Gynecologic Procedures Research Articles

Postoperative Telemedicine Use: Satisfaction and Safety After Benign Gynecologic Surgery: A Randomized Controlled Trial [ID 2683391

INTRODUCTION: Telemedicine for postoperative care can be appropriate after minimally invasive surgery, but few studies have examined this option in gynecologic surgery. The objective of this randomized controlled trial was to determine whether virtual, compared to in-person postoperative care, after minimally invasive gynecologic procedures would increase patient satisfaction without negative safety concerns. METHODS: Patients were randomized to a telemedicine or in-person visit 2 weeks postoperatively. Eligible participants included women undergoing elective, minimally invasive gynecologic surgery. All participants completed the PSQ-18 form with addendum questions at their 6-week postoperative visit. Chart review was performed to assess frequency of postoperative adverse events. The Wilcoxon rank sum and Fisher exact test were used. RESULTS: Of 51 participants enrolled, 29 were randomized to standard (in-person) visits versus 22 randomized to intervention (telehealth). There was no statistical difference in the overall satisfaction with the postoperative care received between the intervention and the standard groups (93.8% agree or strongly agree versus 95.7%; P=1). There was no increase in postoperative complications in the intervention arm of the study, with an overall complication rate of 12.5% in all cases. CONCLUSION: It is reasonable to use telemedicine as an option for postoperative care based on shared decision-making with appropriate patients. A virtual postoperative visit is a safe option for patients who may not be able to travel to the office. Future study is ongoing to confirm statistical significance.

Pain Management in Outpatient Gynecologic Procedures: An Exploration of #Colposcopy on TikTok [ID 2683582

INTRODUCTION: TikTok, a rapidly expanding social platform, features content on painful outpatient gynecologic procedures like colposcopy. Although pain management strategies have been studied, mainstream perceptions of this procedure remain underresearched. This study aims to describe #colposcopy content on TikTok. METHODS: On August 30, 2023, the first 200 videos under #colposcopy on TikTok were collected for cross-sectional content analysis. Data were collected for author demographics, intent, tones, timing, and content themes. Educational videos were rated for quality and reliability utilizing the modified DISCERN scale. RESULTS: As of August 2023, #colposcopy on TikTok had 65.3 million views. 183 of the first 200 posts were eligible for inclusion. On average, each video received 21,754 likes, 623 comments, and 752 shares. The majority of creators (n=133; 72.7%) were White, 14 (7.7%) were Black, 6 (3.3%) were Asian, 6 (3.3%) were Hispanic/Latino, and 24 (13.1%) were unable to determine. 109 (59.6%) of the creators were patients sharing their experiences, and 26 (14.2%) were physicians or APPs intending to educate. 33 (18.0%) TikToks were educational, with a median DISCERN score of 2. Among 13 content categories, the category most observed was “pain and pain management” (n=117; 63.9%), with 81 (75.7%) creators describing the procedure as painful and 26 (25.5%) describing it as painless. Significant differences in content were also analyzed by author demographics, intent, tone, and timing. CONCLUSION: Colposcopy-related content on TikTok centers on patients’ pain experiences. Specifically, users of #colposcopy discussed the providers’ lack of pain management options. Opportunities exist to improve pain expectations and management strategies with patients.

Non-descent vaginal hysterectomies: a brief report

Non-descent vaginal hysterectomies: a brief report

Hypotension prediction index guided goal-directed therapy to reduce postoperative acute kidney injury during major abdominal surgery: study protocol for a multicenter randomized controlled clinical trial

BackgroundAcute kidney injury (AKI) is a significant postoperative complication associated with increased mortality and hospital costs. Hemodynamic strategies, such as goal-directed therapy, might reduce AKI risk. Predicting and proactively managing intraoperative hypotension may be helpful. This trial aims to investigate if a preemptive hemodynamic strategy guided by the hypotension prediction index (HPI) can decrease the incidence of moderate-to-severe AKI within 30 days following major elective abdominal surgery.MethodsThis is an open-label, controlled, multicenter, randomized clinical trial that involves daily patient follow-up until hospital discharge. Inclusion criteria are patients aged over 65 and/or categorized as ASA III or IV physical status, undergoing major elective abdominal surgery (general, urological, or gynecological procedures) via laparoscopic or open approach under general or combined anesthesia.InterventionIn the intervention group, hemodynamic management will be based on the HPI and the advanced functional hemodynamic variables provided by the Hemosphere platform and the AcumenIQ® sensor (Edwards Lifesciences). The primary outcome is the incidence of moderate-to-severe AKI within 7 days post-surgery. Secondary outcomes include postoperative complications and 30-day mortality.DiscussionThis study explores the potential of HPI-guided hemodynamic management in reducing AKI after major elective abdominal surgery, with implications for postoperative outcomes and patient care.Trial registrationClinicalTrials.gov NCT05569265. Registered on October 6, 2022.

Efficacy of 3D Printed Uterus and Silicone Cervix for Medical Education in Learning and Practicing Gynecologic Procedures

Efficacy of 3D Printed Uterus and Silicone Cervix for Medical Education in Learning and Practicing Gynecologic Procedures

Restoration of Pulmonary Compliance after Laparoscopic Gynecologic Surgery Using a Recruitment Maneuver.

This study aimed to investigate the hypothesis that an alveolar recruitment maneuver can restore lung compliance to initial values after laparoscopic gynecological surgery. A total of 31 patients who underwent laparoscopic gynecological surgery were enrolled. Protective mechanical ventilation was applied, and the radial artery was catheterized in all patients. An alveolar recruitment maneuver (incremental and decremental positive end-expiratory pressure) was applied ten minutes after the release of pneumoperitoneum. The respiratory mechanics and blood gas results were recorded at eight different time points: after induction of anesthesia (T1), in the lithotomy position (T2), in the Trendelenburg position (T3), 10 and 90 min after insufflation of carbon dioxide (T4 and T5), in the supine position (T6), after desufflation (T7), and 10 min after an alveolar recruitment maneuver at the end of surgery (T8). Pneumoperitoneum and the Trendelenburg position caused a decline of 15 units in compliance (T7 vs. T1; p < 0.05) compared to baseline. After the alveolar recruitment maneuver, compliance increased by 17.5% compared with the mean value of compliance at time T1 (T8 vs. T1; p < 0.05). The recruitment maneuver had favorable results in patients with low initial compliance (41.5 mL/cmH2O, IQR: 9.75 mL/cmH2O), high Body Mass Index 30.32 kg/m2 (IQR: 1.05 kg/m2), and high initial plateau airway pressure (16.5 cmH2O, IQR: 0.75 cmH2O). Lung compliance does not return to initial values after performing laparoscopic gynecological procedures. However, after the release of pneumoperitoneum, an alveolar recruitment maneuver is beneficial as it improves compliance and gas exchange.

Efficacy and safety of ciprofol for sedation in outpatient gynecological procedures: a phase III multicenter randomized trial.

Ciprofol (also known as cipepofol and HSK3486), is a compound similar to propofol in chemical structure and hypnotic effect. Herein we evaluated the efficacy and safety of ciprofol for sedation in outpatient gynecological procedures. This phase III multicenter randomized trial with a non-inferiority design was conducted in nine tertiary hospitals. We enrolled 135 women aged 18-65 years who were scheduled for ambulatory gynecological procedures. Patients were randomly assigned to receive either ciprofol (0.4 mg/kg for induction and 0.2 mg/kg for maintenance) or propofol (2.0 mg/kg for induction and 1.0 mg/kg for maintenance) sedation in a 2:1 ratio. Patients and investigators for data collection and outcome assessment were blinded to study group assignments. The primary outcome was the success rate of sedation, defined as completion of procedure without remedial anesthetics. The non-inferiority margin was set at -8%. Secondary outcomes included time to successful induction, time to full awake, time to meet discharge criteria, and satisfaction with sedation assessed by patients and doctors. We also monitored occurrence of adverse events and injection pain. A total of 135 patients were enrolled; 134 patients (90 patients received ciprofol sedation and 44 patients propofol sedation) were included in final intention-to-treat analysis. The success rates were both 100% in the two groups (rate difference, 0.0%; 95% CI, -4.1 to 8.0%), i.e., ciprofol was non-inferior to propofol. When compared with propofol sedation, patients given ciprofol required more time to reach successful induction (median difference [MD], 2 s; 95% CI, 1 to 7; p < 0.001), and required more time to reach full awake (MD, 2.3 min; 95% CI, 1.4 to 3.1; p < 0.001) and discharge criteria (MD, 2.3 min; 95% CI, 1.5 to 3.2; p < 0.001). Fewer patients in the ciprofol group were dissatisfied with sedation (relative risk, 0.21; 95% CI, 0.06 to 0.77; p = 0.024). Patients given ciprofol sedation had lower incidences of treat-emergent adverse events (34.4% [31/90] vs. 79.5% [35/44]; p < 0.001) and injection pain (6.7% [6/90] vs. 61.4% [27/44]; p < 0.001). Ciprofol for sedation in ambulatory gynecological procedures was non-inferior to propofol, with less adverse events and injection pain. ClinicalTrials.gov, identifier NCT04958746.

Ovarian tissue biopsy for cryopreservation by vaginal natural orifice transluminal endoscopic surgery: a new approach for a minimal invasive ovarian biopsy

Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is an emerging surgical procedure that combines the advantages of the vaginal approach with laparoscopic vision and instrumentation. Shorter hospitalization and lesser postoperative pain associated with vNOTES may be explained by the advantages of this innovative surgical approach (e.g., absence of abdominal incisions, shorter operative time, and lower insufflation pressure). Ovarian tissue cryopreservation allows to preserve reproductive and endocrine functions in young women with oncological disease at risk of premature ovarian insufficiency (POI) caused by gonadotoxic treatments. Ovarian tissue biopsy for cryopreservation consists of a large biopsy of 1 or both ovaries that is usually performed by laparoscopy. Then, the removed ovarian tissue is cryopreserved for the future transplant after cancer remission. The volume of ovarian biopsy ranges from 50% of the ovary for women at moderate risk of POI to 70%-100% of it for those at high risk. The inclusion criteria for ovarian tissue cryopreservation are women aged <35 years who cannot delay start of oncological treatments for follicle cryopreservation, with a moderate or high risk of POI and good chance of 5-year survival. Ovarian tissue cryopreservation cannot be performed if tumor treatments include uterine irradiation or for tumors at risk of ovarian metastases (as in the case of ovarian cancer, leukemia, neuroblastoma, or Burkitt lymphoma). Despite widespread adoption of vNOTES in gynecology, ovarian biopsy for cryopreservation has never been performed using this route. Step-by-step explanation of the procedure with descriptive text and narrated video footage. Tertiary-level referral academic center. A 27-year-old patient recently diagnosed with low-grade follicular non-Hodgkin lymphoma was referred to our center for ovarian tissue cryopreservation before chemotherapy. The patient included in this study gave informed consent for publication of the video and posting of the video online including social media, the journal website, scientific literature websites (e.g., PubMed, ScienceDirect, and Scopus), and other applicable sites. Because of the nature of the study, institutional review board approval was not required. Access to the peritoneal cavity was created by a 3-cm posterior colpotomy. The peritoneum was then opened using cold scissors and temporarily fixed to the posterior vaginal wall. The GelPOINT Mini Advanced Access Platform (Applied Medical, Rancho Santa Margarita, CA), with 1 10-mm and 2 5-mm trocars, was used as the vNOTES port. The inner Alexis ring of the GelPOINT was inserted through the colpotomy into the pouch of Douglas. A hysterometer was placed into the uterine cavity to keep the uterus anteverted during the surgery. A pneumoperitoneum was created to a pressure of 8 mm Hg, and the operating table was tilted to a 20° Trendelenburg position. A 10-mm rigid 30° camera was inserted in the inferior and larger trocar, and both ovaries were visualized. Seventy percent of the left ovary was removed with cold scissors to minimize trauma on the surgical specimen. After removal of the GelPOINT cap, ovarian biopsy was immediately picked up by the biologist of our fertility center. The ovary was coagulated with a bipolar instrument. The hysterometer was then replaced by a uterine manipulator to perform tubal patency test, and blue dye passage through both salpinges was observed. Finally, the Alexis retractor and stich on the posterior peritoneum were removed, and the vagina was sutured using interrupted stiches. The total operative time was 25 minutes. Ovarian tissue biopsy for cryopreservation by vNOTES. No intraoperative and postoperative complications were reported, and the patient was discharged after 24 hours from surgery. Vaginal natural orifice transluminal endoscopic surgery may be a feasible alternative approach to laparoscopy for ovarian tissue cryopreservation: it allows an easy access to the ovaries and removal of different tissue volumes. Patients undergoing ovarian cryopreservation may benefit from the vNOTES approach because a rapid postoperative recovery is crucial to start chemotherapy in a short time. As for other vNOTES procedures, accurate selection of patients seems to be crucial for a successful ovarian tissue cryopreservation. We believe that the inclusion and exclusion criteria reported for other gynecologic procedures performed through vNOTES may also be valid for ovarian tissue cryopreservation by vNOTES. Women at high risk of pelvic adhesions (e.g., coexistent endometriosis, previous pelvic surgery, or inflammatory pelvic disease), those with an increased body mass index or enlarged uterus, and those with cervical, vaginal, or uterine cancer cannot be considered for this approach because all these factors are associated with failure of vNOTES. On the other hand, women with no history of surgery, endometriosis, and large myomas may benefit from the vNOTES approach, and these women represent most of patients who undergo ovarian tissue cryopreservation. Further and larger studies are needed to assess the efficacy and safety of this new approach.

Novel Performance Rating Instruments for Gynecological Procedures in Primary Care: A Pilot Study.

Improving training and confirming the acquisition of gynecological procedure skills for family physicians (FPs) is crucial for safe healthcare delivery. The objectives of this study were to (a) develop performance rating instruments for four gynecological procedures, and (b) pilot them to provide preliminary validity evidence using modern validity theory. Sixteen academic FPs and gynecologists participated in a modified Delphi technique to develop procedure-specific checklists (PSCs) for four procedures: intrauterine device insertion, endometrial biopsy, punch biopsy of the vulva, and routine pessary care. We modified a previously validated global rating scale (GRS) for ambulatory settings. Using prerecorded videos, 19 academic FPs piloted instruments to rate one first-year and one second-year family medicine resident's performance. They were blinded to the level of training. We compared the mean scores for PSCs and GRS for each procedure using paired samples t tests and Cohen'sdto estimate effect sizes. Consensus on items for the final PSCs was reached after two Delphi rounds. PSC and GRS scores were numerically higher for the second-year resident than the first-year resident for every procedure, with statistically significant differences for six of eight comparisons (P&lt;.05). All comparisons demonstrated large effect sizes (Cohen'sd&gt;0.8). Both instruments received high scores for ease of use by raters. We developed novel performance rating instruments for four gynecological procedures and provided preliminary validity evidence for their use for formative feedback in a simulation setting. This pilot study suggests that these instruments may facilitate the training and documentation of family medicine trainees' skills in gynecological procedures.

Postoperative cognitive disorders and delirium in gynecologic surgery: Which surgery and anesthetic techniques to use to reduce the risk?

Despite their general good health, an increasing proportion of elderly individuals require surgery due to an increase in average lifespan. However, because of their increased vulnerability, these patients need to be handled carefully to make sure that surgery does not cause more harm than good. Age-related postoperative cognitive disorders (POCD) and postoperative delirium (POD), two serious consequences that are marked by adverse neuropsychologic alterations after surgery, are particularly dangerous for the elderly. In the context of gynecologic procedures, POCD and POD are examined in this narrative review. The main question is how to limit the rates of POCD and POD in older women undergoing gynecologic procedures by maximizing the risk-benefit balance. Three crucial endpoints are considered: (1) surgical procedures to lower the rates of POCD and POD, (2) anesthetic techniques to lessen the occurrence and (3) the identification of individuals at high risk for post-surgery cognitive impairments. Risks associated with laparoscopic gynecologic procedures include the Trendelenburg posture and CO2 exposure during pneumoperitoneum, despite statistical similarities in POD and POCD frequency between laparoscopic and laparotomy techniques. Numerous risk factors are associated with surgical interventions, such as blood loss, length of operation, and position holding, all of which reduce the chance of complications when they are minimized. In order to emphasize the essential role that anesthesia and surgery play in patient care, anesthesiologists are vital in making sure that anesthesia is given as sparingly and quickly as feasible. In addition, people who are genetically predisposed to POCD may be more susceptible to the disorder. The significance of a thorough strategy combining surgical and anesthetic concerns is highlighted in this article, in order to maximize results for senior patients having gynecologic surgery.

Risk Factors of Wound Dehiscence in Abdominal Surgery

Background: Wound dehiscence, a significant postoperative complication characterized by the partial or complete separation of a surgical wound, remains a challenge despite advances in surgical techniques and perioperative care. It is associated with increased morbidity, mortality, prolonged hospital stays, and higher healthcare costs. Understanding the risk factors that predispose patients to wound dehiscence is crucial for improving surgical outcomes. Objective: The aim of this study was to identify the patient-related and surgical factors that contribute to the risk of wound dehiscence in individuals undergoing abdominal surgery, in order to inform strategies for risk reduction and management. Methods: This prospective cohort study was conducted at the General Surgery Department of Hayatabad Medical Complex, Peshawar, Pakistan, from January 2021 to January 2023. A total of 150 patients who underwent elective or emergency abdominal surgery were included. Exclusion criteria encompassed individuals undergoing obstetric or gynecological procedures and those with a prior history of wound infection or dehiscence. Data on demographic characteristics, comorbidities, type of surgery, surgical approach, and postoperative outcomes were collected. Wound dehiscence was the primary outcome, identified clinically and confirmed by surgical review. Statistical analysis involved descriptive statistics, bivariate analyses using chi-square tests, with significance set at p ≤ 0.05. Results: The mean age of the study population was 45.6 ± 12.3 years, with 60% male and 40% female participants. Comorbidities included obesity (30%), diabetes mellitus (23.3%), hypertension (16.7%), cardiovascular disease (13.3%), and smoking (20%). Elective surgeries constituted 66.7% of cases, with gastrointestinal disorders being the most common indication (46.7%). The open surgical approach was utilized in 80% of procedures. Wound dehiscence occurred in 23.4% of patients with obesity, 18.2% with diabetes mellitus, 15.6% who were smokers, 13% with hypertension, and 18.2% of advanced age. Conclusion: The study highlights obesity, diabetes mellitus, smoking, hypertension, and advanced age as significant risk factors for wound dehiscence following abdominal surgery. Addressing these modifiable factors through tailored preoperative assessment and postoperative care is essential for reducing the incidence of wound dehiscence.

A retrospective review of effectiveness of ERAS post-operative pain protocol in hip replacement surgeries under general anaesthesia at a tertiary orthopaedic hospital

: The concept of enhanced recovery after surgery (ERAS) was first introduced in 1997 by a group of European surgeons led by Henrik Kehlet. The ERAS concept was introduced to target the factors delaying post-operative recovery such as organ dysfunction, surgical stress and to improve the surgical outcomes and length of stay at the hospital. The primary aim of this approach is to reduce the body’s response to surgical stress by implementing a multidisciplinary, multitude of interventions in a coordinated clinical pathway. It was first implemented for colorectal surgeries to improve the post-surgical recovery rates by decreasing the post-operative ileus and thereby reducing the cost and length of hospital stay. Since the successful introduction of the program, ERAS has been used in several other specialties such as breast, urological, gynaecological, and musculoskeletal procedures. Off-late ERAS has become important in orthopaedic surgeries, particularly elective hip and knee arthroplasties. A retrospective review audit was conducted at tertiary Orthopaedic NHS Hospital to determine the effectiveness of ERAS post-operative pain protocol in patients who had primary hip arthroplasty under general anaesthesia. The qualitative and quantitative data included the length of stay at the hospital and default rates in the ERAS pain protocol. The length of stay at the hospital in ERAS compliant group was a mean of 3.95 days and in ERAS default group was 4.7 days, showing an increase of 16% in the total duration. The IV PCA group had 4.6 days of the average length of stay.: ERAS pathway advocates for using opioid-sparing multimodal analgesia to control pain, peripheral nerve blocks (single-shot/continuous), and local infiltration /peri-articular injections have become a better alternative to opioids in controlling the immediate post-surgical pain effectively. There is clear evidence to suggest that these techniques can improve patient outcomes and decrease the duration of stay.

Gasless transvaginal natural orifice transluminal endoscopic surgery for hysterectomy and salpingectomy on a robot platform with flexible devices in a porcine model

In this report, we described a new technique of gasless V-NOTES for hysterectomy and salpingectomy on a robotic platform with flexible devices in a porcine model. As a result, the gynecological procedures were successfully completed. The total operative time was 110 min, while the docking time was 10 min. The estimated blood loss was estimated to be 10 mL with no intraoperative complications. It revealed that gasless V-NOTES for hysterectomy and salpingectomy on a robotic platform with flexible devices appeared to be feasible and safe in the porcine model and has the potential for clinical use in human beings.

The use of ultraviolet light generated from light-emitting diodes for the disinfection of transvaginal ultrasound probes.

Transvaginal ultrasound probes (TVUS) are used for several gynecological procedures. These need to be disinfected between patient use. In the current study we examine whether UVC delivered using light emitting diodes for 90 seconds can provide sufficient disinfection efficacy. A new UVC device that delivers UVC radiation at 265nm-275nm for 90 seconds was used. TVUS probes were swabbed before and after use in an in vitro fertilization clinic. Microbes on the swabs were cultured and identified. In addition, the ability of the UVC device to provided repeated high-level disinfection was analysed by deliberately contaminating probes with spores of Bacillus subtilis and then performing the UVC disinfection and bacterial culture. 50% of probes were contaminated with bacteria, most commonly Bacillus sp., directly after in vivo use. Whereas 97% were sterile after UVC disinfection for 90 seconds. The UVC treatment resulted in no growth of B. subtilis spores after each of five repeated contaminations with 5-9 x 107 spores on the probes. This study has found that UVC delivered via light emitting diodes for only 90 seconds can produce high level disinfection of transvaginal probes.

Postoperative Incisional Complications in Gynaecologic Single-Incision Laparoscopic Surgery: Comparing Closure Techniques

ObjectivesSingle-incision laparoscopic surgery (SILS) and robotic SILS (rSILS) have been found to be safe, minimally invasive techniques in gynaecology. However, one major perceived drawback of these techniques is the increased risk of incisional hernia, compared to multiport laparoscopy or robotic surgery. This study’s aim was to determine the optimal technique to reduce postoperative incisional complications such as hernia. MethodsA retrospective cohort study was performed at an academic centre from November 2014 to June 2022 on 1036 women who underwent SILS and rSILS gynaecologic procedures with various closure techniques. Techniques included running absorbable sutures without tagging incision apices (standard closure) and tagging incision apices at the beginning of surgery with the use of permanent suture, absorbable suture, or a combination. ResultsRates of hernia (primary outcome) and incisional issues (secondary outcome) such as separation or infection were analyzed by technique. Hernia rates were lower when incision apices were tagged compared to when not tagged (P < 0.001). Cellulitis/abscess rates were not significantly different. Incision separation was higher when apices were tagged with absorbable and a combination of permanent and absorbable sutures than if apices were tagged with all permanent sutures or not at all. In multivariate analysis, hernia rate decreased in groups with tagged apices, although other incision complications did not vary. ConclusionsThe incidence of incisional hernia after SILS procedures is low, though it does vary by technique. Tagging apices for closure, regardless of suture type, can mitigate one of the biggest concerns of performing SILS by reducing postoperative incisional hernia risk.

Impact of patient-reported salpingitis on the outcome of hysterectomy and adnexal surgery: A national register-based cohort study in Sweden.

Salpingitis is caused by ascending microbes from the lower reproductive tract and contributes to tubal factor infertility, ectopic pregnancy, and chronic pelvic pain. The aim of this study was to analyze if the risk for complications and dissatisfaction after hysterectomy and adnexal surgery was increased in women reporting previous salpingitis. This is an observational cohort study including women undergoing gynecologic surgery from 1997 to 2020, registered in the Swedish National Quality Register of Gynecologic Surgery (GynOp). Patient-reported previous salpingitis was the exposure. Complications up to 8 weeks and satisfaction at 1 year postoperatively were the outcomes. Multivariable logistic regression and ordinal regression were performed. Results were adjusted for potential confounders including age, body mass index, smoking and year of procedure as well as endometriosis and previous abdominal surgery. Multiple imputation was used to handle missing data. In this study, 61 222 women were included, of whom 5636 (9.2%) women reported a previous salpingitis. There was an increased risk for women reporting previous salpingitis in both the unadjusted and fully adjusted models to have complications within 8 weeks of surgery (adjusted odds ratio [aOR] 1.22, 95% confidence interval [CI] 1.14-1.32). The highest odds ratios were found for bowel injury (aOR 1.62, 95% CI 1.29-2.03), bladder injury (aOR 1.52, 95% CI 1.23-1.58), and postoperative pain (aOR 1.37, 95% CI 1.22-1.54). Women exposed to salpingitis were also more likely to report a lower level of satisfaction 1 year after surgery compared with unexposed women (aOR 0.87, 95% CI 0.81-0.92). Self-reported salpingitis appears to be a risk factor for complications and dissatisfaction after gynecologic surgery. This implies that known previous salpingitis should be included in the risk assessment before gynecologic procedures.

Challenges in cosmetic gynecology surgery: A case series

Background: Cosmetic and functional gynecology is a novel specialty that is rapidly gaining tractionacross the globe, particularly in Europe, Asia, and America. These intricate procedures enhance theesthetics and restore the physiological function of the genitalia. This relates very closely to womensexuality, dignity, self-esteem, and overall confidence. Self-esteem is often closely mirrored anddependent on a person’s perception of her genitalia, both functionally and more recently esthetically. Anincreasing number of gynecologists are gradually embracing this art of restoration as the demand rapidlyincreases among patients. The outcomes are sometimes not pleasing to the patients and may requirerevision.Case series: We present four case series of undesirable outcomes from labiaplasty andperineovaginoplasty. The surgical procedures had to be repeated in two instances because of spousaldemand or from the lady herself.Case 1: Reconstruction after Type IV female genital mutilation (FGM)A 46-year-old grand multipara with Type IV FGM presented with sexual dysfunction and psychosexualproblems arising from FGM. She requested reconstruction of the labia minora, restoration of the labiamajora, and perineovaginoplasty. Examination revealed partial clitoridectomy, a narrowed vaginalintroitus with the removal of the labia minora, and excision of the labia majora. The missing tissues madethe reconstruction technically difficult. Labia minora was reconstructed from the labia majora by thegrooving technique, and labia majora fat augmentation with perineoplasty was performed with goodoutcomes.Case 2: Perineoplasty revision.A 43-year-old, para 3+0, presented with complaints of lax vaginal muscles after her third delivery. All herdeliveries were normal, vertex. She sustained a second-degree perineal tear after her last delivery, whichwas repaired. She was started on Kegel’s exercises with no improvement. She had a perineoplasty donesuccessfully, but she healed with a small rent. A revision was performed with good results.Case 3: Perineoplasty revisionThe patient underwent vaginoperineoplasty, but the perineum healed with a little bump, which both thepatient and the spouse did not like. Revision of perineoplasty was performed with excellent outcomes.Case 4: Revision of an overly tight vagina after vaginoperineoplastyThe patient had previously undergone vaginoperineoplasty but felt it was not tight enough. However,three months after revision, the spouse complained of incomplete penetration, whereas the patientcomplained of pain at the fourchette. Another revision was performed to address their concerns withgood outcomes. Conclusion: Cosmetic gynecological procedures must achieve satisfactory outcomes and restore theclient’s genital esthetics and functionality. Although some procedures are technically challenging and mayrequire repeat procedures, patient satisfaction is key. Knowledge of pelvic anatomy and restoration techniques is a prerequisite for achieving acceptable outcomes. Counseling of the couple is an integralpart of cosmetic gynecology to manage expectations and rule out psychosocial causes.

Antibiotic prophylaxis in obstetric and gynaecological procedures: Acomparative study between two regimens of antibiotics

Background: Postoperative wound infections have an enormous impact on the quality of life and contribute substantially to the financial cost of patient care. The study aims to compare the clinical efficacy of two perioperative/postoperative antibiotic regimens, the wound outcome and difference in cost on healthcare between these regimens.&#x0D; Methods: This is an observational prospective cohort study of 290 women. Women scheduled for elective surgeries in the department were grouped to have either a combination of ampicillin/cloxacillin (Ampiclox), Gentamicin, and Metronidazole (triple regimen) or a combination of ceftriaxone and metronidazole (double regimen). Data was analysed using Statistical Package for Social Science (SPSS) Windows version 21. The wound outcome and the cost implication of the antibiotic regimen were compared by chi-square test and t-test as appropriate. A p-value less than 0.05 was considered significant.&#x0D; Results: The postoperative wound infection rate in this study was 7.24%. There was no statistical significant difference in postoperative infection in the triple regimen group compared to the double regimen group. However, there was a significantly longer duration of stay in the hospital in the triple regimen group (P &lt;0.05). There was also a statistical significant difference in the cost of hospital stay and the cost of antibiotics in the triple regimen group (P&lt;0.05). There was no statistically significant difference in the pattern of organisms cultured in both groups.&#x0D; Conclusions: Ceftriaxone/Metronidazole regime of antibiotics showed superiority over ampicillin/cloxacillin, Metronidazole, and Gentamicin in the prevention of postoperative wound infection, hospital stay, and reduced cost of healthcare. &#x0D; &#x0D; French title: Prophylaxie antibiotique dans les procédures obstétricales et gynécologiques : une étude comparative entre deux schémas thérapeutiques antibiotiques&#x0D; Contexte de l'étude: Les infections postopératoires des plaies ont un impact énorme sur la qualité de vie et contribuent considérablement au coût financier des soins aux patients. L'étude vise à comparer l'efficacité clinique de deux régimes antibiotiques péri opératoires/postopératoires, l'issue de la plaie et la différence de coût des soins de santé entre ces régimes.&#x0D; Paramètres et conception : Il s'agit d'une étude de cohorte prospective observationnelle portant sur 290 femmes. Les femmes devant subir des interventions chirurgicales électives dans le département ont été regroupées pour recevoir soit une combinaison d'ampicilline/ cloxacilline (Ampiclox), de gentamicine et de métronidazole (triple régime), soit une combinaison de ceftriaxone et de métronidazole (double régime).&#x0D; Analyse statistique : les données ont été analysées à l'aide du progiciel statistique pour les sciences sociales (PSSS) Windows version 21. L'issue de la plaie et les implications financières du régime antibiotique ont été comparées par le test du chi carré et le test t, le cas échéant. Une valeur p inférieure à 0,05 était considérée comme significative.&#x0D; Résultats de l'étude : Le taux d'infection des plaies postopératoires dans cette étude était de 7,24 %. Il n'y avait pas de différence statistiquement significative en termes d'infection postopératoire dans le groupe à triple régime par rapport au groupe à double régime. Cependant, la durée de séjour à l'hôpital était significativement plus longue dans le groupe triple régime (P&lt;0,05). Il y avait également une différence statistiquement significative dans le coût du séjour à l'hôpital et le coût des antibiotiques dans le groupe triple régime ( P &lt;0,05) . Il n'y avait pas de différence statistiquement significative dans le modèle d'organismes cultivés dans les deux groupes. &#x0D; Conclusion: Le régime d'antibiotiques Ceftriaxone/métronidazole a montré une supériorité sur l'ampicilline/cloxacilline,le métronidazole et la gentamicine dans la prévention de l'infection postopératoire des plaies, du séjour à l'hôpital et de la réduction du coût des soins de santé.

Socioeconomic factors influence surgical wait times for non-emergent gynecologic surgical procedures: a retrospective analysis

BackgroundIn various disciplines, an association between surgical wait times and patient outcomes has been identified. This study is among the first to investigate whether practice setting influences wait times for elective surgeries in benign gynecology.MethodsThis retrospective study of patients at three New York hospitals from 10/2019–2/2020 compared surgical wait times among patients seen in federally-qualified health centers (FQHC’s) and private practice settings. Emergent surgeries, oncology cases, abortions, urogynecology procedures, and cases concurrently booked with another specialty were excluded. Surgical wait time was defined as the time (days) from the decision to operate to the day of the procedure. A multivariable mixed model was used to model surgical wait time by setting of care, adjusting for age, BMI, race, ethnicity, insurance, need for medical clearance, and scheduled block time. A univariable analysis was then utilized to assess surgical wait times by clinical setting for each insurance type.ResultsFive hundred forty patients were identified with a median age of 45.6 years (range 16–87). Average surgical wait time was 27 days (range 1–288 days). In multivariable analysis, longer surgical wait times were associated with being seen preoperatively in a FQHC compared to the private practice setting (102% longer, 59.5 days vs. 22 days, p < 0.0001), and with needing medical clearance (56.4% longer, 45 days vs. 22 days. p = 0.0001).ConclusionsThese results suggest that in benign gynecology, surgical wait times are significantly influenced by the practice setting in which a patient gets care, with notable delays in care among patients who are seen in a federally qualified health center preoperatively.

(273) The Use of In-Office Nitrous Oxide to Aid in Diagnosing Hypertonic Pelvic Floor and Improve Patient Comfort with Pelvic Exams

Abstract Introduction Nitrous oxide is an anesthetic, anxiolytic, and analgesic commonly used for general and dental anesthesia, sedation, and severe pain. Studies show that nitrous oxide is also used in several in-office gynecological and urological procedures as a sedative and anxiolytic agent with a safer drug profile than other anesthetic agents. It is also being trialed as a treatment for mood disorders. Nitrous oxide does not render individuals unconscious, making it a more favorable option for stressful and painful medical procedures than general anesthesia because it allows the patient to feel more in control of their body and aware of the proceedings. Objective To analyze the use of in-office nitrous oxide during medical procedures and evaluate its effectiveness in reducing pain and anxiety levels to predict the utility of it during pelvic exams in patients with vestibulodynia. Methods A literature review was performed through the PubMed database between 2007-2022. The authors independently and thoroughly screened abstracts and full-text articles and assessed the relevant medical literature that acknowledged the use of nitrous oxide in in-office medical procedures. Key terms used to refine the search include [“nitrous oxide in medical procedures”], [“nitrous oxide in gynecology”], [“nitrous oxide in urology”]. Results One study explored the use of nitrous oxide during childbirth in women diagnosed with PTSD, and the results were significant for nitrous oxide reducing PTSD symptom severity. Multiple studies suggest the use of nitrous oxide during dental procedures reduces patient anxiety; one specifically measured sixty anxious patients pre- and post-endodontic procedures and noted a significant reduction in anxiety during the procedure with the use of nitrous oxide. Various studies of gynecological and urological procedures report the successful use of nitrous oxide in reducing peri-procedural pain compared to other analgesic alternatives. A common example is its use during intrauterine device insertion, which is correlated with higher patient satisfaction as it decreases pain. Additionally, a study among patients undergoing extracorporeal shockwave lithotripsy found no significant difference between the use of meperidine, an opioid, and nitrous oxide in post-procedural Visual Analog Scale pain scores with no adverse events reported in the nitrous oxide group. Another study revealed that using local anesthesia in transrectal prostate biopsies resulted in some patients experiencing notable anxiety and pain. At the same time, no such relationship was observed among patients who received nitrous oxide before this procedure. Conclusions Vestibulodynia is a subset of genitopelvic pain isolated to the vulvar vestibule. Vestibulodynia has three proposed etiologies: tissue neural proliferation, musculoskeletal, and hormonally mediated. Discriminating these three etiologies can be difficult, especially when a proper pelvic exam cannot be achieved due to patients’ discomfort. The three etiologies are biologically intertwined, often resulting in vestibulodynia patients experiencing pelvic floor hypertonicity without regard to specific etiology. A painful pelvic exam is stressful and often an anxiety-producing experience for patients with pelvic hypertonicity and vulvodynia. Hence, with the data provided, we suspect that nitrous oxide will be a useful treatment option to mitigate these consequences for the patient, with the added benefit of easing the exam for the provider, leading to a more accurate diagnosis. Disclosure No.