Journal of Gynecologic Surgery

This study aims to determine the necessity of obtaining a basic metabolic panel (BMP) and/or comprehensive metabolic panel (CMP) prior to minor laparoscopic gynecological surgery by looking at intraoperative anesthetic or surgical complications in patients with electrolyte abnormalities found on routine testing.

The electronic medical record (Epic Systems Corporation) was queried for patients who had received minor laparoscopic gynecological surgery at Jeanes Hospital or Temple University Hospital in Philadelphia, Pennsylvania, between January 1, 2018, and December 31, 2022. Patients included underwent laparoscopic adnexal surgeries or exploratory laparoscopy. Patients included had complete blood count (CBC), BMP, or CMP performed within 4 months of their surgery. Patients who had BMP or CMP were included as cases. Patients with only CBC were used as the control group, resulting in 117 cases and 121 controls. Charts were then analyzed for either anesthetic or intraoperative surgical complications. Anesthesia complication was defined as any complication as documented by anesthesia (i.e., arrhythmias, significant desaturations). Surgical complication was defined as documentation of complication noted by the surgeon in the operative note (i.e., uterine perforation, instrument malfunction, laparotomy). Continuous data were analyzed using the Wilcoxon test, while categorical data were analyzed using the chi-square or Fisher’s test. A p-value of <0.05 was considered statistically significant.

Among 117 cases, 47 patients (40.2%) had no electrolyte abnormalities on routine preoperative labs, and a total of 70 cases (59.8%) had some form of electrolyte abnormality preoperatively. Only one case received preoperative repletion based on labs collected in the Emergency Room, despite normal preoperative laboratories. Of the 70 cases with an abnormality, 4 had an anesthetic or surgical complication (0.05%) as compared with 1 patient out of 47 who had no electrolyte abnormalities (0.02%). There was no significant difference in anesthetic or surgical complications between cases with or without an electrolyte abnormality (p = 0.52). There was no significant difference in anesthetic or surgical complications between cases and controls (p = 0.91). No life-threatening anesthetic or surgical complications were noted within this study group.

The majority of cases had some form of electrolyte abnormality; however, few had any form of preoperative intervention, and the case proceeded as planned. Additionally, there was no significant difference in the number of anesthetic or surgical complications between the two study groups. This study suggests that routine BMP or CMP prior to minor gynecological laparoscopic surgery does not change outcomes for patients and may be an unnecessary step, potentially saving the patient and hospital both time and money prior to surgery. Further research is needed to investigate the necessity of metabolic panel in a more age-diverse population prior to minor and major gynecological laparoscopic surgeries for increased applicability.

Evaluate patient-reported symptoms and quality of life (QOL) before and after female sterilization device (Essure) removal.

Multicenter prospective study.

Three academic institutions.

Patients with device-attributed symptoms undergoing Essure removal.

Symptoms were measured using a study-specific questionnaire and Short Form-8 (divided into Physical and Mental Component Scores). Scores at 4 months postoperative were compared to baseline using a mixed effects logistic regression and linear mixed model. Subgroup analysis was performed for hysterectomy and uterine-preserving groups.

Patient-reported symptoms and Short Form-8 4 months after Essure removal compared to baseline.

A total of 80 patients enrolled in the study and underwent Essure removal: 53 (66.3%) with laparoscopic hysterectomy and 27 (33.8%) with laparoscopic bilateral salpingectomy or bilateral cornuectomy. Fifty-one participants (63.8%) completed the 4-month postoperative questionnaire. Of the 17 device-attributed symptoms evaluated, participants reported clinically important improvement in 16 of the symptoms postoperatively. QOL improved significantly following device removal, with the Physical Component Score improving by 9.9 points (95% CI: 7.0–12.9) and the Mental Component Score by 13.8 points (95% CI: 10.4–17.2). QOL improved in both physical and mental score domains after device removal with no difference between hysterectomy and uterine-preserving groups (p = 0.83 and p = 0.06, respectively). Of the entire cohort, 92.2% (n = 47) were satisfied with their surgical results.

Patients undergoing Essure removal for device-attributed symptoms report improved symptoms and QOL following surgery. Device removal may benefit those experiencing device-attributed symptoms and is associated with high patient satisfaction.

This study sought to determine if paracervical block with 0.5% bupivacaine reduces immediate postoperative pain as a mode of preemptive analgesia in total laparoscopic hysterectomy (TLH).

This double-blind, placebo-controlled randomized trial was conducted at a tertiary care teaching institute over a period of 2 years. Women undergoing TLH for benign pathologies were included and randomized to the intervention group (received paracervical block with 0.5% bupivacaine) or placebo group (received paracervical block with normal saline). Postoperative pain scores were assessed at 30 and 60 minutes from the extubation time along with additional analgesia requirement, time to first mobilization, and duration of hospital stay.

A total of 154 women were randomized; six women were excluded from the analysis after conversion to open surgery or dense adhesiolysis. The remaining 148 women comprised the study population (74 in each group). We found no differences in the groups with regard to basic demographics and surgical characteristics. A significant reduction was found in pain scores in the intervention group (p = 0.011 at 30 minutes and p = 0.019 at 60 minutes). There was no difference in the need for additional analgesia, time to first mobilization, and duration of hospital stay between the two groups.

Paracervical block is an effective mode of preemptive analgesia in TLH.

Suture type is thought to influence prolapse recurrence following sacrospinous ligament fixation (SSLF), but comparative data between absorbable and permanent suture remains sparse. This study aimed to compare prolapse recurrence rates after SSLF using absorbable versus permanent suture, hypothesizing no difference in outcomes.

We conducted a retrospective cohort study of women who underwent vaginal SSLF from January 2017 to June 2021 at a single institution. We compared two groups: (1) absorbable suspension suture (Maxon or polydiaxanone) (2) permanent suspension suture (prolene). Our primary outcome was composite prolapse recurrence, defined as (1) anatomical failure (recurrent prolapse in any compartment past the hymen) and/or (2) retreatment for prolapse with either surgery or pessary at the most recent pelvic exam.

Our cohort was composed of 152 women, of whom 47.4% (n = 72) underwent SSLF with only delayed absorbable suture and 80 (52.6%) with permanent suture. Overall, there were no differences between the two groups in composite prolapse recurrence (11.1% vs. 22.5%, p = 0.06), anatomical failure (6.9% vs. 16.3%, p = 0.08), or retreatment (4.2% vs. 5.0%, p = 0.82) at a median of 217.5 days of follow-up. There was no difference in postoperative complications between groups (32.4% vs. 33.8%, p = 0.86). When adjusting for differential characteristics, hazard ratios of composite prolapse recurrence were similar between suture groups (adjusted hazard ratio: 0.52; confidence interval [CI]: 0.18–1.49; p = 0.22).

Vaginal SSLF with delayed absorbable suture demonstrates similar durability to permanent suture in terms of prolapse recurrence.

Minimally invasive hysterectomy, with removal of the specimen through the vagina, has minimal morbidity and superior intraoperative and postoperative outcomes compared to abdominal hysterectomy. There are times, however, when vaginal specimen removal may not be feasible, and a minilaparotomy can be utilized. The purpose of this study was to compare outcomes of robotic-assisted total laparoscopic hysterectomies with vaginal specimen extraction (RV) versus minilaparotomy specimen extraction (RL).

A retrospective cohort study was conducted among two groups of patients who underwent a robotic-assisted total laparoscopic hysterectomy with RV or RL by the gynecological oncology service at an academic institution. Blood loss, pain medication requirements, length of stay, and surgical complications were compared between groups.

From January 2017 to October 2022, 1643 patients underwent a robotic hysterectomy. Sixty patients required a minilaparotomy for specimen extraction versus 1583 patients who had a vaginal extraction. RL cases had a larger BL (114.8 mL vs. 60.0 mL, p < 0.001), morphine milligram equivalents requirements (95.8 vs. 84.2, p = 0.018), and length of stay (1.5 vs. 1.2 days, p < 0.001) when compared to RV cases. Postoperative complications were more common in malignant RL cases compared to malignant RV extraction cases (p-value = 0.028).

Despite a statistical increase in BL, pain medication needs, and length of stay, these outcomes were of limited clinical significance, and overall, RL was found to be a safe option for specimen removal when vaginal extraction is not feasible.

We aimed to evaluate the feasibility of performing gynecological laparoscopic surgeries under spinal anesthesia (SA) and compare the anesthetic parameters and patient satisfaction between SA and general anesthesia (GA) in gynecological laparoscopic surgeries.

This prospective, single-blinded, randomized clinical trial included 80 women indicated for laparoscopic surgery. Participants were randomly assigned to two groups of 40 each, SA and GA, and outcomes were compared between them.

Respiratory rate and mean arterial blood pressure were generally lower in the GA group than in the SA group (p > 0.05). During surgery, the SA group experienced more complications than the GA group (p < 0.05). There was no significant difference between the two groups in the incidence of hypertension, bradycardia, restlessness, dyspnea, abdominal pain, respiratory depression, and chills during surgery (p > 0.05). Post-Anesthesia Care Unit (PACU) recovery time was significantly longer in the GA group (p = 0.001). The prevalence of chills and restlessness as PACU complications was significantly higher in the GA group than in the SA group (p = 0.001). Surgeons’ satisfaction levels were significantly higher with GA (p < 0.05).

Although SA and GA showed no significant differences, SA appears more satisfactory for gynecological surgeons performing laparoscopic procedures. However, the best anesthesia choice depends largely on the type of surgery and the patient’s condition.

To demonstrate the laparoscopic conservative technique (cornuostomy) for the interstitial pregnancy.

Demonstration of the laparoscopic cornuostomy technique for the interstitial pregnancy with narrated video. The optimal treatment approach for interstitial pregnancy remains uncertain and surgical treatment may include cornuostomy, cornual resection, or hysterectomy.

The authors present a case of interstitial pregnancy in a 29-year-old woman with no identifiable risk factors for ectopic pregnancy. Laparoscopic cornuostomy was successfully performed, involving the application of adrenaline and a cerclage suture around the interstitial pregnancy on the right side, followed by ipsilateral cornuostomy and salpingectomy. During the procedure, Fitz-Hugh-Curtis syndrome was diagnosed, which may have contributed to the occurrence of this ectopic pregnancy.

Interstitial pregnancy is a rare condition that can lead to significant morbidity and mortality, particularly in cases of uterine rupture and hemorrhage. Diagnosing interstitial pregnancy is often challenging and may only occur during surgery. Therefore, early detection is vital to prevent a potentially life-threatening condition and facilitate conservative approaches, since the optimal treatment approach for interstitial pregnancy remains uncertain.