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We present the findings of a prospective cohort study in a single tertiary hospital to review the patient experience and economic benefit of ambulatory hysteroscopy (AH). Data were collected between May 2017 and February 2020. Patient satisfaction was measured with qualitative survey. Hospital level financial data were obtained over two financial years (2017/18 and 2018/19) to identify seasonal variation. The primary outcome was patient satisfaction and the secondary outcome was cost of AH compared to hysteroscopy under GA. Three hundred and twenty-nine patients underwent AH. Two hundred and ninety-eight responses (91%) were collected. Ninety-five percent of procedures were successful. Median pain score was five out of 10. Despite pain, 94% of patients would undergo AH again and 97% would recommend it. The average hospital cost for AH was $259 compared with $3098 for hysteroscopy under GA. These findings support AH as a safe, well-tolerated and economically viable alternative to hysteroscopy under GA. What is already known on this subject? Hysteroscopy is traditionally performed in an operating theatre under general anaesthesia (GA). Technological advancements allow for the procedure to be performed in an outpatient setting. Despite advantages of ambulatory hysteroscopy (AH), GA hysteroscopy is still the predominant intervention in Australia. What the results of this study add? Patient satisfaction in AH was assessed. The median pain score was five out of 10. Despite pain, 94% of patients would undergo AH again and 97% would recommend it. What the implications are of these findings for clinical practice and/or further research? AH is a well-tolerated alternative to hysteroscopy under GA with significant cost benefits to the hospital and high patient satisfaction. Further research should focus on direct comparison of the two procedure approaches using randomised controlled trials. [ABSTRACT FROM AUTHOR]

Most adnexal masses are benign, incidental findings of pregnancy which resolve spontaneously. They may present clinically due to haemorrhage, rupture, torsion and mass effect. Aetiological classification includes ovarian benign, ovarian malignant, non-ovarian, gynaecological, non-ovarian non-gynaecological and an additional subset of pathologies unique to pregnancy. Ultrasound is the first-line imaging modality for the evaluation of adnexal masses. This may be supplemented with magnetic resonance imaging. Tumour markers support evaluation of malignant potential, but interpretation of results in pregnancy is challenging. Surgical intervention requires consideration of gestation, lesion characteristics and presence of complications. Laparoscopy is preferred owing to shorter operative time, quicker recovery and resultant lower thrombotic risk. Post-viability, fetal wellbeing and assessment must be considered. Management of the pregnancy may include cardiotocography, steroids, non-teratogenic antibiotics and tocolytics. In rare cases, particularly related to malignancy, termination of pregnancy may be required to enable immediate management where there are concerns for maternal wellbeing. [ABSTRACT FROM AUTHOR]

Background Musculoskeletal disorders (MSDs) are an occupational hazard amongst surgeons, causing detrimental effects in up to 20% of surgeons in their lifetime. However, there is a paucity of data examining solutions for the problem. There isalso a lack of research comparing MSDs in surgeons who perform open surgery compared with those who perform newer methods of surgery such as laparoscopic and robotic surgery. Aims We aim to explore existing literature about the various risk factors and the consequences of MSDs. We believe that by raising awareness of such risk factors to medical students from early on in their medical careers, they can develop an appreciation of the potential Jong-term impacts and take an early approach to prevention. We discuss preventative strategies in the categories of individual, occupational, institutional, and intra-operative techniques. Materials and Methods Ovid Medline, Cochrane Library, and PubMed databases were used to identify articles. Studies reporting on work-related MSDs in surgeons were included. Articles relevant to medical fields with a high level of surgical involvement, such as gynaecology, were also included. This information was used to construct a narrative review of the literature (see Appendix 1 for full methodology). Within each database search, only a few articles relevant to this review were generated. Therefore, the citations were also screened to find additional articles that fit within the scope of this review. Results Multiple factors were found to contribute to the development of MSDs, including individual and occupational factors, MSDs have resulted in a high percentage of surgeons performing fewer surgeries or taking more time off work. Similar risk factors applied to laparoscopic and robotic surgery. Few studies examined strategies to combat MSDs, but techniques such as intraoperative exercise and ergonomic training have shown to be promising. Conclusion There is a need for ongoing research into strategies to prevent MSDs in surgeons. Currently there are no evidence-based guidelines for management of work-related MSDs. Medical students should be aware that this occupational hazard has deleterious effects on the body and should be encouraged to employ some of the currently available strategies to prevent MSDs. The authors of this review advocate for ergonomics education to be integrated into surgical training programs via collaboration between ergonomists and surgical program directors. [ABSTRACT FROM AUTHOR]

Background: Transabdominal cerclage can reduce the risk of preterm birth in women with cervical insufficiency. Aims: This study evaluated outcomes following insertion of a laparoscopic transabdominal cerclage in pregnant women. Materials and methods: A retrospective observational study. Patients: pregnant women who underwent laparoscopic transabdominal cerclage from 2011 to 2017. Eligible women had cervical insufficiency and were not suitable for a transvaginal cerclage. Intervention: the insertion of a laparoscopic transabdominal cerclage in the pregnancy. Measurements: neonatal survival, delivery of an infant at ≥34 weeks gestation and surgical morbidity were evaluated. Results: Of 19 women who underwent laparoscopic transabdominal cerclage in pregnancy, at 6–11 weeks gestation, the perinatal survival rate was 100%. There were no complications. The average gestational age at delivery was 37.1 weeks. Sixteen women delivered after 34 weeks. Conclusions: Laparoscopic transabdominal cerclage is a safe and effective procedure in women with poor obstetric histories. It requires the correct skill, expertise and patient selection. [ABSTRACT FROM AUTHOR]

Objectives: There are no current established pathognomonic diagnostic features for uterine leiomyosarcomas in the pre- or perioperative setting. Recent inadvertent upstaging of this rare malignancy during laparoscopic morcellation of a presumed fibroid has prompted widespread debate among clinicians regarding the safety of current surgical techniques for management of fibroids. This study aims to conduct a systematic review investigating significant diagnostic features in magnetic resonance imaging (MRI) of uterine leiomyosarcomas. Methods: A comprehensive database search was conducted guided by PRISMA recommendations for peer-reviewed publications to November 2017. Parameters available in MRI were compared for reliability and accuracy of diagnosis of leiomyosarcomas. A decision tree algorithm classifier model was constructed to investigate whether T1 and T2 MRI signal intensities are useful indicators. Results: Nine eligible studies were identified for analysis. There appears to be a significant relationship between histopathological type and T1 and T2 intensity signals (p <.05). A decision tree model analyzing T1 and T2 signal intensity readings supports this trend, with a diagnostic specificity of 77.78 percent for uterine leiomyosarcomas. The apparent diffusion coefficient (ADC) values were not observed to have a significant relationship with tumor pathology (p =.18). Conclusions: Various studies have investigated pre- and perioperative techniques in differentiating uterine leiomyosarcoma from benign fibroids. Given the rarity of the malignancy and lack of pathognomonic diagnostic parameters, there is difficulty in establishing definitive criteria. A decision tree model is proposed to aid diagnosis based on MRI signal intensities. [ABSTRACT FROM AUTHOR]

Keywords: Minimally invasive surgical procedures; Gynecology; Thromboembolism EN Minimally invasive surgical procedures Gynecology Thromboembolism 60 60 1 02/02/21 20210201 NES 210201 Although VTE risk in minor gynaecological procedures is low, a systematic approach to prophylaxis is necessary Venous thromboembolism (VTE) is a rare but highly morbid risk of surgery that is largely preventable with appropriate prophylaxis.1,2 Methods of VTE prophylaxis range from conservative options with early ambulation, to mechanical compression devices used during and after surgery, to pharmacological prophylaxis with unfractionated or low molecular weight heparin. Pharmacological VTE prophylaxis offers no additional benefit to mechanical prophylaxis in low... The importance of VTE prophylaxis during and after surgery is well recognised, with most hospitals subscribing to a VTE prophylaxis protocol. [Extracted from the article]