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Meigs syndrome is a classic triad of ascites, pleural effusions, and an ovarian fibroma with resolution following excision. Pseudo‐Meigs syndrome presents similarly but is caused by a pelvic mass other than an ovarian fibroma, such as a fibroid. We present a case report of a 33‐year‐old gravida 2 para 0‐0‐1‐0 woman with a massive, pedunculated fibroid who developed rapid onset of ascites and edema beginning at 5 weeks of gestation. Malignant, cardiac, renal, hepatic, and rheumatologic causes were ruled out. Her symptoms resolved following myomectomy and delivery via cesarean. Pseudo‐Meigs syndrome was suspected. Pseudo‐Meigs syndrome is a diagnosis of exclusion and requires surgical management for resolution. Pregnancy may be an inciting factor. Myomectomy may be done safely at the time of cesarean. Synopsis: Pseudo‐Meigs syndrome consists of ascites, pleural effusions, and a benign pelvic mass and resolves with surgical excision; it may be exacerbated in pregnancy. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions Studies on parasitic myomas after laparoscopic morcellation are mainly limited to case reports, and the incidence and risk factors have not yet been well‐understood. We aimed to clarify the actual incidence and risk factors of parasitic myoma after laparoscopic myomectomy using uncontained power morcellation by reviewing cases with subsequent laparoscopic surgery.This retrospective study included 87 patients who had laparoscopic myomectomy using uncontained power morcellation, followed by subsequent second laparoscopic surgery for gynecological disease between 2008 and 2021. First, the incidence and characteristics of parasitic myomas detected at the second laparoscopic surgery were reviewed. Second, patients were stratified according to the presence of parasitic myoma (PM+ and PM− groups), and risk factors were analyzed by comparing the background, intraoperative findings, and clinical course after laparoscopic myomectomy.Of the 87 patients, parasitic myomas were detected in 16 (18.4%). Twelve patients (75.0%) were asymptomatic and diagnosed incidentally during surgery. Two patients presented with acute abdomen requiring emergency surgery. Comparing the PM+ and PM− groups, the total weight of the enucleated myomas and the diameter of the largest myoma at the initial laparoscopic myomectomy were significantly greater in the PM+ group. Other factors, including age and number of enucleated myomas did not differ between the groups.The actual incidence of parasitic myoma after laparoscopic myomectomy using uncontained power morcellation is higher than that previously reported. In laparoscopic power morcellation, large myomas increase the risk of developing parasitic myoma, and a containment bag system is expected to minimize this complication. [ABSTRACT FROM AUTHOR]

Objectives Methods Results Conclusion Our study aimed to evaluate the effect of superior hypogastric nerve plexus (SHNP) block in postoperative pain management in the first 24 h after minimally invasive gynecological (MIG) surgeries.We conducted a double‐blinded, randomized controlled trial in the Department of Obstetrics and Gynecology at a tertiary care centre from May 1, 2023 to September 30, 2023 in women undergoing major MIG surgeries. At the completion of the surgery, women were randomized to the intervention group who received SHNP block with ropivacaine 10 mL (0.75%) before port removal, whereas no intervention was taken in the control group. The extubation time was noted, and the pain score was assessed after 1, 2, 6, 12, and 24 h of extubation in the postoperative period using the visual analog scale (VAS). Statistical analysis was done, with a significance level of 0.05, to test the differences between the two groups.A total of 64 patients were randomly allocated to intervention and control groups. The median pain score was lower at 1 and 2 h post‐extubation and comparable between the two groups at 6, 12, and 24 h. The surrogate markers that is need for additional analgesia and duration of stay did not differ significantly in the two groups, with P‐values of 0.08 and 0.943, respectively.Although the SHNP group experienced considerably lower immediate postoperative pain levels in the initial hours following extubation, the impact of this benefit remains uncertain in the longer postoperative period. The effectiveness of this modality for pain control needs further study, particularly at later postoperative hours. [ABSTRACT FROM AUTHOR]

Introduction Material and Methods Results Conclusions Evidence about intra‐ and postoperative complication rates related to transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for benign gynecological conditions is still limited. We report and analyze data from a large cohort of patients operated in a single institution during 3.5 years.To evaluate the safety and feasibility of vNOTES for benign gynecological indications, we performed a single‐center observational study reporting and analyzing perioperative outcomes of 550 consecutive patients operated between 2020 and 2024.Of the 550 included patients, 365 (66.4%) underwent a vNOTES hysterectomy, 167 (30.4%) a procedure limited to the adnexa, and 18 (3.3%) other interventions, including myomectomy, pelvic adhesiolysis, post‐hysterectomy pelvic hematoma drainage, pelvic organ prolapse repair, and appendectomy. The mean age was 49.4 ± 12.2 years, and the mean BMI was 26.2 ± 5.8 kg/m2. The total complication rate was 6.5% (36 cases), of which 2.7% (15 cases) were intraoperative complications and 4.0% (22 cases) were postoperative complications. Patients presented postoperative complications classified as Clavien–Dindo (CD) grade I in 4 cases (0.7%), grade II in 10 cases (1.8%), and grade III in 8 cases (1.5%). We observed no CD grade IV and V complications. Three patients (0.5%) were rehospitalized for postoperative complications management. The conversion rate was 1.6%, with nine cases of conversion to conventional laparoscopy and none to laparotomy.The application of vNOTES appears safe and feasible for most benign gynecological surgeries. Our study focused on surgical complications and demonstrated a profile similar to those reported in previous studies. [ABSTRACT FROM AUTHOR]

Background: Myomectomy is the preferred treatment for women with uterine fibroids and fertility requirements. There are three modalities are used in clinical practice for myomectomy: abdominal myomectomy (AM), laparoscopic myomectomy (LM), and robot‐assisted laparoscopic myomectomy (RLM). Objectives: To compare the perioperative and postoperative outcomes of RLM, AM, and LM. Search Strategy: We searched PubMed, Web of Science, Embase, and Clinical Trials for relevant literature published between January 2000 and January 2023. Selection Criteria: We included all studies reporting peri‐ and postoperative outcomes of myomectomy in patients with uterine myomas. Surgical treatments were classified as RLM, LM, or AM. Data Collection and Analysis: Two or more authors selected studies independently, assessed risk of bias, and extracted data. We derived mean difference (MD) or odds ratio (OR) with 95% confidence intervals (CIs) for each outcome, subgrouping trials by the patient characteristics and myoma characteristics. We used the I2 statistic to quantify heterogeneity and the random‐effects model for meta‐analysis when appropriate. We used the funnel plot to assess the publication bias. Main Results: A total of 32 studies with 6357 patients were included, of which 1982 women had undergone RLM. The operating time was significantly longer (MD = 43.58, 95% confidence interval [CI]: 25.22–61.93, P < 0.001), and the incidence of cesarean section after myomectomy was significantly lower (OR = 0.27, 95% CI: 0.10–0.78, P = 0.02) in RLM than in LM. Compared with AM, the operation time, blood loss, blood transfusion rate, complication rate, total cost, length of hospital stay, and pregnancy rate of patients with RLM were significantly different. Conclusions: The safety and effectiveness of RLM are superior to those of AM but inferior to those of LM. Synopsis: The safety and effectiveness of robot‐assisted laparoscopic myomectomy are superior to those of abdominal myomectomy but inferior to those of laparoscopic myomectomy. [ABSTRACT FROM AUTHOR]

Background: ArtiSential, a class of innovative laparoscopic instrument, has been developed to overcome the limitations of conventional laparoscopic surgery by enabling free, 360°‐unrestricted movement of the wrist joint, as in robotic surgery. Objective: The aim of the present study was to describe the initial experiences with these devices in myomectomy and to report the surgical outcomes. Methods: A total of 77 women undergoing laparoscopic or robotic myomectomy between January 2021 and June 2022 were included in this multicenter prospective study. The ArtiSential instruments used by the surgeons were those chosen according to their respective preferences. The baseline characteristics, surgical outcomes, trocar placement options, and operator survey results were scrutinized. Results: The mean age of the patients was 39.9 ± 6.3, and the mean body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) was 22.4 ± 3.4 kg/m2; 46.8% of the patients underwent robotic surgery, while 53.2% underwent laparoscopic surgery. The number of removed myomas was 3.3 ± 3.0, the size of the largest myoma was 7.1 ± 2.3 cm, and the operative time was 130.0 ± 54.0 min. No transfusions or laparotomy conversions were required. Other than one case of ileus, there were no postoperative complications. In most cases, the instruments were inserted through the umbilicus trocar, and the fenestrated forceps, needle holder, and bipolar fenestrated forceps, in that order, were frequently employed. According to a surgeon survey, 29.9% moderately or strongly agreed that the ArtiSential devices utilized were more convenient than conventional laparoscopic instruments, while only 9.7% moderately or strongly agreed that they were more convenient than robotic instruments. Conclusions: Myomectomy as performed with an ArtiSential instrument seems to be feasible and safe. Further studies are necessary in order to comparatively assess the outcomes and potential benefits of ArtiSential, robotic, and conventional laparoscopic myomectomy. Synopsis: Myomectomy as performed with an ArtiSential instrument enabling free, 360°‐unrestricted movement of the wrist joint seems to be feasible and safe. [ABSTRACT FROM AUTHOR]

Objective: To investigate the associations between time interval from myomectomy to pregnancy (TIMP) and subsequent pregnancy and obstetric complications, and to explore whether these associations vary according to maternal age at birth. Methods: A retrospective population‐based cohort study was conducted from 2008 to 2017. Data were extracted from the National Health Insurance Research Database and the Taiwan Maternal and Child Health Database, comprising 2024 379 births from 1 391 856 pregnancies. Eligible cases were identified using diagnostic and procedure codes; 4006 first singleton births in 4006 women after their first laparotomic myomectomy were identified. We estimated the risks of pregnancy and obstetric outcomes according to TIMP (<6, 6–11, and ≥12 months). Subgroup analysis was performed by further dividing according to maternal age at birth (18–34 vs ≥35 years old). Results: We observed higher risks of gestational hypertensive disorders (adjusted odds ratio [aOR] 1.97, 95% confidence interval [CI] 1.22–3.18, P = 0.005) and neonatal death (aOR 4.59, 95% CI 1.49–14.18, P = 0.008) for TIMP of <6 months versus TIMP of 6–11 months. Likewise, a TIMP ≥12 months was associated with increased risks of gestational hypertensive disorders (aOR 1.72, 95% CI 1.14–2.58, P = 0.010), and neonatal death (aOR 3.27, 95% CI 1.16–9.24, P = 0.025) versus a TIMP of 6–11 months. In subgroup analysis, women over 35 years old still had higher risks of gestational hypertensive disorders when TIMP was <6 months (aOR 2.26, 95% CI 1.17–4.37, P = 0.015) or ≥12 months (aOR 2.04, 95% CI 1.17–3.54, P = 0.012), and a higher risk of neonatal death when TIMP was <6 months (aOR 4.05, 95% CI 1.06–15.53, P = 0.041); whereas women aged 18–34 years old did not. Conclusions: This study suggests that a TIMP between 6 and 11 months is associated with lower risks of gestational hypertensive disorders and neonatal death compared with a TIMP <6 months or ≥12 months, especially for women over 35 years old. Synopsis: A population‐based cohort study to investigate the association between myomectomy‐to‐pregnancy interval and obstetric outcomes. [ABSTRACT FROM AUTHOR]

Diffuse uterine leiomyomatosis (DUL) is a prevalent leiomyoma variant in women of childbearing age, characterized by a uniformly enlarged uterus with numerous interconnected small myomas. Given that most DUL patients are in their reproductive years, treatments that preserve fertility are increasingly vital. This case report introduces an innovative hysteroscopic technique that forgoes uterine distension to remove multiple submucosal fibroids in a single procedure, maintaining endometrial integrity and fertility. A 27‐year‐old single woman experienced prolonged and heavier menstruation. Magnetic resonance imaging (MRI) scans showed an enlarged uterus with several round‐like masses in the uterine wall/submucosa. Addressing the patient's financial limitations and treatment preferences, a groundbreaking hysteroscopic surgery was performed using thoracic tissue forceps, alongside bedside ultrasonography, enabling fibroid excision without uterine distension. In total, 38 uterine fibroids were successfully excised without complications such as uterine perforation or hyponatremia. According to the FIGO classification system: three were type III, nine were type II, 15 were type I, and 11 were type 0. Postoperative follow‐up indicated normalized menstrual cycles, improved hemoglobin levels, and no recurrence of fibroids. A hysteroscopic examination 1 month after surgery revealed no significant fibroids or endometrial thickening. This case report underscores the effectiveness of a novel hysteroscopic surgical approach in treating DUL. This method eliminates the need for multiple staged surgeries and the risks of endometrial damage inherent in traditional techniques. It offers a minimally invasive, fertility‐preserving alternative for young DUL patients, marking a significant advancement in gynecologic surgery. [ABSTRACT FROM AUTHOR]

This article examines the costs and carbon emissions associated with virtual preoperative visits in a gynecologic surgery practice. The study found that virtual visits significantly reduced driving costs, CO2 emissions, and driving time compared to in-person visits, with no negative impact on surgical outcomes. The authors emphasize the potential environmental benefits of telemedicine in reducing carbon footprints in healthcare. However, the study has limitations, including its retrospective design and single-center setting. [Extracted from the article]

Objective Methods Results Conclusion To evaluate the safety and efficacy of myomectomy for recurrent uterine fibroids (UFs) after high‐intensity focused ultrasound (HIFU) ablation.This was a retrospective study. Patients who underwent abdominal myomectomy (AM) and laparoscopic myomectomy (LM) from January 2018 to December 2021 at the Three Gorges Hospital of Chongqing University were included. Among them, 73 had undergone prior HIFU ablation (Group 1), while 120 had not undergone HIFU (Group 2). Outcome measures included operating time, estimated blood loss (EBL), blood transfusion, postoperative activity times (PAT), duration of hospital stay (DOHS), and complications.The operating time was 90.0 min (70.5, 115.0) for Group 1 and 110.0 min (81.5, 130.0) for Group 2 (P < 0.05). During all AM pathways, there were no significant differences observed between the two groups in EBL, blood transfusion, PAT, DOHS, and complications; however, operating time was shorter in Group 1. The operating time, EBL, blood transfusion, PAT, DOHS, and complications were similar in both groups during LM pathway. During the follow‐up 40 (range: 24–53) months, the rate of relief, recurrence, and reintervention in Groups 1 and 2 was 78.1% versus 74.1%, 14.6% versus 16.4%, and 3.7% versus 2.6%, respectively (P > 0.05).Myomectomy is a safe and effective surgical method for treating recurrent UFs after HIFU. Myomectomy for treating recurrent UFs resulted in a shorter operative and hospital stay, reduced blood loss, faster postoperative recovery, and fewer complications, better symptom relief rates, and lower risk of recurrence or reintervention. These findings indicate that previous HIFU ablation does not worsen the outcomes of the subsequent myomectomy. [ABSTRACT FROM AUTHOR]

Background: Hypertrophic cardiomyopathy (HCM) affects millions of individuals worldwide. In severe cases, it can cause life‐threatening conditions such as left ventricular outflow tract (LVOT) obstruction, mitral regurgitation (MR), and sudden cardiac death, making surgical treatment necessary. This study aimed to report the long‐term outcomes of HCM patients undergoing septal myectomy or mitral valve replacement (MVR) and compare the results between different types of surgeries. Methods: This was a retrospective cohort study on HCM patients who underwent surgical treatment in an Iranian referral center between 2005 and 2021. Patients were divided into three groups according to the type of surgery received: septal myectomy, MVR, or a combination of both surgeries. Patient characteristics, surgical and echocardiographic features, and in‐hospital and long‐term outcomes were reported and compared between the three groups. Results: A total of 102 patients with an average age of 53.3 ± 16.9 were included. Twenty‐six patients had septal myectomy, 23 had MVR, and 53 had combined septal myectomy and MVR surgery. All surgeries were associated with a significant reduction in interventricular septum thickness and LVOT gradients. After a median of 6.8‐year follow‐up time, patients with an isolated septal myectomy had significantly lower mortality and major adverse cardiac and cerebrovascular events rates than the other groups. Conclusion: Isolated septal myectomy showed better long‐term survival rates and can correct HCM‐related MR, while MVR should be preserved only for intrinsic valve defects. More extensive studies are needed to confirm these findings and achieve a comprehensive guideline on surgical treatment of HCM. [ABSTRACT FROM AUTHOR]

Objective: To estimate the rate and risk factors of re‐intervention for patients with uterine fibroids (UFs) undergoing high‐intensity focused ultrasound (HIFU) at different age distributions. Method: A retrospective cohort study was conducted in Nanchong Central Hospital, recruiting a total of 672 patients with UFs undergoing HIFU from June 2017 to December 2019. Using univariate and multivariate logistic regression, risk factors for re‐intervention were assessed. Results: Among 401 patients with UFs who completed the follow‐up visits (median 47 months, range 34–61), 50 (12.46%) patients underwent re‐intervention (such as high‐intensity focused ultrasound, uterine artery embolization, myomectomy and hysterectomy). In the different age distributions, the re‐intervention rate was 17.5% (34/194) in patients aged <45 years and 7.7% (16/207) in those aged ≥45 years. Regarding the younger patient group (aged <45 years), hypo‐ or iso‐intensive fibroids in T2‐weighted magnetic resonance imaging (T2WI) intensity may elevate the risk of re‐intervention for UFs (odds ratio [OR] 2.96, 95% confidence interval [CI] 1.37–6.62; P = 0.007). Among the older patient group (aged ≥45 years), preoperative anemic patients had an increased risk of re‐intervention compared with those without anemia (OR 3.30, 95% CI 1.01–10.37; P = 0.041). Conclusion: The re‐intervention rate of HIFU decreased with increasing age. Among those aged <45 years, T2WI intensity was the independent risk factor for re‐intervention, and among those aged ≥45 years, preoperative anemic status may be related to re‐intervention outcome. Synopsis: There are different risk factors for re‐intervention in UF patients who received HIFU treatment with different age distributions (< 45 vs ≥45 years). [ABSTRACT FROM AUTHOR]

Introduction: Performing surgical procedures is a recognized source of stress for surgeons. Vocational stress is an important contributor to performance, patient care, and burnout with dispositional and environmental factors contributing. Accurately assessing surgeon stress is critical to measuring effectiveness of stress reduction programs. The primary aim was to identify differences between surgeons' self‐reported anticipated stress and anxiety prior to gynecological surgery, compared with their recollection of experienced stress and anxiety during surgery. Secondary aims assessed any differences by level of training, surgical type, and surgeon role. Material and methods: Attending and resident gynecologists performing routine elective surgeries completed a visual analog scale (VAS) assessing perceived stress and the State–Trait Anxiety Inventory (STAI) prior to and immediately after completing 161 elective surgeries including total laparoscopic hysterectomy, laparoscopic excision of moderate–severe endometriosis, or hysteroscopic myomectomy. Results: Eight attending gynecologists and nine residents participated. Residents commenced as primary surgeon in 62/90 (69%) procedures. Stress experienced during surgery was greater than anticipated in 92/161 (57%) surgery episodes (mean VAS increase: 3.9; 95% CI: 1.1–6.8, p = 0.009). State anxiety was greater than anticipated in 99/161 (62%) episodes (mean state anxiety increase: 4.4; 95% CI: 3.0–5.8, p < 0.001). Greater preprocedural anticipatory stress and anxiety was observed in residents vs. attending gynecologists (VAS 51.9 vs. 22.8, p < 0.001; state anxiety 38.3 vs. 28.1, p < 0.001) and in primary vs. assistant surgeons (VAS 47.2 vs. 29.9, p < 0.001; state anxiety 36.9 vs. 28.3, p < 0.001). Intraoperative stress and anxiety were greater in primary surgeons (VAS 50.4 vs. 30.5, p < 0.001; anxiety 41.3 vs. 32.5, p < 0.001) and residents (VAS 43.4 vs. 31.7, p < 0.001; anxiety 53.5 vs. 33.7, p < 0.001) compared with assistants and attending gynecologists. Perceived stress and anxiety were positively correlated at both timepoints (r = 0.68, p < 0.001; r = 0.82, p < 0.001). Conclusions: When asked to reflect on stress experienced during surgery, our data show that stress during surgery is greater than anticipated for many surgical episodes. Self‐reported stress symptoms commence prior to surgery and are more commonly reported by surgeons operating as primary surgeon and by those in training. Future research should focus on determinants of presurgical stress and examine when stressors become inhibitory to performance. [ABSTRACT FROM AUTHOR]

Obtaining medical consent preoperatively is one of the key steps in preparing for surgery, and is an important step in informed decision making with the patient. According to good medical practice guidelines, doctors are required to have the knowledge and skills to treat patients as well as inform them, respect their wishes, and establish trust between themselves and their patients. Valid consent includes elements of competence, disclosure, understanding, and voluntariness. Documentation of these elements is also very important. The International Federation of Gynecology and Obstetrics (FIGO) Education Communication and Advocacy Consortium (ECAC) has realized that the quality of consent varies considerably across the world and has developed simple guidelines regarding consent and procedure‐specific checklists for the most common obstetric and gynecological procedures. Synopsis: To standardize medical care, it is important to understand what constitutes good consent. FIGO has endorsed this guidance for the most common obstetric and gynecological procedures. [ABSTRACT FROM AUTHOR]

Objective: To assess factors influencing preoperative diagnosis and hemorrhage during surgery with uterine intravenous leiomyomatosis. Methods: This retrospective single‐institution study used univariate analysis and multivariate models to investigate potential factors contributing to preoperative diagnosis and hemorrhage during surgery associated with intravenous leiomyomatosis in 135 patients from January 2012 to April 2022. Risk factors for disease recurrence were also investigated. The SPSS statistical analysis package was used for data analysis. Results: Previous myomectomy or fibroid ablation and tumor location on color Doppler were related to preoperative diagnosis (P = 0.031 and P = 0.003, respectively). Multivariate regression analysis demonstrated that lesions extending to the broad ligament were the only factors affecting preoperative diagnosis (odds ratio [OR] 5.383, 95% confidence interval [CI] 1.49–19.47). Univariate analysis showed that previous myomectomy or fibroid ablation (P = 0.017), tumor location (P = 0.027), and parauterine involvement (P = 0.014) were associated with intraoperative hemorrhage. Parauterine involvement was an independent risk factor for increased bleeding (OR 1.36, 95% CI 1.14–3.92). Six patients (4.4%) relapsed. The present study demonstrated that age (P = 0.031) and surgical type (P < 0.001) might be associated with disease recurrence. Conclusions: Treatment emphasis should focus on lesions extending to the broad ligament. Intraoperative bleeding associated with parauterine involvement should be stopped as effectively as possible. Synopsis: Lesions extending to the broad ligament affected preoperative diagnosis, and parauterine involvement was an independent risk factor for increased bleeding in intravenous leiomyomatosis. [ABSTRACT FROM AUTHOR]

Introduction: After incomplete healing of the uterine cesarean section scar, a niche can be observed; 24% of the women develop large niches with a residual myometrial thickness <3 mm. In these cases a laparoscopic resection is possible. The effect of this new treatment on fertility outcome is not known yet. This paper describes reproductive outcomes 2 years after a laparoscopic niche resection and compares women with or without secondary infertility at baseline. Material and methods: A prospective cohort study was performed, with consecutive inclusion of women between 2011 and 2019. Women with a niche in the uterine cesarean scar, with a residual myometrial thickness of <3 mm and with a desire to become pregnant, were scheduled to undergo a laparoscopic niche resection because of one or more of the following problems (1) postmenstrual spotting; (2) midcycle intrauterine fluid accumulation diagnosed during the fertility workup or (3) difficulties with a previous embryo transfer and preferring a surgical therapy. The study is registered in the ISRCTN register (ref. no. ISRCTN02271575) on April 23, 2013. Results: There were 133 (62%) women included with a desire to become pregnant, 88 with secondary infertility. In all, 83 had an ongoing pregnancy at the 2‐year follow‐up. The ongoing pregnancy rate in patients with previous fertility problems was 60.2% compared with 66.7% in patients without infertility (odds ratio [OR] 0.68, 95% confidence interval [CI] 0.32–1.7). The OR for live births was 0.57 (95% CI 0.02–1.2). Overall, 8.3% of the pregnancies resulted in miscarriages by the 2‐year follow‐up. Conclusions: The reproductive outcomes in women with and without previous fertility problems undergoing resection of a large niche are very promising and quite comparable in both groups. These results suggest, but do not prove, a beneficial effect of this therapy for these indications. The results support the design of future randomized controlled trials to evaluate the effect of niche resection vs expectant management to assess its additional value in women with or without fertility problems who desire pregnancy. [ABSTRACT FROM AUTHOR]

Hypertrophic obstructive cardiomyopathy can be the phenotype of storage disorders as Fabry disease cardiomyopathy. In this instance, its recognition through GLA gene analysis and preventive administration of enzyme replacement therapy may reduce heart failure risk of surgical septal myectomy (SSM). A 59‐year‐old man was referred for SSM as dyspnoea and low threshold muscle fatigue associated to severe left ventricular outflow obstruction (gradient of 100 mmHg) due to both interventricular septal hypertrophy and mitral leaflet systolic anterior motion were not controlled by metoprolol 100 mg bid. Electrocardiogram showed sinus rhythm and a complete left bundle branch block. Cardiac magnetic resonance imaging showed a preserved left ventricular (LV) contractility (ejection fraction 70%) but failed to reveal reduced T1 mapping and fibrosis of postero‐lateral LV wall suggesting Fabry disease cardiomyopathy. Cardiac catheterization and coronary angiography documented increased LV end‐diastolic pressure but normal coronary arteries. SSM was followed by acute renal and heart failure with left ventricular ejection fraction declining to 35%. Histology of SSM showed regularly arranged severely enlarged cardiomyocytes containing extensive vacuoles that were intensely positive to immunofluorescence with anti‐Gb3 antibodies and appeared at electron microscopy to consist of myelin bodies suggesting the diagnosis of FD. This entity was confirmed by low blood levels of alpha‐galactosidase A (0.8 nmol/mL/h; NV > 1), high values of Lyso‐Gb3 (5.85 nmol/L; NV < 2.3), and the presence of the pathogenic mutation c.644A>G in the exon 5 of GLA gene. This study emphasizes the importance of a genetic screening for FD before SSM be considered for hypertrophic obstructive cardiomyopathy. [ABSTRACT FROM AUTHOR]

Background: The effect of FIGO (the International Federation of Gynecology & Obstetrics) type 3 myomas on in vitro fertilization (IVF) is uncertain. Objectives: To evaluate whether FIGO type 3 myomas affect IVF outcomes, through a systematic review and meta‐analysis (CRD42022379700). Search strategy: Electronic databases were searched until November 15, 2022. Selection criteria: Studies evaluating the effects of FIGO type 3 myomas on IVF outcome. Data collection and analysis: Pooled results were expressed as odds ratios (OR) with 95% confidence intervals (CI). Heterogeneity was assessed using Higgins I2. Sources of heterogeneity were explored with sensitivity and subgroup analyses. Main results: In total, 1020 patients were included: 324 with FIGO type 3 myomas and 696 controls (without myomas). A pooled data analysis showed a significantly lower live birth rate (OR 2.16, 95% CI 1.55–3.01, I2 = 0%, P < 0.00001), clinical pregnancy rate (OR 2.06, 95% CI 1.52–2.81, I2 = 0%, P < 0.00001), and implantation rate (OR 1.77, 95% CI 1.35–2.32, I2 = 0%, P < 0.00001) in women with untreated myomas compared with controls. The number and size of fibroids correlated with a worsening of IVF outcomes. Conclusions: FIGO type 3 myomas are significantly associated with a lower implantation rate, cumulative pregnancy rate, and live birth rate. Furthermore, their deleterious effect on the outcome of IVF increases further with increasing size and number. Nevertheless, no firm conclusions could be drawn about the potential benefits of surgery for FIGO type 3 uterine fibroids on IVF outcomes. Synopsis: FIGO type 3 myomas are significantly associated with a lower implantation rate, cumulative pregnancy rate, and live birth rate in IVF. [ABSTRACT FROM AUTHOR]

Objective: To provide perspectives on preoperative diagnosis and conservative treatment for diffuse uterine leiomyomatosis (DUL). Methods: The clinical characteristics, management, and outcome of the five cases diagnosed with DUL receiving surgical treatment at Peking Union Medical College Hospital between January 2010 and December 2021 were retrospectively analyzed. Results: DUL is a diagnosis based on histopathology. It is a subtype of uterine leiomyoma, characterized by innumerable, poorly circumscribed hypercellular nodules of bland smooth muscle cells with no cytologic atypia diffusely involving the myometrium. Clinical manifestations, including menorrhagia, anemia, and infertility, are similar to those of typical uterine leiomyomas, making a definitive preoperative diagnosis difficult. Magnetic resonance imaging plays an important role in the pre‐treatment mapping. Conservative surgery can reduce the uterine volume and improve the contour of the uterine cavity, thereby relieving symptoms of menorrhagia and improving the chance of conception. Gonadotropin‐releasing hormone (GnRH) agonist therapy is of great significance for controlling vaginal bleeding, reducing uterine volume, and delaying postoperative recurrence, and can be used alone or as postoperative adjuvant therapy for conservative surgery. Conclusion: The treatment goal for DUL patients with fertility‐sparing request should not aim at complete fibroid removal. A successful pregnancy can be achieved following conservative surgery and/or GnRH agonist therapy. SYNOPSIS: The treatment goal for diffuse uterine leiomyomatosis should not be complete fibroid removal; a successful pregnancy can be achieved following conservative surgery and/or GnRH agonist therapy. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Villar's nodule is a rare presentation of endometriosis. Only a few cases report coexistence with uterine fibroids and infertility. We report an incidental discovery of a bleeding umbilical lesion confirmed as Villar's nodule in a 37‐year‐old woman with primary infertility who presented for myomectomy on account of leiomyomas. [ABSTRACT FROM AUTHOR]

Aims: Mechanical function of the left atrium (LA) and the left ventricle (LV) has been demonstrated to be a prognostic factor in patients with hypertrophic cardiomyopathy (HCM). We explore whether myocardial mechanical function can be improved by septal reduction therapy in symptomatic obstructive HCM. Methods and results: Among 65 patients who underwent septal myectomy for symptomatic obstructive HCM from 2006 to 2022, 44 were analysed after excluding those who underwent simultaneous valve repair or replacement or maze operation. LA and LV functional variables including LA strain and LV global longitudinal strain were evaluated by two‐dimensional and speckle‐tracking echocardiography and compared before and 1 year after surgery. After septal myectomy, LA volume index (58.1 ± 18.3 vs. 45.3 ± 14.6 mL/m2, P = 0.001) decreased significantly. As LV end‐systolic dimension increased after surgery, the LV ejection fraction decreased (73.8 ± 6.7 vs. 62.9 ± 8.3%, P < 0.001). LA strain (24.4 ± 9.3 vs. 30.5 ± 13.6%, P = 0.004) improved after septal myectomy, but LV global longitudinal strain deteriorated (−12.6 ± 3.6 vs. −11.6 ± 4.3%, P = 0.033), mainly related to worsening non‐septal longitudinal strain (−14.4 ± 4.3 vs. −10.9 ± 8.4%, P = 0.005). Conclusions: As haemodynamic loads due to LV outflow tract obstruction was relieved through surgical septal reduction therapy in patients with symptomatic obstructive HCM, there was a significant reduction in LA volume and restoration of LA mechanical dysfunction. However, LV mechanical dysfunction deteriorated even after surgical septal reduction therapy. [ABSTRACT FROM AUTHOR]

Objective: The authors conducted a large‐scale cohort study using the Japan Society of Obstetrics and Gynecology's perinatal registry database to determine the effect of myomectomy on perinatal outcomes. Methods: This retrospective cohort study enrolled 203 745 women who gave birth between January and December 2020 in Japan. The participants were classified into two groups based on their history of myomectomy (open/laparoscopic) to investigate fertility treatment, delivery information, obstetric complications, maternal treatment, infant information, fetal appendages, obstetric history, underlying disease, infectious disease, drugs used, and case information regarding maternal and infant death. Results: In total, 1161 pregnant women had a history of myomectomy and 202 584 did not. Compared with the nonmyomectomy group, the myomectomy group had a higher occurrence rate of uterine rupture (0.9% vs 0.06%, P < 0.01) and placenta accreta (1.5% vs 0.5%, P < 0.01). In addition, history of myomectomy (odds ratio [OR], 2.62 [95% confidence interval (CI), 1.500–4.226]; P < 0.001) was found to be an independent factor for placenta accrete and uterine rupture (OR, 14.4 [95% CI, 6.75–27.02]; P < 0.001). Furthermore, myomectomy increased the risk of uterine rupture by 14 times. Conclusion: Postmyomectomy pregnancy may increase the risk of placenta accreta and uterine rupture. Synopsis: Postmyomectomy pregnancy may increase the risk of placenta accreta and uterine rupture. [ABSTRACT FROM AUTHOR]

Just as the investigation of abnormal uterine bleeding (AUB) is approached systematically using the two FIGO systems for AUB in the reproductive years, treatment options can be considered similarly. Therapeutic options fall into two categories—medical and surgical—and while medical management is typically regarded as first‐line therapy, there are several exceptions defined by the presenting cause or causes, mainly when infertility is a concurrent issue. In the early 1990s, up to 60% of women underwent a hysterectomy for the symptom of heavy menstrual bleeding (HMB), but this figure has decreased. The number of women undergoing a hysterectomy for benign disorders continues to decline, along with an increase in hysterectomies performed using minimally invasive techniques. Discussions about therapeutic options are tailored to the individual patient, and we include the risks and benefits of each option, including no management, to enable the patient to make an informed choice. The different types of treatment options and the factors affecting decision‐making are considered in this article. Synopsis: This article discusses management, including medical and surgical options, for abnormal uterine bleeding. Options are categorized by medical or procedural and FIGO's System 2—the PALM‐COEIN system. [ABSTRACT FROM AUTHOR]

This article, titled "EP20.14: Analysis of blood transfusion need and its determinants in women who had abdominal myomectomy at the University of Benin Teaching Hospital," presents a study conducted at the University of Benin Teaching Hospital (UBTH) to determine the proportion of patients who required blood transfusion during myomectomy surgery and to identify the factors that influenced the need for transfusion. The study analyzed the records of 289 women who underwent abdominal myomectomy at UBTH between July 2019 and June 2022. The results showed that 35.6% of the patients required blood transfusion, and the significant determinants for transfusion included high fibroid burden, preoperative anemia, general anesthesia, prolonged surgery, and the use of hemostatic techniques other than a tourniquet. The authors emphasize the importance of adequate preparation and early anticipation of bleeding to improve outcomes in myomectomy surgeries. [Extracted from the article]

This article, titled "Improving outcomes in hysteroscopic surgery using intraoperative ultrasound: current evidence," provides a comprehensive review of the application and usefulness of intraoperative ultrasound (IOUS) in hysteroscopic surgery. The authors conducted a literature review and found that IOUS can effectively and safely be used in various hysteroscopic interventions, such as myomectomy, metroplasty, management of Asherman syndrome, and treatment of Caesarean scar pregnancy. IOUS reduces the risk of complications and incomplete procedures in these cases. While not necessary for routine use, IOUS can be a valuable tool in complex cases. [Extracted from the article]

Synopsis: Uteroenteric fistulae in the setting of degenerating leiomyomas may present with small bowel obstruction and require multidisciplinary surgical management to perform fertility‐sparing myomectomy. [ABSTRACT FROM AUTHOR]

Objective: To assess comparative rates of further uterine‐preserving procedures (UPP) or hysterectomy reintervention, after myomectomy or uterine artery embolisation (UAE). Design: Population‐based, retrospective cohort study. Setting: England. Population Women who underwent myomectomy or UAE between 2010 and 2015 under the NHS. Methods: Data was abstracted from NHS Health Episode Statistics datasets. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox proportional‐hazards regression. Main Outcomes Measures: 30‐day readmission, UPP and hysterectomy reintervention rates. Results: 9443 and 6224 women underwent elective myomectomy or UAE, respectively. After 118 136 total person‐years of follow‐up, the rate of hysterectomy was 8.34 and 20.98 per 1000 patient years for myomectomy or UAE, respectively. There was a 2.4‐fold increased risk of undergoing hysterectomy after UAE when compared with myomectomy in adjusted models (HR 2.38 [95% CI 2.10–2.66]) [adjusted for age, ethnicity, multiple deprivation index, geographical region and comorbidities]. The HR for undergoing a UPP reintervention was 1.44 (95% CI 1.29–1.60) in favour of myomectomy. The rate of hysterectomy was increased 22% following UAE compared with laparoscopic myomectomy (0.97–1.52). Age may influence reintervention rates, and there was variation in hysterectomy risk when stratified by geographical region. Conclusions: After a median of 7 years of follow‐up, there is a 2.4‐fold increased rate of hysterectomy and 44% increased risk of UPPs as reintervention after UAE, relative to myomectomy. These findings will aid pre‐procedure counselling for women with fibroids. Future work should investigate the effect of other outcome modifiers, such as fertility intentions and fibroid anatomical characteristics. [ABSTRACT FROM AUTHOR]

Despite the amount of research into hysteroscopic myomectomy, questions about the optimal treatment of heavy menstrual bleeding remain. This study reviewed publication trends on this topic from 2002 to 2019 and assessed the usefulness of studies. A total of 580 articles were published on PubMed in this time frame, in 15 different languages. There were meta‐analyses (1.6%), systematic reviews (12%), and randomized controlled trials (4.2%). Twelve percent were published in high impact factor journals. After applying our selection criteria, the usefulness of 37 articles was assessed: one article scored high, 31 scored moderate, and five scored low. The costs of these studies were estimated at US$ 971 700. Synopsis: Usefulness assessment showed that only one article scored high, 31 scored moderate, and five scored low. Study costs were estimated to be US$ 971 700. [ABSTRACT FROM AUTHOR]

Objective: To compare operative data and patient satisfaction between open and laparoscopic surgery for postpartum‐diagnosed uterine rupture. Methods: In this questionnaire‐based cohort study, the authors collected all cases of postpartum‐diagnosed uterine rupture after vaginal delivery between 2016 and 2020 in a single academic tertiary center. The cohort was divided according to surgical method of repair, and demographic, clinical, operative and postoperative data were collected and compared between groups. A phone questionnaire on various satisfaction domains was conducted and satisfaction rates were compared between groups. Results: Eight cases of uterine rupture following vaginal delivery were treated by laparoscopy and eight were treated by laparotomy. The median operative time was 103 min (interquartile range [IQR], 86.3–129.0 min) for the laparoscopy group and 61 min (IQR, 59.0–75.0 min) for the laparotomy group (P = 0.04). Blood transfusion was required in 25% of women who underwent laparoscopy, as compared with 88% of women who underwent laparotomy (P = 0.01 < 0.05). Median hospitalization time was 3 days (IQR, 3–4 days) in the laparoscopy group and 4 days (IQR, 4–4 days) in the laparotomy group (P = 0.2). Overall satisfaction, satisfaction from recovery, satisfaction from scars, satisfaction from ability to care for the neonate, and postoperative pain and mood were all improved in the laparoscopy group, as compared with the laparotomy group. Conclusion: Minimally invasive surgery is a viable surgical option for patients with uterine rupture diagnosed after vaginal delivery and may result in better patient recovery and satisfaction. Synopsis: Laparoscopic repair of uterine rupture after vaginal delivery is feasible, safe, and may result in better patient satisfaction, as compared to open repair. [ABSTRACT FROM AUTHOR]

Percutaneous and surgical therapies for septal reduction for hypertrophic cardiomyopathy have been going head‐to‐head for the past 20 years with similar outcomes and mortality rates, although contemporary myectomy seems to materialize its superiority. However, on closer analysis, the external validity of studies advocating myectomy does not translate to all centres. The aim of this review was to examine the most recent data on septal reduction therapy and to attempt to phenotype the appropriate patient for each of the two treatments. The key to similar low mortality rates between ventricular septal myectomy and alcohol septal ablation appears to be proper patient selection performed in high volume clinical environments. Furthermore, we analyse the role of mavacampten (the recently approved cardiac myosin inhibitor) in replacing or complementing the two septal reduction therapies. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the safety and operability of the GM142 (TENALEAF®, Medical Division, Gunze Limited, Tokyo, Japan) adhesion barrier applied in patients undergoing surgery for benign gynecologic disease. Methods: This multicenter open study enrolled 34 patients from November 2018 to October 2019. Results: The primary outcome was the incidence of adverse events (AE) within 12 weeks postoperatively. None of the 30 patients completing the study experienced a life‐threatening AE. Thirteen patients (43.3%) suffered 30 mild or moderate AE in total. No intestinal obstruction (0/30) was observed, with the sample size justified by the AdSpray® trial (8/61 patients with AE). No gelatin‐specific Immunoglobulin E (IgE) antibodies were induced in the patients. The adhesion barrier could be easily inserted (even via trocar) and positioned. After malfunctions were reported in six patients, the instructions for use were updated for trocar use. Conclusion: This study showed the safety and clinical feasibility GM142 as an adhesion barrier. [ABSTRACT FROM AUTHOR]

Objective: To investigate the incidence of neoplasm of uncertain behavior of uterus (NUBU) diagnosed after hysterectomy, myomectomy, or hysteroscopy for presumed leiomyomas. Methods: We performed this population‐based retrospective cohort study using the Korean national health insurance database between January 2002 and December 2018. Women with or without NUBU diagnosed after surgery were extracted using diagnosis codes and procedure codes. Results: The median age of patients who underwent surgery for presumed leiomyomas was 39 years (interquartile range [IQR] 31–47 years). The median age of women diagnosed with NUBU after surgery was 45 years (IQR 38–49 years). The incidence of NUBU diagnosed after surgery for presumed leiomyomas was 1.89%. The incidences of NUBU diagnosed after hysterectomy, myomectomy, or hysteroscopic myomectomy for presumed leiomyomas were 2.03%, 1.84%, or 1.64%, respectively. There was no difference in the incidence of NUBU according to these surgical methods. Conclusions: Regardless of the surgical procedure performed, the incidence of NUBU diagnosed after surgery was higher than that of unexpected uterine malignancy diagnosed after hysterectomy (0.19%), myomectomy (0.12%), or hysteroscopic myomectomy (0.86%) for presumed leiomyoma. Compared with unexpected uterine malignancy, NUBU seems to occur in relatively young women. Synopsis: The incidence of neoplasm of uncertain behavior of uterus diagnosed after surgery for presumed leiomyomas was 1.89%. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to compare the laparoscopic‐enclosed electromechanical morcellation (LEM) with vaginal‐enclosed scalpel morcellation (VSM) in laparoscopic myomectomy procedures. Methods: One hundred eighteen patients who underwent laparoscopic myomectomy were enrolled the prospective randomized interventional clinical study in tertiary university hospital. After myomectomy, tissue removal was accomplished via either LEM using the in‐glove morcellation technique or VSM. Results: The median tissue removal time was longer in the LEM group (25 min [range: 14–55]) than the VSM group (20 min [range: 6–38] [p = 0.001]). Rescue analgesia requirement was significantly higher in the LEM group than the VSM group (mean rank: 56.92 vs. 40.92 doses, respectively; p < 0.001). There was no significant difference between preoperative and postoperative third month total scores of female sexual function index (FSFI) and subdomains in the LEM group. Conversely, all subdomains and total scores of FSFI (26.5 [16.7–34.8] vs. 22.7 [15.2–28.7]) except pain significantly worsened 3 months after operation in the VSM group. Conclusions: LEM was associated with a longer tissue removal time and increased postoperative analgesic requirement. On the other hand, VSM was associated with worsened postoperative sexual function from baseline. [ABSTRACT FROM AUTHOR]

Objective: To determine treatment options (myomectomy vs. uterine artery embolization (UAE)) for women wishing to avoid hysterectomy. Methods: A multicenter randomized controlled trial was conducted on 254 women and data were collected on fibroid‐specific quality of life (UFS‐QOL), loss of menstrual blood, and pregnancy. Results: At 4 years, the mean difference in the UFS‐QOL was 5.0 points (95% confidence interval (CI) −1.4 to 11.5; P = 0.13) in favor of myomectomy. This was not statistically significant as it was at 2 years. There were no differences in bleeding scores, rates of amenorrhea, or heavy bleeding. Of those who were still menstruating, the majority reported regular or fairly regular periods: 36 of 48 (75%) in the UAE group and 30 of 39 (77%) in the myomectomy group. Twelve women after UAE and six women after myomectomy became pregnant (4 years) with seven and five live births, respectively (hazard ratio 0.48, 95% CI 0.18–1.28). There was no difference between the levels of hormones associated with the uterine reserve in each group. Conclusion: Leiomyoma are common in reproductive‐aged women, causing heavy menses and subfertility. Among women with uterine fibroids, myomectomy resulted in better fibroid‐related quality of life at 4 years, compared with UAE but the treatments decreased menstrual bleeding equally. There was also no significant difference in the impact of treatment on ovarian reserve. Synopsis: Women with uterine fibroids were randomized between uterine artery embolization and myomectomy. Quality of life was greater in the myomectomy group at 2 years, but neither menstrual blood loss nor markers of ovarian function differed. [ABSTRACT FROM AUTHOR]

Watch a video of this article. [ABSTRACT FROM AUTHOR]

A case report published in the journal "Ultrasound in Obstetrics & Gynecology" describes a 36-year-old pregnant woman who presented to the emergency room with abdominal distension. The woman had a history of adenomyomectomy, a surgical procedure to remove uterine growths, performed two years prior. Ultrasound revealed a cystic mass suspected to be a uterine rupture related to the prior surgery. The case emphasizes the importance of considering uterine structural abnormalities in pregnant women with a history of uterine surgery and the need for careful monitoring and intervention to ensure optimal outcomes for both mother and baby. The report also highlights the risks associated with undergoing surgery for uterine conditions before pregnancy and recommends conservative management with careful monitoring during pregnancy. [Extracted from the article]

Preoperative anaemia (haemoglobin <12 g/dL) is a risk factor for adverse perioperative outcomes following gynaecological surgery, including an increased risk of blood transfusions, surgical site infections, prolonged hospital stay and hospital readmission.[1] Clinical practice guidelines have also identified preoperative anaemia as a quality metric impacting patient safety.[[2]] It is imperative that institutions continuously assess performance around this quality indicator and use findings to inform and target quality improvement initiatives. Patient, case and surgeon characteristics for patients with and without anaemia were reported descriptively and bivariate comparisons between the groups were completed. Patients with abnormal uterine bleeding and larger uteri were most likely to have preoperative anaemia, as were patients who had surgery at community sites and/or with surgeons in practice the longest. [Extracted from the article]

B Recommendation: A b Contraindications Absolute contraindications to UAE include: • Active viable pregnancy • Suspected pelvic malignancy • Active or subacute pelvic infection Patients should be counselled about increased risks associated with embolisation procedures in some patients with the following co-morbidities, with additional details below. B Recommendation: A b Who should perform embolisation UAE procedures should be performed by those who have undergone appropriate training and experience, ideally including credentialing from a relevant specialist college as well as local hospital accreditation for performing advanced embolisation procedures. Quality care guidelines for uterine artery embolisation in women with symptomatic uterine fibroids in Australia and New Zealand: According to the AGREE-II checklist and endorsed by the Interventional Radiology Society of Australasia Keywords: hysterectomy; interventional radiology; myomectomy; uterine artery embolisation; uterine fibroid embolisation EN hysterectomy interventional radiology myomectomy uterine artery embolisation uterine fibroid embolisation 819 825 7 09/08/22 20220901 NES 220901 Objective This guideline defines recommendations for quality care in women being treated with UAE for symptomatic uterine fibroids in Australia and New Zealand. [Extracted from the article]

Placenta accreta spectrum disorder (PASD) is a condition where the placenta attaches abnormally to the uterus due to prior damage. This disorder has become more common with the increase in procedures like cesarean delivery. Ultrasound is typically used to evaluate the uterus, but it has limitations. Magnetic resonance imaging (MRI) is a complementary tool that offers advantages such as better tissue contrast and a larger field of view. Three articles in the Journal of Magnetic Resonance Imaging explore the use of deep learning algorithms to diagnose PASD using MRI. These studies show promising results and have the potential to improve the management of high-risk deliveries. [Extracted from the article]

Porous diaphragm syndrome includes all pleural cavity conditions, including pleural effusion, hemothorax, or pneumothorax, that occur secondary to peritoneal cavity disorders through defects in the diaphragm. In this report, we describe the first known case of porous diaphragm syndrome presenting as hemothorax after laparoscopic myomectomy. A 46‐year‐old nulliparous woman underwent laparoscopic myomectomy for multiple fibroids. Eight hours after surgery, the patient developed exertional dyspnea followed by hemoptysis. Radiological diagnosis revealed massive hemothorax in the right thoracic cavity. Thoracoscopic findings showed the presence of small fenestrae at the center of the right diaphragm, which were repaired thoracoscopically. Hence, quick postoperative diagnosis resulted in successful treatment. In this case, porous diaphragm syndrome is believed to be caused by retention of intraoperative bleed and saline from intra‐abdominal lavage, in the abdominal cavity. Porous diaphragm syndrome is a potential life‐threatening condition that gynecological surgeons should consider in this era of laparoscopic surgery. [ABSTRACT FROM AUTHOR]

Objective: To describe the characteristics and peripartum outcomes of patients diagnosed with uterine rupture (UR) by an observational cohort retrospective study on 270 patients. Methods: Demographic information, surgical history, symptoms, and postoperative outcome of women and neonates after UR were collected in a large database. The statistical analysis searched for correlation between UR, previous uterine interventions, fibroids, and the successive perinatal outcomes in women with previous UR. Results: Uterine rupture was significantly associated with previous uterine surgery, occurring, on average, at 36 weeks of pregnancy in women also without previous uterine surgery. UR did not rise exponentially with an increasing number of uterine operations. Fibroids were related to UR. The earliest UR occurred at 159 days after hysteroscopic myomectomy, followed by laparoscopic myomectomy (251 days) and laparotomic myomectomy (253 days). Fertility preservation was feasible in several women. Gestational age and birth weight seemed not to be affected in the subsequent pregnancy. Conclusion: Data analysis showed that previous laparoscopic and abdominal myomectomies were associated with UR in pregnancy, and hysteroscopic myomectomy was associated at earlier gestational ages. UR did not increase exponentially with an increasing number of previous scars. UR should not be considered a contraindication to future pregnancies. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the incidence of occult uterine sarcomas and investigate whether an accurate and well‐established preoperative assessment for uterine fibroids could help identify uterine sarcomas more effectively. Methods: A retrospective analysis of patients who underwent gynecological laparoscopic surgery for presumed uterine fibroids at Sant'Anna Hospital, a single tertiary institute in Turin, Italy, between January 2003 and December 2019. Results: Over the 17‐year period, 5826 laparoscopic surgical procedures (myomectomies or subtotal/total hysterectomies) were performed for presumed uterine fibroids. A total of 48 patients with a final diagnosis of uterine sarcoma were identified, the majority of which (n = 39; 81.3%) were recognized as suspicious uterine sarcomas during the preoperative assessment, and morcellement was avoided. The occurrence of unexpected uterine sarcomas was 0.1% (6/5826). Morcellation was conducted in one patient with uterine sarcoma. Conclusion: Analysis of our data showed that unexpected uterine sarcomas are uncommon. Accurate preoperative evaluation can help avoid, but does not exclude, the possibility of morcellation of unknown uterine sarcomas. Data analysis showed that unexpected uterine sarcomas are uncommon. Accurate preoperative evaluation can help avoid, but does not exclude, the possibility of morcellation of unknown uterine sarcomas. [ABSTRACT FROM AUTHOR]

Myomectomy improves the reproductive ability of women. However, the risk for uterine rupture and abnormal placentation remains a concern. In two cases with scar defects after laparoscopic‐assisted myomectomy, one case developed amniocele, while other case showed abnormally invasive placenta. Obstetrical management measures with cesarean sections yielded uneventful postoperative courses. [ABSTRACT FROM AUTHOR]

Here, we report a 41‐year‐old female with type II VUF after hysteromyomectomy.We report the diagnosis of VUF by imaging method, and provide a feasible treatment for this complication after pelvic surgery. [ABSTRACT FROM AUTHOR]

Aim: To report our initial experience with robotic single‐port myomectomy (RSPM) using the da Vinci SP surgical system and to evaluate the feasibility of the procedure. Material and Methods: This prospective observational study was performed at a university teaching hospital from January 2019 to December 2019. Sixty‐one women with symptomatic fibroids received RSPM. Results: Based on seven resected fibroids and a maximal diameter of resected fibroids <10 cm, the women were arbitrarily divided into two groups. The mean number and maximal diameter of the removed fibroids were 3.7 ± 3.8 (2.3 ± 1.8 in Group 1 vs. 7.2 ± 5.3 in Group 2) and 7.6 ± 2.9 cm (6.8 ± 1.6 in Group 1 vs. 9.5 ± 4.3 in Group 2), respectively. The mean operation time, hemoglobin change, and hospital stay were 149.9 ± 72.9 min (123.8 ± 43.8 in Group 1 vs. 217.6 ± 89.4 in Group 2), 2.3 ± 1.0 g/dL (2.1 ± 0.9 in Group 1 vs. 2.7 ± 1.2 in Group 2), and 4.5 ± 0.8 days (4.4 ± 0.8 in Group 1 vs. 4.7 ± 0.9 in Group 2). There was no conversion to multi‐port laparoscopy or laparotomy nor were there any major complications. Conclusions: RSPM using the da Vinci SP surgical system is feasible surgical modality for women with symptomatic fibroid and is expected to increase indications of single‐port myomectomy by solving many of the ergonomics problems inevitably accompanying single‐port laparoscopic myomectomy. [ABSTRACT FROM AUTHOR]

Performing laparoscopic myomectomy for an intracervical myoma, especially a single giant myoma, is challenging. Only skilled surgeons attempt this operation. Surgeons frequently encounter cases of massive intraoperative bleeding, difficulty suturing the cervical incision, risk of injuring the neighbouring tissues, haematoma formation and conversion to laparotomy or hysterectomy. We previously developed a the technique of loop ligation of the pseudocapsule and have been using it to treat sizeable intracervical myomas laparoscopically. Its advantages include less blood loss, lower risk of injuries to the neighbouring tissues, maintenance of the cervical canal and sparing of the pseudocapsule. This technique is safe and feasible, and facilitates fertility. The loop ligation technique is safe and feasible for laparoscopic myomectomy involving intracervical myomas. The loop ligation technique is safe and feasible for laparoscopic myomectomy involving intracervical myomas. [ABSTRACT FROM AUTHOR]

The article discusses the surgical options available for women with heavy menstrual bleeding who do not have (pre)malignant disease or large fibroids. The prevailing view that endometrial ablation should be the preferred surgical option is challenged, as satisfaction rates are higher with hysterectomy. The HEALTH trial compared laparoscopic supracervical hysterectomy (LSH) with endometrial ablation and found that LSH was more effective, with greater satisfaction and improvements in quality of life. However, LSH had longer recovery times and higher pain scores in the first 2 weeks following surgery. Women should be informed about both procedures and make a decision based on their preferences and the relative advantages and disadvantages. The notion that hysterectomy is a "last resort" should be abandoned. [Extracted from the article]