Facts, Views & Vision in ObGyn

Adhesions are a frequent, clinically relevant, and often costly complication of surgery that can develop in any body location regardless of the type of surgical procedure. Adhesions result from surgical trauma inducing inflammatory and coagulation processes and to date cannot be entirely prevented. However, the extent of adhesion formation can be reduced by using good surgical technique and the use of anti-inflammatory drugs, haemostats, and barrier agents. Strategies are needed in the short-, medium- and longer-term to improve the prevention of adhesions...

No abstract text is available yet for this article.

BACKGROUND: One in eight women will be diagnosed with breast cancer. At the time of diagnosis, 75% of patients are postmenopausal. Many will receive anti-hormone therapy, which often induces menopausal symptoms. Premenopausal breast cancer patients frequently become postmenopausal as a result of the treatment and often experience menopausal symptoms. The increased incidence of breast cancer, combined with longer survival, has led to an increase in the number of women experiencing menopausal symptoms...

BACKGROUND: Knot security of half-knot (H) sequences varies with rotation, but half-knots risk destabilisation. OBJECTIVES: To investigate the rotation of half-hitch (S) sequences on knot security. MATERIALS AND METHODS: The loop and knot security of symmetrical and asymmetrical sliding and blocking half-hitch sequences was measured using a tensiometer. RESULTS: Loop security of symmetrical sliding half-hitch sequences is much higher than asymmetrical sequences, increasing from 6+2 to 21+2 and from 27+6 to 48+5 Newton (N) for 2 and 4 half-hitches respectively (both P<0...

BACKGROUND: An isthmocele is a myometrial defect in the site of the caesarean scar. In symptomatic women with abnormal uterine bleeding and secondary infertility, surgical correction can be considered. Most authors advocate that when there's a residual myometrium ≥ 3mm it can be corrected through resectoscopic approach and when < 3mm the treatment should be laparoscopic, eventually guided by diagnostic hysteroscopy. Both these techniques have important limitations; therefore, the authors propose combining both techniques, in the same procedure, in order to overcome them...

BACKGROUND: In France, 62,000 hysterectomies are performed per year, 70% of which are benign. The choice of approach (laparotomy, laparoscopy or vaginal route) is particularly important in the case of large uterus (> 280g) which are associated with a higher risk of complications. The current data are not sufficient to favour one or other approach. A new medical device, the vNOTES (Natural Vaginal Orifice Transluminal Endoscopy System), offers the advantage of both laparoscopic and vaginal route for pelvic surgery...

Sacrocolpopexy is considered as the "gold standard" for management of women with apical prolapse. Numerous technical variants are being practiced. The first aim of this survey was to determine the habits of practice of laparoscopic sacrocolpopexy (LSCP) in Europe. The second aim was to determine whether surgeons who perform laparoscopic pelvic organ prolapse (POP) repair are familiar with the practice of alternative techniques and with mesh-less laparoscopic treatment of prolapse. The questionnaire was designed by the Urogynaecology Special Interest Group of the European Society for Gynaecological Endoscopy (ESGE)...

BACKGROUND: Endometrial Cancer (EC), the most common genital tract malignancy in women, is recognised to be associated with a high Body Mass Index (BMI). OBJECTIVE: The aim of the study was to evaluate the impact of obesity on intra and post-operative morbidity for patients treated for EC. MATERIALS AND METHODS: This was a retrospective observational study including patients with EC that were surgically treated at Hospital de la Santa Creu i Sant Pau during nine consecutive years...

BACKGROUND: Coronavirus disease 19 (COVID-19) has affected many aspects of the lives of medical professionals. Postgraduate training has also been affected and mitigation plans are still ongoing. OBJECTIVE: To understand the perspectives of trainees in obstetrics and gynaecology (ObGyn) during the pandemic. MATERIALS AND METHODS: A cross-sectional exploratory survey conducted electronically from 20th of April 2020 to 1st July 2020. MAIN OUTCOME MEASURES: The original questionnaire comprised of 40 questions and a free-text option...

BACKGROUND: Background: Myomectomy is often the preferred treatment for symptomatic patients with myomas who wish to preserve their fertility, with a shift from open surgery towards minimally invasive techniques. OBJECTIVES: Retrospective study assessing patient and surgery characteristics, follow-up, and outcomes of robot-assisted myomectomy (RAM) and abdominal myomectomy (AM) in women treated between January 1, 2018, and February 28, 2022, in a Belgian tertiary care hospital...

BACKGROUND: Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome has an incidence of 1 in 4000. The absence of the vagina and uterus results in sexual dysfunction and infertility. The first-line treatment is vaginal dilatation. There exists a number of second-line surgical options including the Uncu-modified Davydov procedure. OBJECTIVE: To determine the complication rate, anatomical outcomes, and long-term sexual outcomes of MRKH syndrome patients after Uncu-modified Davydov procedure...

BACKGROUND: Anonymized videotaped endoscopic procedures can be used for the assessment of surgical competence, but a reliable non-procedure-specific scoring system is needed for gynaecology. OBJECTIVES: To design and evaluate the validity of the Generic Laparoscopic Video Scoring System (GLVS), a novel tool in the assessment of various gynaecological laparoscopic procedures. MATERIALS AND METHODS: Seventeen anonymized unedited video recordings of various gynaecological laparoscopic procedures and the 4-minute-long edited versions of the same videos were independently scored by two experts, twice, using GLVS...

BACKGROUND: Updating evidence-based clinical practice guidelines is an onerous process and there is a call for more efficient determination of key questions that need updating. Especially for surgical techniques it is unclear if new evidence will result in substantial changes after wide implementation and if continuous updating is always necessary. OBJECTIVES: This study analyses the impact of updating a surgical guideline and proposes suggestions for optimising this process...

BACKGROUND: Management of endometriosis should be based on the best available evidence. The pyramid of evidence reflects unbiased observations analysed with traditional statistics. Evidence-based medicine (EBM) is the clinical interpretation of these data by experts. Unfortunately, traditional statistical inference can refute but cannot confirm a hypothesis and clinical experience is considered a personal opinion. OBJECTIVES: A proof of concept to document clinical experience by considering each diagnosis and treatment as an experiment with an outcome, which is used to update subsequent management...

Pelvic exenteration is a radical procedure representing a salvage option in patients with recurrent or persistent gynaecological malignancies. It can be performed with an open or minimally invasive approach. Different studies have demonstrated optimal peri-operative outcomes of minimally invasive pelvic exenteration with no survival difference when compared with an open approach. In this article, we discuss the importance and the challenge of patient selection for pelvic exenteration and more specifically for minimally invasive pelvic exenteration...

No abstract text is available yet for this article.

Pudendal neuralgia (PN) is a rare and underestimated condition. The reported incidence by the International Pudendal Neuropathy Association is 1/100000. However, the actual rate may be significantly higher, with a propensity for women. It is most frequently caused by an entrapment of the nerve at the level of the sacrospinous and sacrotuberous ligament, also known as pudendal nerve entrapment syndrome. Due to the late diagnosis and inadequate management, pudendal nerve entrapment syndrome often leads to considerable reduction in the quality of life and high health care costs...

Mullerian duct anomalies are prevalent in 4-7% of the female population and come in many different shapes and forms. A lot of effort has already gone into trying to classify these anomalies, and some are still found that do not match any of the subcategories. We report a 49-year-old patient, presenting with abdominal pressure and recent onset of abnormal vaginal bleeding. A laparoscopic hysterectomy was performed, which revealed a U3a-C(?)-V2 mullerian anomaly with three cervical ostia. The origin of the third ostium remains unclear...

BACKGROUND: Laparoscopic mesh sacrohysteropexy has been established as an effective, safe, and popular technique to treat uterine prolapse. Nevertheless, recent controversies regarding the role of synthetic mesh in pelvic reconstructive surgery have triggered a trend towards meshless procedures. Other laparoscopic native tissue prolapses techniques such as uterosacral ligament plication and sacral suture hysteropexy have been previously described in literature. OBJECTIVES: To describe a meshless minimally invasive technique with uterine preservation, which incorporates steps from the above-mentioned procedures...

BACKGROUND: A complete uterine septum, double cervix and vaginal septum is a complex and rare congenital genital tract anomaly. The diagnosis is often challenging and based on the combination of different diagnostic techniques and multiple treatment steps. OBJECTIVE: To propose a combined one-stop diagnosis and an ultrasound-guided endoscopic treatment of complete uterine septum, double cervix, and longitudinal vaginal septum anomaly. MATERIALS AND METHODS: Stepwise demonstration with narrated video footage of an integrated approach management of a complete uterine septum, double cervix and vaginal longitudinal septum treated by expert operators combining minimally invasive hysteroscopy and ultrasound...