Comparison of Laparoscopic Anterior Discoid Resection and Laparoscopic Low Anterior Resection of Deep Infiltrating Rectosigmoid Endometriosis

Anterior discoid resection is associated with a shorter operative time, lower blood loss, shorter hospital stay, and lower rate of anastomotic strictures than laparoscopic anterior resection is in the treatment of rectal endometriosis

HYSTEROSCOPIC MYOMECTOMY

Leiomyomas are the most common pelvic tumors. Submucosal fibroids are a common cause of abnormal bleeding and infertility. Hysteroscopic myomectomy is the definitive management of symptomatic submucosal fibroids, with high efficacy and safety. Several techniques have been introduced over time and will be covered in depth in this manuscript. Advances in optics, fluid management, electrosurgery, smaller diameter scopes, and tissue removal systems, along with improved training have contributed to improving the safety and efficiency of hysteroscopic myomectomy

Outcomes of laparoscopic management of chronic pelvic pain and endometriosis

This study was designed to determine the rates of reoperation following laparoscopic management of endometriosis, with additional aims to examine long-term fertility and quality of life outcomes. This is a retrospective study and a prospective questionnaire of subjects who underwent laparoscopic surgery for pelvic pain and/or endometriosis from 2010 to 2015. The rate of reoperation was 8.60%. Following surgery, 83.3% of previously infertile subjects with endometriosis attempted to conceive with an 80.0% success rate. Subjects had significant improvement in each quality of life measurement and most sexual function indices analysed.Impact Statement What is already known on this subject? Endometriosis is estimated to affect around 35–50% of women experiencing chronic pelvic pain and/or infertility. Surgical management of endometriosis is recommended for patients who desire fertility, are afflicted by a more severe form of endometriosis, or have had persistent or recurrent pain in spite of medical management. What the results of this study add? The overall rate of reoperation for subjects was low at 8.6%. The majority of infertile patients were able to conceive following surgery. What the implications are of these findings for clinical practice and/or further research? Laparoscopic management of endometriosis is an effective management tool with low rates of reoperation and high efficacy in treating infertility caused by endometriosis

Efficacy of hysteroscopy in improving fertility outcomes in women undergoing assisted reproductive technique: a systematic review and meta-analysis of randomized controlled trials

INTRODUCTIONUsefulness of hysteroscopy before assisted reproductive technique (ART) was considered debatable. However, over the last decade, several new trials were added to available literature. We aimed to assess the impact of diagnostic and operative hysteroscopy on reproductive outcomes of infertile women with and without intrauterine abnormalities.MATERIALS AND METHODSMEDLINE, Scopus, Scielo, EMBASE, Cochrane Library at CENTRAL, PROSPERO, CINAHL, grey literature, conference proceedings, and international controlled trials registries were searched without temporal, geographical, or language restrictions. Randomized controlled trials (RCTs) of infertile women comparing hysteroscopy versus no hysteroscopy prior to the first ART or after at least one failed attempt were included. RCTs of infertile women with intrauterine pathology comparing diagnostic vs operative hysteroscopy were included in separate analysis. Random-effect meta-analysis was conducted according to PRISMA guidelines. GRADE and Cochrane criteria were used for quality of evidence and risk of bias assessment. Primary outcome was live birth rate (LBR). Secondary outcomes were clinical pregnancy (CPR) and pregnancy loss rate (PLR).RESULTSFifteen studies (5038 women) were included. Compared to no hysteroscopy before first or after failed ART attempts, moderate quality evidence showed that hysteroscopy increased the LBR (relative risk (RR) 1.24, 95% confidence interval (CI) 1.09-1.43, I2=21%), confirmed by subgroup analysis for women with failure after one or more ART cycles (RR 1.43, 95% CI 1.19- 1.72, I2=0%) but not before the first ART. Moderate quality evidence showed that it increased the CPR (RR 1.36, 95% CI 1.18-1.57; I2=51%), confirmed in subgroup analysis for both implantation failure (RR 1.40, 95% CI 1.12-1.74, I2=52%) and before first ART (RR 1.32, 95% CI 1.11-1.57, I2=42%). Low-quality data suggest that operative hysteroscopy increases CPR when used to treat intrauterine pathologies (RR 2.13, 95% CI 1.56 - 2.92, I2=0%).CONCLUSIONSAlthough moderate quality evidence supports performing hysteroscopy before ART in women with history of implantation failure, hysteroscopic evaluation of uterine cavity should be considered a first-line technique in all infertile women undergoing ART. Additional high-quality RCTs are still needed, particularly to assess yield during couple's initial evaluation even before ART is considered. PROSPERO Registration number: CRD42023363344

International Consensus Statement for Recommended Terminology Describing Hysteroscopic Procedures

To develop a consensus statement of recommended terminology to use for describing different aspects of hysteroscopic procedures that can be uniformly used in clinical practice and research.Open forum discussion followed by online video meetings. Setting: International community of hysteroscopy expertsNot applicable.Series of online video meetings to complete a previously established agenda until a final agreement for standardized nomenclature was obtained.The adoption and implementation of a common terminology to standardize reporting of hysteroscopic procedures was proposed to cover five domains: pain management, healthcare setting, model of care, type of hysteroscopic procedure and the hysteroscopic approach to the uterine cavity. A final agreement was obtained after 3 online video meetings.Hysteroscopy is the gold standard technique for the evaluation and management of uterine disorders. A clear definition and understanding of the terminology used to describe hysteroscopic procedures is lacking. The production of this international consensus statement for terminology to describe hysteroscopic procedures, covering pain management, setting, model of care, type of procedure and hysteroscopic approach, has the potential to enable more effective communication for both clinical and research purposes with the ultimate aim of improving patient care and clinical outcomes