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Introduction Endometriosis is a benign gynecologic disorder that is defined as functional endometrial tissue outside of the uterine cavity. It is an estrogen-dependent, inflammatory disease that leads to symptoms of pelvic pain, dysmenorrhea, dyspareunia, and infertility, occurring in 6-10% of reproductive aged women. The severity of the disease ranges from asymptomatic to debilitating symptoms that have a major impact on women's lives. It is a chronic, recurrent disease, frequently requiring long term management until menopause and beyond. It is considered a chronic disorder that is managed with surgery, medical treatment, and oftentimes, both. Current medical therapy for endometriosis is considered suppressive of the disease, rather than curative. Fortunately, many patients do experience improvement and control of their symptoms with medical therapy. However, long-term efficacy of the medical treatments is often limited by side effects and the cost of therapy, and symptoms do tend to recur after discontinuation of these medications. Areas covered This review summarizes our understanding of the pathogenesis of endometriosis and provides more in-depth discussion of specific medical management options used to treat endometriosis, including mechanism of action and side effects. It also provides recommendations on strategy with a forward look to novel endometriosis treatments in the future. Expert opinion The authors emphasize that endometriosis is a chronic disorder requiring long term medical therapy. Early diagnosis of endometriosis is key in preventing severe, debilitating symptoms and progression of disease. By utilizing our current knowledge of the pathophysiology of endometriosis and by correctly implementing currently available medical and surgical therapies we can significantly reduce the physical, psychosocial and financial burden of this chronic, recurrent and indolent disease. Current available medications are suppressive therapies, but the authors are looking forward to future therapies that can effectively cure or at least control endometriosis with minimal side effects. Future research should continue to look for the genetic trigger for endometriosis which can lead us to its underlying pathogenesis and eventually a cure or prevention.

OBJECTIVES This study aims to identify risk factors for elevated preoperative postvoid residual (PVR) and persistently elevated postoperative PVR and to evaluate the resolution rate of elevated PVR urine volume in patients undergoing reconstructive surgery for pelvic organ prolapse (POP). METHODS This was a retrospective cohort study comparing 50 women with elevated preoperative PVR (≥100 mL) and 50 women with normal PVR (

Study Objective We aim to present a combined hysteroscopic and laparoscopic approach to the resection of a post-cesarean section scar causing complete obstruction of the endometrial cavity. Design Video presentation. Setting Ambulatory surgery center, academic hospital. Patients or Participants 31-year-old multiparous patient with history of c-section who presented with secondary amenorrhea and infertility due to Asherman's Syndrome. She underwent laparoscopic guided hysteroscopic adhesiolysis followed by postoperative hormone therapy and close follow up. Interventions The patient's workup included saline infusion sonohysterogram, 2D ultrasound, and 3D ultrasound. She underwent a combined hysteroscopic and laparoscopic procedure in which hysteroscopic scissors were used to remove the adhesion under laparoscopic guidance. An intrauterine balloon catheter was placed postoperatively. She took postoperative antibiotics while the balloon remained in situ as well as postoperative hormone therapy to promote growth of healthy endometrium and prevent new adhesion formation. Measurements and Main Results The use of a combined hysteroscopic and laparoscopic approach resulted in a safe and successful removal of post-cesarean uterine scar tissue and treatment of Asherman's Syndrome with subsequent resumption of menses. Conclusion Asherman's Syndrome should remain on the differential for women who present with secondary amenorrhea. The addition of 3D ultrasound to saline infusion sonohysterogram is useful for surgical planning. A combined hysteroscopic and laparoscopic approach to the resection of uterine adhesions should be considered when managing severe cases of Asherman's Syndrome and dense adhesions, especially when the location of adhesions is not clear from imaging.

Background Hysterectomies are the most common benign gynecologic surgical procedures performed in the United States. Currently, there are no tissue models that exist to teach trainees the techniques for colpotomy during laparoscopic hysterectomy. To address this educational gap, we have created a laparoscopic colpotomy model using a porcine stomach attached to a uterine manipulator. Methods A segment of a porcine stomach is secured onto a uterine manipulator to simulate the cervicovaginal junction. A uterus model created with craft materials and reused in subsequent sessions is placed above the porcine stomach onto the uterine manipulator tip. Porcine stomach was obtained from a local butcher or meat market costing less than $1.00 per model. The tissue can be refrigerated or frozen for storage, then thawed before each use. This model can be used with any energy device and any laparoscopic platform to teach and perform the colpotomy. Usability survey showed that trainees responded positively to the model and attendings thought it was a useful teaching tool. Experience Trainees and faculty responded favorably to the model and stated that the use of actual tissue enhanced the realism of a colpotomy simulation. Conclusion The porcine stomach laparoscopic colpotomy model is an innovative, low-cost teaching tool to add to a gynecologic surgical education simulation toolkit.

The practice of obstetrics and gynecology poses specific ethical challenges for informed consent (IC). Data regarding resident confidence with the IC process are lacking. Our objective was to evaluate obstetrics and gynecology residents' education, experience, and confidence related to IC.This was a cross-sectional survey of obstetrics and gynecology residents. Descriptive analyses were performed using mean and standard deviation or frequency expressed as a percentage. The results were analyzed for statistical significance using chi-square or Fisher's exact tests for categorical variables and Student t or Mann-Whitney U tests, as appropriate, for continuous variables; all results yielding p0.05 were deemed statistically significant.Electronic survey.Two hundred eighty-one trainees completed the survey. The majority of participants were female (84.3%) and from an academic training program (65.1%). Two hundred seventy-seven trainees (98.6%) reported that they had obtained IC for operating room procedures; the majority had first done this in the first postgraduate year (PGY) (n = 258, 91.8%). Trainees most commonly obtain IC for resident and general gynecology attending cases. Most trainees primarily learn how to obtain IC via observation of their coresidents and attendings. Nearly 90% of trainees have obtained IC for a procedure for which they were unsure of all the risks. One hundred seventy-three trainees (61.6%) reported that they would like to have more training in IC. Increasing PGY was significantly associated with increasing confidence in obtaining IC for gynecologic, obstetric, and office procedures (all p0.01). There were no differences based on PGY in frequency of reviewing who will perform the surgical procedure (p = 0.75), how trainees will be involved in the procedure (p = 0.35), review of alternative treatments (p = 0.91), or in documentation of the IC process (p = 0.16).Based on the findings of this survey study, education related to the IC process is warranted and curriculum development should be the focus of future study.

Study Objective To compare postoperative incisional pain on postoperative days (PODs) 1 and 14 when using a fascial closure device (FCD) versus a traditional fascial closure (TFC) of the 12-mm upper quadrant port during robotic surgery. Time required to close the incision was also compared. Design Randomized controlled trial (Canadian Task Force classification I). Setting Two academic affiliated hospitals, The Hospital of Central Connecticut and The University of Connecticut. Patients Women undergoing robotic surgery for benign indications by minimally invasive gynecologists at our institutions between November 2012 and October 2014 were enrolled in the study at their preoperative visit. Interventions Patients were randomized to either an FCD or TFC immediately before closure of the fascial incision. Pain score using a 10-point analog pain scale was recorded on POD 1 and POD 14. Time to close the fascial incision, length of surgery, and body mass index were also recorded. Measurements and Main Results Sixty-seven patients were enrolled, and 65 were randomized at the time of the fascial closure, whereas 2 enrolled patients converted to laparotomy. Statistical analysis demonstrated that pain scores differed by fascial closure technique. Mean pain scores on POD 1 were 3.43 ± 2.48 and 2.06 ± 2.03 for the FCD and TFC, respectively (p = .028). On POD 14 the mean pain scores were 1.97 ± 2.48 and .83 ± 1.42 for the FCD and TFC, respectively (p = .102). Times to close fascia were 106.5 ± 102.28 seconds and 141.97 ± 102.85 seconds for the FCD and TFC, respectively (p = .138). Conclusion Our study demonstrates that at POD 1 the use of the fascia closure device results in higher pain scores without a significant difference in closure time.

This article discusses the continued subordination of Third World women, despite the protections implemented by international law. The author focuses on the experience of impoverished women living in rural areas, and how initiatives implemented by international organizations and international human rights documents such as the Convention on the Elimination of All Forms of Discrimination against Women, although well-intentioned, have not been successful in improving the social and economic position of women. In analyzing these initiatives, the author adopts a Third World Feminist Approach, concluding with a discussion of the reliance of Thirld World women upon models outside the realm of international law in order to improve their rights and economic status.