after surgery poses a significant concern for women, particularly for those in their youth. Aim Evaluate which method of vertical trans umbilical and tranverse supra umbilical entry approaches in laparoscopic surgeries ought to be prioritized regarding cosmetic, pain and infection. Patients and methods This prospective comparative study was performed on 50 individuals aged from 18 to 60 years old, both sexes, undergoing diagnostic or operative laparoscopy for infertility, ovarian torsion, or cystectomy, chronic pelvic pain and total laparoscopic hysterectomy. Participants divided in to two groups equally: group 1: Vertical trans umbilical incision. Group 2: Transverse supra umbilical incision. Results There were significantly lower pain scores and overall scar scores after 1 week, 1 month, and 3 months of the operation in individuals with vertical trans umbilical incision than in patients with transverse supra umbilical incision. A substantial variation existed among both groups as regard redness warmth, tenderness, and increased pain. There was significantly lower vascularity, pigmentation, pliability, thickness sub scale scores, and overall scar scores after 1 week, 1 month, and following 3 months of the operation in individuals with trans umbilical vertical incision than in patients with supra umbilical transverse incision (P&lt;0.05). Lower painful, itchy, stiff, irregular, and hyperpigmented scar in vertical trans umbilical incision than patients with transverse supra umbilical incision however, this difference was significant in itching and irregular scar formation (P&lt;0.05). Conclusion A vertical incision provides better cosmetic outcomes compared with a transverse incision one.

A multi-center study on the use of lidocaine thermogel for pain control in outpatient operative hysteroscopy

ObjectivesThis study aimed to explore the use of an anesthetic lidocaine thermogel in outpatient operative hysteroscopies. Specifically, it assessed the safety, tolerability, and ease of use of the gel, as well as its potential for pain reduction during the procedure. Study designThis was a multicenter observational study conducted in 9 gynecological units between March 2023 and January 2024. The study included adult women scheduled for outpatient operative hysteroscopies, excluding those with hypersensitivity to the product or recent participation in other clinical studies. The target sample size was 60 to account for potential dropouts. Data collection was electronic, and SPSS was used for analysis. The study assessed visibility conditions, procedure duration, pain scores at different stages of the procedure, and adverse event frequency. Statistical analyses utilized descriptive statistics, Student’s t-tests, Wilcoxon and Friedman tests, and Chi-Square or Fisher tests as appropriate. Binary logistic regression was applied to identify factors influencing gel volume. ResultsAll 60 participants met the inclusion criteria. The mean age was 45.5 (SD 8.8) years, with a mean BMI of 27.0 (SD 5.6) kg/m2. Medical histories were reported in 46.7% of participants, and 50% had undergone previous gynecological surgeries. Prior to the procedure, 51.8% of participants took analgesics. The average procedure duration was 13.9 (SD 15.1) minutes. Pain scores were collected at different stages of the procedure, with median VAS scores ranging from 0 to 5 out of 10. In 50% of cases, the quality of vision during the procedure was rated 9 or higher on a 10-point scale. The full recommended dose of thermogel was administered in 91.7% of cases. The mean gel volume used was 7.0 (SD 1.9) milliliters. Regression analysis showed that younger age and a history of abortions or childbirth were significantly associated with higher gel volume use. ConclusionsThe anesthetic thermogel demonstrated effectiveness in managing pain during outpatient operative hysteroscopies, with median pain scores ranging from 0 to 5 out of 10 across different stages of the procedure. The gel showed a favorable safety profile, with only 15% of participants reporting adverse effects, all of which were minor and resolved satisfactorily. The high rate of complete gel application (91.7% of cases) and positive physician feedback suggest good tolerability and ease of use. Further research is recommended to evaluate the gel’s efficacy in other gynecological procedures and to optimize application protocols based on patient-specific factors such as age and reproductive history.

Abdominal wall incisional hernias: techniques to minimise the risks in open gynaecological surgery

Abdominal wall incisional hernias: techniques to minimise the risks in open gynaecological surgery

Rosalind Franklin Society Proudly Announces the 2023 Award Recipient for Journal of Gynecologic Surgery

Rosalind Franklin Society Proudly Announces the 2023 Award Recipient for <i>Journal of Gynecologic Surgery</i>

Older age is associated with postoperative nausea and vomiting in patients receiving intravenous patient-controlled analgesia containing droperidol: A retrospective observational analysis

BackgroundThis study investigated the associations of age and other factors with postoperative nausea and vomiting (PONV) in patients receiving fentanyl and droperidol intravenous patient-controlled analgesia (IVPCA) after laparoscopic gynecological surgery. A younger age is generally considered a higher risk factor for PONV. However, in our clinical experience, older age represents a higher risk factor for patients receiving IVPCA containing fentanyl and droperidol. Thus, we hypothesized that older age was a higher risk factor, and we explored factors associated with PONV in those patients. MethodsThe incidence of PONV was investigated in 5401 patients who received fentanyl–droperidol IVPCA after laparoscopic gynecological surgery under general anesthesia. Patient characteristics, operative/anesthetic factors, and intraoperative prophylactic antiemetics were investigated by multiple logistic regression analysis to determine the relationships of these factors with PONV. ResultsAmong the 5401 patients, 4929 (91.3 %) received propofol-based anesthesia, and 5187 (96.0 %) received a prophylactic antiemetic. The overall incidences of nausea, vomiting, and postoperative antiemetic use were 36.6 %, 17.6 %, and 17.7 %, respectively. Older age was associated with a significantly higher risk (adjusted odds ratio 1.18 per 10 years, 95 % confidence interval [1.11–1.25], p < 0.001) for PONV. No PONV after previous anesthesia, entry time into the operating room, and maximum duration of IVPCA were factors that influenced the risk of PONV, together with previously identified risk factors. ConclusionsOlder age was a higher risk factor for PONV in patients receiving fentanyl–droperidol IVPCA after laparoscopic gynecological surgery.

Postoperative Complications After Gynecological Surgry in Al Kut City

Introduction: Post-operative problems are common. How the complications develop depends on the kind of operation, the preoperative treatment, and the patient's pre-existing comorbid condition. Problems following surgery can be divide into two categories: general and procedure-specific, as well as having emerged promptly, early, or late. Objectives: To determine the postoperative complications type after gynecological surgery in AL-Kut city. Methodology: A cross-sectional study had carried out in AL-Kut City, at the AL-Zahraa Teching Hospital and AL-Kut Hospital for Gynecology and Pediatrics. The seven-month data collection period started on October 16, 2023, and ended on May 16, 2024. Results: 400 female participants, ranging in age from 13 to 72, were be studied. The age distribution of the patients was 31.5 ±10, with the age group 24-34 accounting for the largest percentage of patients (41%) and the age group over 45 accounting for the lowest percentage (7.8%). In terms of marital status, the largest proportion of women (96.2%) were married, while the lowest (1.3%) were widowed. 51.2% of patients lived in urban areas, compared to 48.8% in rural ones. Patients with two to three children had the highest number of parities (34.8%), whereas 18% of patients did not have any parties. 31.8% of patients had an abortion, whereas 68.3% did not. Of which 44.3% had considered as normal BMI, 34.5% of people are overweight, 12% belong to the obese I, 4.3% to the obese II, and 4.5% are morbidly obese. Based on the patients' past medical history, hypertension was the most common ailment detected, accounting for 30.3% of cases (chronic HTN 13%, gestational HTN 17.3%), while diabetes patients made up 9.5% (chronic D.M. 6.5%, gestational D.M. 3%). Classification of Complications: 90.3% of complications occurred within 48 hours, whereas 51.3% developed intraoperative complications. Finally, 50.2% of patients experienced a late problem 48 hours later. Conclusion: The study discovered a link between complications after gynecologic surgery and pre-operative blood transfusion and hospital stay. Hemorrhage, anesthesia difficulties, and cardiac arrhythmia were significant, were the most common late complications among the patients. On the other hand, late complications had linked to surgical duration, number of parities, and age.

Role of Laparoscopy in Reproductive Age Group Women with Gynecological Problems in a Tertiary Medical College

Background Laparoscopy has been a revolution in gynecological surgery as it is safe and minimally invasive. It can be used as a diagnostic as well as treatment modality for different gynecological problems like Chronic pelvic pain, adnexal cyst, ectopic pregnancy, Pelvic inflammatory disease and infertility.MethodsThis study was carried out at College of Medical Sciences-Teaching Hospital from April 2022 to March 2023 in 105 women. All the women undergoing laparoscopic surgeries were analyzed for indications, intraoperative findings and interventions.ResultsThe mean±SD of age of women was 30.34±7.73 years, most were in age group 26-35 years. The most common indications for Laparoscopy were for Adnexal cyst (74.28%), Chronic Pelvic Pain (14.28%) and Infertility (11.42%). The most common findings according to site were Ovarian pathology (48.60 %) followed by peritoneal pathology (22.9 %), Tubal pathology (17.14%) and normal findings (10.50%). In ovarian - Dermoid cyst (31.37 %), in tubal - ectopic pregnancy (55.56%), in peritoneal-Adhesions (45.83%) were the most common finding. In laparoscopic interventions, 26.70% had cystectomy, 14.3 % had salpingectomy and 13.3 % had Sterilization. Conclusions Laparoscopy as a modality for diagnosis and treatment of gynecological problems has been well established in recent times. It’s been a choice of surgery because of its reduce postoperative pain, shorter hospital stay, faster recovery and minimal scar. However, adequate advanced training and equipment are needed to perform skillful laparoscopic surgeries.

Quality of IVM ovarian tissue oocytes: impact of clinical, demographic, and laboratory factors.

To determine how clinical, demographic, and laboratory characteristics influence ovarian tissue oocyte quality. Immature cumulus-oocyte complexes were isolated from removed ovaries and cultured for 48-52h in either monophasic standard or biphasic CAPA media for fertility preservation. A total of 355 MII oocytes from 53 patients were described for intracytoplasmic and extracytoplasmic anomalies. Multiple clinical, laboratory, and demographic characteristics were analyzed. Statistically significant differences between independent groups in qualitative variables were identified using Pearson's χ2 and Fisher's exact tests. The diagnostic value of quantitative variables was assessed using the ROC curve analysis. Factors associated with the development of dysmorphism, taking patient age into account, were identified using the binary logistic regression analysis. Dysmorphisms were observed in 245 oocytes (69.0%), with a median number of dysmorphisms of 2. Oocyte dysmorphisms were found to be 2.211 times more likely to be detected in patients with ovarian cancer, while the presence of dark-colored cytoplasm was associated with gynecologic surgery in the anamnesis (p = 0.002; OR 16.652; 95% CI, 1.977-140.237; Cramer's V 0.187). Small polar bodies developed 2.717 times more often (95% CI, 1.195-6.18) in patients older than 35. In the case of ovarian transportation on ice at 4 ℃, the chances of development of cytoplasmic granularity increased 2.569 times (95% CI, 1.301-5.179). The use of biphasic CAPA IVM media contributed to a decrease in the probability of large polar body formation (p = 0.034) compared to the standard monophasic IVM media. Both patients' characteristics and laboratory parameters have an impact on the quality of IVM ovarian tissue oocytes.

Determination of Comfort Levels and Spiritual Care Needs of Gynecologic Cancer Patients with Abdominal Drains: A Cross-Sectional Descriptive Study in Turkey.

This study was conducted to determine the comfort levels and spiritual care needs of gynecologic cancer patients with abdominal drains. The study was conducted with 61 gynecologic cancer patients with abdominal drains at the gynecologic oncology surgery clinic of a state hospital in Turkey. Data were collected using the "Participant Information Form," "Perianesthesia Comfort Questionnaire (PCQ)", and "Spiritual Care Needs Inventory". Kolmogorov-Smirnov test and Mann-Whitney U test were used to analyze the data. It was found that the postoperative comfort of the patients in this study was above a moderate level. Patients who did not need spiritual care, did not fulfil religious rituals regularly and did not receive social support had a high level of comfort in the early postoperative period. Patients with gynecologic cancer were found to have high spiritual care needs. Patients without chronic diseases, possessing a single abdominal drain, familiar with the concept of spiritual care, expressing a need for spiritual care, engaging in regular religious rituals, and enjoying social support were identified as having elevated spiritual care needs. Within the framework of holistic nursing care provided to gynecologic cancer patients with abdominal drains, the results reveal the necessity of spiritual care and the importance of comfort.