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Purpose To compare laparoscopic supracervical hysterectomy (LSH) with total laparoscopic hysterectomy (TLH) with regard to relevant surgical parameters and risk factors of conversion to laparotomy and complications. Methods This prospective, open, single-center, interventional study included women with benign gynecologic disease who underwent standardized LSH or TLH. The techniques were compared for conversion rate and mean operating time, hemoglobin drop, hospital stay, and complication rates using descriptive statistics and standard non-parametric statistical tests. Risk factors of conversion and complications were identified by logistic regression analysis. Results During January 2003 to December 2010, 1,952 women [mean age (SD): 47.5 (7.2) years] underwent LSH [1,658 (84.9 %)] or TLH [294 (15.1 %)], mostly (>70 %) for uterine fibroids. Significant differences in surgical parameters were observed for conversion rate (LSH/TLH: 2.6/6.5 %), mean operating time [87 (34)/103 (36) min], hemoglobin drop [1.3 (0.8)/1.6 (1.0) g/dL], and hospital stay [4.3 (1.5)/4.9 (2.8) days]. Overall intraoperative (0.2/0.7 %) and long-term (>6 weeks) post-operative (0.8/1.7 %) complication rates did not differ significantly, but the short-term LSH complication rate was significantly lower (0.6 vs. 4.8 %). Spotting (LSH, 0.2 %) and vaginal cuff dehiscence (TLH, 0.7 %) were long-term method-specific complications. Logistic regression showed that uterine weight and extensive adhesiolysis were significant factors for conversion while previous surgery, age, and BMI were not. Major risk factors of short-term complications were age, procedure (LSH/TLH), and extensive adhesions. Conclusions Both procedures proved effective and were well tolerated. LSH performed better than TLH regarding most outcome measures. LSH is associated with very low rates of re-operation and spotting.

International guidelines are published to provide standardized information and fertility preservation (FP) care for adults and children. The purpose of the study was to conduct a modified Delphi process for generating FP guidelines for BGD. A steering committee identified 42 potential FP practices for BGD. Then 114 key stakeholders were asked to participate in a modified Delphi process via two online survey rounds and a final meeting. Consensus was reached for 28 items. Among them, stakeholders rated age-specific information concerning the risk of diminished ovarian reserve after surgery as important but rejected proposals setting various upper and lower age limits for FP. All women should be informed about the benefit/risk balance of oocyte vitrification—in particular about the likelihood of live birth according to age. FP should not be offered in rASRM stages I and II endometriosis without endometriomas. These guidelines could be useful for gynecologists to identify situations at risk of infertility and to better inform women with BGDs who might need personalized counseling for FP.

The present study focused on the degree of tissue injury following single-port laparoscopic surgery (SPLS) and multiport laparoscopic surgery (MPLS) for the treatment of various benign gynecologic diseases. A total of 228 patients were prospectively enrolled at seven academic centers in South Korea between April 2011 and September 2012. Of these, 122 patients underwent SPLS and 106 patients underwent MPLS. The serum levels of C-reactive protein, creatine phosphokinase, lactic dehydrogenase and cancer antigen 125 were measured preoperatively and on postoperative day 4 by immunonephelometry. Cosmetic satisfaction and postoperative pain scores (visual analogue scale) were analyzed. Postoperative changes in the levels of the serum markers were found to be similar between the SPLS and MPLS groups. However, the postoperative pain scores at 48 h were significantly lower in the SPLS group when compared with those in the MPLS (P=0.001). In addition, patient-controlled analgesia was used more frequently by patients in the MPLS group (P=0.003). The present study is the first prospective investigation of tissue injury resulting from SPLS and MPLS in gynecology. In conclusion, the current study demonstrated that serum marker levels during SPLS were similar to those during MPLS in the treatment of benign gynecologic diseases. However, SPLS is a reasonable alternative to MPLS and is associated with comparable tissue injury, improved cosmesis and reduced postoperative pain.

Vesicovaginal fistulas (VVF) are the most commonly acquired fistulas of the urinary tract, but we lack a standardized algorithm for their management. Surgery is the most commonly preferred approach to treat women with primary VVF following benign gynaecologic surgery. To carry out a systematic review and meta-analysis on the effectiveness of operative techniques or conservative treatment for patients with postsurgical VVF. Our secondary objective was to define the surgical time and determine the types of study designs. PubMed, Old Medline, Embase and Cochrane Central Register of Controlled Trials were used as data sources. This systematic review was modelled on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, including a registration number (CRD42012002097). We reviewed 282 full text articles to identify 124 studies for inclusion. In all, 1379/1430 (96.4%) patients were treated surgically. Overall, the transvaginal approach was performed in the majority of patients (39%), followed by a transabdominal/transvesical route (36%), a laparoscopic/robotic approach (15%) and a combined transabdominal-transvaginal approach in 3% of cases. Success rate of conservative treatment was 92.86% (95%CI: 79.54-99.89), 97.98% in surgical cases (95% CI: 96.13-99.29) and 91.63% (95% CI: 87.68-97.03) in patients with prolonged catheter drainage followed by surgery. 79/124 studies (63.7%) provided information for the length of follow-up, but showed a poor reporting standard regarding prognosis. Complications were studied only selectively. Due to the inconsistency of these data it was impossible to analyse them collectively. Although the literature is imprecise and inconsistent, existing studies indicate that operation, mainly through a transvaginal approach, is the most commonly preferred treatment strategy in females with postsurgical VVF. Our data showed no clear odds-on favorite regarding disease management as well as surgical approach and current evidence on the surgical management of VVF does not allow any accurate estimation of success and complication rates. Standardisation of the terminology is required so that VVF can be managed with a proper surgical treatment algorithm based on characteristics of the fistula.

Background Gasless transvaginal natural orifice transluminal endoscopic surgery (G-vNOTES) can avoid complications related to pneumoperitoneum, but there is limited research on G-vNOTES. Here, we aimed to compare the hemodynamic profiles and outcomes of G-vNOTES with traditional vNOTES (T-vNOTES) in the treatment of patients with benign gynecologic disease. Methods A total of 120 patients with benign gynecologic disease were randomly assigned to G-vNOTES ( n  = 60) or traditional vNOTES ( n  = 60). The primary outcome was vital sign at different time points. Secondary outcomes included conversion rate, surgical time, anesthesia time, the usage of anesthetics, estimated intraoperative blood loss, visual analogue scale (VAS) score for abdominal and shoulder pain and postoperative nausea and vomiting (PONV) at 2 and 24 h, intraoperative and postoperative complications, time to first anal exhaust, eating, and getting out of bed after surgery, and length of postoperative hospital stay. Multi-level model analysis was used for intraoperative hemodynamic indicators. Results There was no significant difference between the two groups at the baseline level. The results of the multilevel model indicate that there is no difference in intraoperative hemodynamic performance between the G-vNOTE group and the T-vNOTES group. The conversion rate in the G-vNOTES group was higher than that in the T-vNOTES group (16.95% vs. 5.26%, p  = 0.046). No significant differences were observed in other areas. Conclusions This study did not find advantages of gasless vNOTES in intraoperative hemodynamic fluctuations. The surgical conversion rate of the G-vNOTES group is higher than that of the T-vNOTES group, which may be related to poor surgical field exposure in the G-vNOTES group, making it more suitable for experienced and confident surgeons.

Introduction Laparoscopy is widely used in benign gynaecological surgeries. However, postoperative gastrointestinal dysfunction, abdominal distension, abdominal pain, nausea, vomiting and delayed defecation are often negatively affected after surgery. At present, the management of gastrointestinal function in these patients is not standardised; therefore, this project used the available evidence to improve awareness and practice of standardised management of postoperative gastrointestinal function recovery in patients undergoing laparoscopic surgery for benign gynaecological diseases. Objectives This project aimed to standardise the management of postoperative gastrointestinal function recovery in patients undergoing laparoscopic surgery for benign gynaecological diseases according to best practice. Methods This study used clinical audit strategies under the JBI Practical Application of Clinical Evidence System (JBI PACES) module. An audit‐feedback cycle was used from September 2023 to December 2023. Twenty‐seven best practice recommendations were used for the audit cycle, and the baseline audit was conducted using 15 nurses and 45 patients in a gynaecological surgery ward. The Getting Research into Practice audit and feedback tool was used to identify the barriers, strategies, resources and outcomes. After implementing evidence‐based strategies, a re‐audit was conducted following the same number of samples and criteria. We analysed compliance with best practice and its impact on the degree of abdominal distension 24 h after the operation, the first flatus time and the first defecation time after surgery. Results After implementing best‐practice strategies, the compliance rate of the 27 criteria was as follows: the implementation rate of indicators 1, 2, 3, 4, 8, 9, 11, 12, 13, 14 and 18 remained above 80%, among which the implementation rates of indicators 1, 2, 3, 11, 12, 13, 14 and 18 reached 100%. The implementation rates of criteria 5, 6, 7, 10, 15, 19–27 had all improved, among which the implementation rate of criteria 6, 7, 19, 22, 23, 24 reached 100%, criteria 5, 10, 15, 16, 17, 20, 21, 25, 26, 27 were 93.56%, 90.89%, 6.67%, 87.89%, 70.56%, 86.40%, 88.89%, 60.67%, 70.89%, 78.60%, respectively. In the follow‐up audit cycle, the time of patients' first postoperative anal exhaust (Z = −4.810, p < 0.001) was shorter than the baseline audit group, the time of patients' first postoperative defecation time (Z = −2.934, p < 0.01) was shorter than the baseline audit group, and the degree of abdominal distension (Z = −2.567, p = 0.010 < 0.05) was reduced than the baseline audit group, which all showed statistically significant. Conclusions The results indicate that evidence‐based practice has significantly improved the management of gastrointestinal function in patients after laparoscopic surgery for benign gynaecological diseases, improved the implementation rate of audit criteria, shortened the time of first flatus and defecation and reduced the degree of abdominal distension after surgery.

Objective. To demonstrate various benign gynecologic diseases that can be performed by laparoendoscopic single-site surgery (LESS) with conventional laparoscopic instruments. Method. Patients with benign gynecologic diseases that need ovarian cystectomy, fallopian tube resection, or myomectomy were divided into experimental group and control group, and perioperative outcomes of these patients were analyzed. Results. From November 2017 to May 2018, 65 LESS gynecological surgeries were performed, among which there were 25 ovarian cystectomies, 28 unilateral fallopian tube resections, and 12 myomectomies. All the surgeries were completed smoothly, and only one surgery needed one more additional port. No patients have severe complications. Operative time, intraoperative blood loss, and perioperative complications have no difference between the two groups. The LESS laparoscopy group had less postoperative pain scores and longer bowel recovering time, compared with the conventional laparoscopy group (<0.05). Conclusion. Compared with traditional laparoscopy, LESS surgery with conventional laparoscopic instruments is feasible and safe, but postoperative exhaust time is longer than the control group.

Background Endometriosis is a chronic, estrogen-dependent, benign condition, affecting 10–15% of women of reproductive age. It is associated with a prevalence of sexual dysfunction that is nearly twice as high as that seen in women with other benign gynecological conditions. Our study aimed to assess the effect of surgical intervention on sexual function, as measured by the FSFI (Female Sexual Function Index) score, in women with endometriosis compared to those with other benign gynecological conditions, both before and after surgery. Methods A comparative analysis was conducted at the Medical University of Vienna from 2015 to 2020. The study included patients suspected of having endometriosis, fibroids, adnexal cysts, and/or infertility. Based on findings during surgery, patients were categorized into two groups: those with endometriosis ( n  = 64) and control patients ( n  = 38). All participants completed the FSFI questionnaire before surgery and again 8 to 18 weeks after the operation. Results No significant differences were observed in the preoperative FSFI scores between the endometriosis patients and the control group. Similarly, no significant differences were found between the two groups in postoperative scores. However, in women diagnosed with endometriosis, surgical removal of endometriotic lesions significantly increased their full-scale FSFI score, and resulted in a significant improvement in the areas “desire” and “satisfaction”. Improvements were noted in all other areas as well, though they were not statistically significant. Conclusions Our research indicates that the surgical removal of endometriotic lesions can lead to an improvement in sexual function, as measured by the FSFI, within 8 to 18 weeks post-surgery. This improvement was not observed in the control group, which underwent surgery for other benign gynecological issues.

Purpose The study aimed to create a deep convolutional neural network (DCNN) model based on ConvNeXt-Tiny to identify classic benign lesions (CBL) from other lesions (OL) within the Ovarian-Adnexal Reporting and Data System (O-RADS), enhancing the system's utility for novice ultrasonographers. Methods Two sets of sonographic images of pathologically confirmed adnexal lesions were retrospectively collected [development dataset (DD) and independent test dataset (ITD)]. The ConvNeXt-Tiny model, optimized through transfer learning, was trained on the DD using the original images directly and after automatic lesion segmentation by a U-Net model. Models derived from both training paradigms were validated on the ITD for sensitivity, specificity, accuracy, and area under the curve (AUC). Two novice ultrasonographers were assessed in O-RADS with and without assistance from the model for Application Effectiveness. Results The ConvNeXt-Tiny model trained on original images scored AUCs of 0.978 for DD and 0.955 for ITD, while the U-Net segmented image model achieved 0.967 for DD and 0.923 for ITD; neither showed significant differences. When assessing the malignancy of lesions using O-RADS 4 and 5, the diagnostic performances of two novice ultrasonographers and senior ultrasonographer, as well as model-assisted classifications, showed no significant differences, except for one novice's low accuracy. This approach reduced classification time by 62 and 64 min. The kappa values with senior doctors' classifications rose from 0.776 and 0.761 to 0.914 and 0.903, respectively. Conclusion The ConvNeXt-Tiny model demonstrated excellent and stable performance in distinguishing CBL from OL within O-RADS. The diagnostic performance of novice ultrasonographers using O-RADS is essentially equivalent to that of senior ultrasonographer, and the assistance of the model can enhance their classification efficiency and consistency with the results of senior ultrasonographer.