Journal of Gynecologic Surgery

Journal Information
ISSN / EISSN: 10424067 / 15577724
Total articles ≅ 2,100

Latest articles in this journal

, Petra Voigt, Matthew D. Ponzini, Machelle D. Wilson, H. Amy Chen
Published: 20 January 2023
Journal of Gynecologic Surgery; https://doi.org/10.1089/gyn.2022.0093

Abstract:
Objectives: The effects of an algorithm for postoperative prescriptions on opioid-prescribing practices, pain-related postdischarge clinical encounters, and patient satisfaction were studied. Materials and Methods: A quality-improvement initiative was implemented at a single, tertiary-care, comprehensive cancer center. Perioperative patient education was restructured with detailed verbal and written components. An algorithm for postoperative discharge medications included prescribing nonopioid analgesics to all patients without contraindications. Opioid prescriptions were based on patients' length of stay and inpatient opioids' use. Data on opioids prescribed and postoperative encounters for pain were collected, and surveys at a postoperative visit were taken on patient satisfaction pre- and postintervention. Groups' results were compared. Results: The patients (107 preintervention and 90 postintervention) had similar demographics. The postintervention group had a 25% reduction in median number of opioids prescribed at discharge (p = 0.16), with similar patterns of postoperative encounters for pain and frequency of opioid refills. Patient satisfaction, assessed in 29 preintervention and 40 postintervention participants, had significant improvement; 95% postintervention participants answered that they were satisfied with their pain control, compared with 75% preintervention participants (p = 0.03). Conclusions: Perioperative education plus an algorithm for postoperative discharge medications in gynecologic oncology patients results in improved patient satisfaction, a trend toward fewer opioid prescriptions, and a similar pattern of postoperative pain encounters. Comprehensive perioperative education is effective for improving patient satisfaction and pairs well with an algorithmic approach to decreasing opioid prescriptions. (J GYNECOL SURG 20XX:000)
Thejus George, , Suruchi Pandey
Published: 12 January 2023
Journal of Gynecologic Surgery; https://doi.org/10.1089/gyn.2022.0101

Abstract:
Laparoscopic suturing is an important component of advanced gynecologic procedures. A needle may be inadvertently lost, and searching for it can be especially challenging. The goal of this review is to present useful strategies when this problem occurs. This article reviews current literature and suggests a structured approach for retrieving a lost needle. Preventive measures that reduce the risk of the needle being lost are also highlighted. A systematic search of a lost needle should cover all areas of the gynecologic surgical field, including the abdominal cavity, abdominal wall, laparoscopic cannulas, and the surrounding area. Intraoperative imaging, such as plain film X-ray or C-arm fluoroscopy, has been shown to be useful for localizing lost needles. The benefits and risks of conversion to laparotomy should be carefully evaluated if the needle remains missing after a prolonged search. The 7-step approach described in this article can be followed by laparoscopic surgeons faced with lost-needle occurrences. (J GYNECOL SURG 20XX:000)
, John A. Occhino
Published: 10 January 2023
Journal of Gynecologic Surgery; https://doi.org/10.1089/gyn.2022.0119

Abstract:
Pelvic organ prolapse is a highly prevalent condition that can have a large impact on a patient's quality of life. Multiple approaches to surgical repair exist, each with a unique set of risks and benefits. For patients with apical prolapse, repair of the apex is the cornerstone of any surgical procedure. Since adaptation of robotic techniques to sacrocolpopexy were introduced in the early 2000s, the minimally invasive approach to sacrocolpopexy has surpassed open case volumes. Compared to native-tissue transvaginal procedures, minimally invasive sacrocolpopexy offers potential advantages in durability. This article reviews surgical techniques, troubleshooting, outcomes, and ongoing areas of development regarding the use of a robotic approach to prolapse surgery. (J GYNECOLOGIC SURG 2023:000)
Adam Pyrzak, , Anne K. Grace, Emma L. Barber
Published: 23 December 2022
Journal of Gynecologic Surgery; https://doi.org/10.1089/gyn.2022.0107

Abstract:
Objectives: Centering is a unique form of counseling that unifies education and supporting patients with similar conditions to facilitate learning and develop a mutual support network. This study's primary objective was to evaluate the effect of centering preoperative counseling on anxiety scores in patients with newly diagnosed gynecologic malignancies. Secondary outcomes included the effect of this form of counseling on depression, compliance with preoperative instructions, hospital length of stay, and use of unscheduled health care resources. Materials and Methods: In this prospective cohort study, women with known or suspected gynecologic malignancies were assigned to standard-of-care counseling or centering. The centering cohort participated in a 1–1.5 hour online group-counseling session before surgery. All participants completed Patient-Reported Outcomes Measurement Information System® (PROMIS®) anxiety and depression patient-reported outcome (PRO) surveys at baseline, preoperatively, and 4 weeks postoperatively. Paired and unpaired t-tests were used to evaluate differences in PROs between timepoints and between the cohorts. χ2, Fisher's exact, and Wilcoxon rank-sum tests were used to evaluate secondary outcomes. Results: There were 17 patients in the standard-of-care cohort and 52 patients in the intervention cohort evaluated. The centering group had a reduction of 4.8 points in anxiety scores after the intervention. There was no difference in Enhanced Recovery After Surgery compliance or utilization of unscheduled health care resources between the 2 cohorts. Conclusions: Centering preoperative counseling meaningfully reduces anxiety scores in patients undergoing surgery for suspected gynecologic malignancy. (J GYNECOL SURG 20XX:000)
, Núria Barbany, Clara Platón, Pere Barri-Soldevila
Published: 13 December 2022
Journal of Gynecologic Surgery; https://doi.org/10.1089/gyn.2022.0094

Abstract:
Background: An interstitial ectopic pregnancy implants within the proximal and intramural portion of the fallopian tube that is enveloped by the myometrium. The high mortality rate in this type of pregnancy is due, in part, to delay in diagnosis, as well as from massive intraperitoneal hemorrhage. Excessive blood loss can occur after a rupture or during surgical treatment of an interstitial pregnancy. Several ways to reduce surgical blood loss have been reported. Our team's experiences and management tools are described in this article and in a video (Supplementary Video S1; supplementary data are available online at www.liebertonline.com/GYN) Both show a laparoscopic approach for managing an interstitial ectopic pregnancy to reduce the risk of uterine rupture and to preserve future fertility. To minimize surgical blood loss, both uterine arteries are temporarily occluded with surgical clips. Technique: Laparoscopic cornual resection of a left interstitial ectopic pregnancy involves: (1) successfully identifying the ureters and uterine arteries, and occluding the latter by surgical clipping; (2) making a circular incision in the left horn up to the gestational sac; (3) removing the cornual capsule and ipsilateral fallopian tube; (4) enucleating the entire gestational sac; and (5) suturing the myometrial bed and repairing the incision. Conclusions: Laparoscopic cornual resection is appropriate for interstitial pregnancy in patients wishing to preserve fertility. Temporary occlusion of bilateral uterine arteries using surgical clips is a safe, effective, blood-sparing intraoperative technique. (J GYNECOL SURG 20XX:000)
, Francesc Fargas, Francesc Tresserra, Ariel Glickman, Sonia Baulies, Pere Barri-Soldevila, Rafael Fábregas
Published: 12 December 2022
Journal of Gynecologic Surgery; https://doi.org/10.1089/gyn.2022.0096

Abstract:
Objective: Vulvar extramammary Paget's disease (EMPD) is a rare intraepithelial adenocarcinoma of the vulvar skin. This study evaluated the clinical characteristics, treatment modalities, and oncologic outcomes in patients with vulvar EMPD. Materials and Methods: Cases of patients who were treated for vulvar EMPD between 1994 and 2022 were identified. Patient demographics, associated malignancies, treatments, histopathologic features, need for re-operations, and long-term outcomes were documented. Results: The study involved 10 patients with vulvar noninvasive EMPD, with a median age of 57 (31–86) years. None of the patients had prior malignancies. The index operations performed were wide local excision with reconstructive surgery (5 patients) and vulvectomy with reconstructive surgery (3 patients). Seven patients were positive for margin involvement. Five patients developed recurrences. The mean time of the first recurrence was 32.6 (4–88) months. All recurrences were treated with reoperations. Only 1 associated malignancy was found: cervical cancer. There was no disease progression in any of the patients who were followed; of the 10 patients, 2 were lost to follow-up. Conclusions: EMPD is characterized by a high tendency to recur after surgical resection. Surgical management can be a challenge due to the high rate of residual tumors in the surgical margins. (J GYNECOL SURG 20XX:000)
Alexandra L. Martin, Susan Read, Nadim Bou Zgheib, Jing-Yi Chern, Hye Sook Chon, Mian M. Shahzad, Robert M. Wenham, Mitchel S. Hoffman
Published: 5 December 2022
Journal of Gynecologic Surgery; https://doi.org/10.1089/gyn.2022.0084

Abstract:
Objective: Left adnexectomy and/or pelvic lymphadenectomy often require mobilization of the sigmoid colon to gain adequate exposure, which involves division of peritoneal attachments of the sigmoid colon. Variations in native sigmoid attachments and techniques needed to achieve adequate mobilization have not been well-described. Materials and Methods: This was a prospective cohort study of patients undergoing laparotomy, laparoscopy, or robotic surgery by a gynecologic oncologist. Exclusions were patients who had pelvic surgery (other than tubal ligation), pelvic radiation therapy, concurrent pelvic inflammatory processes, or extensive pelvic peritoneal disease (e.g., ovarian cancer, severe endometriosis). Detailed patient and clinical data were collected, along with anatomical findings in the sigmoid colon, such as diverticula; length; and sigmoid colon attachments relative to the infundibulopelvic ligament (IPL), broad ligament, and posterior cul-de-sac. Results: Of the 92 patients in the study, 75 had peritoneal attachments of the sigmoid colon or its mesentery. The most-common attachment location was lateral to the IPL only (n = 27; 36%), followed by lateral to the IPL and to the IPL (n = 15; 20%). The most-common type of attachment was congenital (n = 60; 45.5%), followed by adhesive (n = 58; 45%). Congenital attachment lateral to the IPL was the most-common at 24% of all documented attachments. Conclusions: Peritoneal attachments of the sigmoid colon are a common finding of natural anatomy and may be complex and/or multifocal, even in patients without risk factors. Knowledge of the peritoneal lines of attachment is important for having adequate exposure when performing left adnexectomy and/or pelvic lymphadenectomy. (J GYNECOL SURG 20XX:000)
Anna Zelivianskaia, Arthur Arcaz, Paul Kolm, James K. Robinson, Nicholas Hazen
Published: 5 December 2022
Journal of Gynecologic Surgery; https://doi.org/10.1089/gyn.2022.0106

Abstract:
Objective: Many uterine procedures cause intrauterine adhesions (IUAs). The standard of care (SOC) for detecting IUAs includes initiating a work-up after a patient reports such symptoms as menstrual irregularity, pelvic pain, or infertility. Routine hysteroscopy (RHSC) is not currently performed after an event that may cause an IUA. This study objective was to determine if routine diagnostic HSC following procedures that are high risk for causing IUAs could be a cost-saving alternative to the current SOC from both medical-system and patient perspectives. Materials and Methods: This nonclinical economic-modeling exercise involved a hypothetical cohort of women who received office RHSC after an inciting event, compared to women who received SOC. The model had 4 scenarios for a range of diagnostic work-up costs and costs of HSC lysis of adhesions of varying severity. Each scenario was run with a proportion of IUA formation after an inciting event varying from 1% to 99%. Results: Costs of RHSC became equivalent to the SOC with an IUA incidence rate from 5% to 22%, depending on the cost of the work-ups. For less expensive work-ups, RHSC yielded cost savings of 18%–22%, with an IUA rate depending on the HSC treatment costs. For more expensive work-ups, including full infertility work-ups, RHSC provided cost savings for only 5% of IUAs in a given cohort of patients. Conclusions: The model demonstrated that RHSC after a procedure known to cause IUAs can be cost-saving in many clinical scenarios. Accounting for various infertility work-up cost estimates and gradients of adhesion severity, RHSC costs were equivalent to SOC with an IUA formation rate of 5%–22%. This suggests that RHSC could be considered in reproductive-age women who desire fertility after procedures known to cause IUAs, without expected increased costs to the medical system. Additionally, RHSC may confer health benefits and increase patient satisfaction due to earlier diagnosis and less loss of reproductive years. (J GYNECOL SURG 20XX:000)
Mitchel S. Hoffman
Published: 1 December 2022
Journal of Gynecologic Surgery, Volume 38, pp 371-371; https://doi.org/10.1089/gyn.2022.0099

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