JSLS : Journal of the Society of Laparoscopic & Robotic Surgeons

Following Fibroids: An Analysis of Social Media Narratives

Many patients with uterine fibroids turn to social media for information, where fibroid-related content has grown substantially. To effectively address misconceptions and deliver high-quality, patient-centered care, physicians should be aware of the online information their patients encounter. This study analyzes fibroid-related content on social media to better understand the information being consumed. The top 100 "liked" posts using "#fibroids" were identified on Facebook, Instagram, and TikTok using a third-party web scraping tool. Post demographics and content were assessed by two reviewers and were included if they were in English and related to uterine fibroids. Information quality was measured with the DISCERN instrument; understandability and actionability were assessed using the Patient Education Materials Assessment Tool (PEMAT). A total of 300 social media posts were analyzed (100 per platform) from October 2019 to June 2024. TikTok posts had the highest engagement, with a median of 23,150 "likes" and 510,800 views. Content themes included promotional (51%), diet/supplements (41%), awareness (36%), and educational (33%). Alternative remedies were the most frequently mentioned treatment (46%), followed by surgery (29%) though with low mention of minimally invasive procedures (6.7%). DISCERN scores indicated poor information quality (mean 28.4), while PEMAT scores showed high understandability (mean 94.9%). Social media contains a large volume of mostly low-quality fibroid-related content and especially lacks representation of minimally invasive surgical options. Improved efforts are needed to promote accurate, evidence-based information online.

Comparative Outcomes of Laparoscopic Radical Hysterectomy and Nerve-Sparing Technique in Cervical Cancer Patients

Aim was to analyze and compare the oncological outcomes, genitourinary quality of life (QOL), disease-free survival (DFS), and overall survival (OS) of patients treated by laparoscopic radical hysterectomy (LRH) and laparoscopic nerve-sparing radical hysterectomy (LNSRH) for early cervical cancer. Retrospective study in patients of carcinoma cervix FIGO (2009) grade 1A to 2A1 from January 1, 2016 until the publication of Laparoscopic Approach to Cervical Cancer (LACC) trial in 2018, after which only 1A and 1B1 were included up to December 31, 2020. Total of 285 patients operated over 5 years at the center were placed in 2 groups, LRH and LNSRH, based on surgical approach. Tumor characteristics, clinical profile, tumor clearance, histopathology, adjuvant treatment, period of follow-up and recurrence were compared. The QOL was analyzed in terms of bladder and sexual function. LNSRH group had significantly faster recovery of bladder (lesser number of days required for PVR <50 mL, quicker catheter removal time, less requirement of self-catheterization, less incidence of urinary retention and incontinence) and sexual function as compared to LRH group. There was no significant difference in radicality of the procedure. None of them had vault recurrences. DFS at 5 years for LRH and LNSRH was 95.3% and 94.1%, respectively. OS at 2 years for LRH and LNSRH was 95.9% and 96.3%, respectively, whereas the OS at 5 years was 95.3% and 94.1%, respectively. LNSRH group had significantly better genitourinary QOL as compared to the LRH group without compromising on oncological clearance. The survival is comparable to the results of open surgery in LACC trial.

Minimally Invasive Myomectomy with Temporary Bilateral Uterine Artery Blockage at Anterior Cul-de-Sac

Minimizing intraoperative bleeding is pivotal in myomectomy, and blockage of uterine arteries has been reported as an effective approach. We developed a novel technique to temporary occlude bilateral uterine arteries at the anterior cul-de-sac in minimally invasive myomectomy (MIS), including minilaparotomy, laparoscopic-assisted myomectomy, and laparoscopic myomectomy. This study aims to evaluate the intraoperative and postoperative outcomes of this technique in complicated myomectomy cases. Twenty-seven patients underwent minimally invasive myomectomy by single minimally invasive surgeon using bilateral uterine arteries blockage. To match the complexity of myomectomy, 66 open cases performed by generalists were used for control. There were no significant differences in fibroid size, number, or weight between MIS and open myomectomy groups. For intraoperative outcomes, the MIS group showed longer operative time (271.3 ± 72.9 vs 179.9 ± 78.8 minutes, Temporary blockage bilateral uterine arteries enable the safe performance of complicated myomectomy via minimally invasive surgery.

Homemade Glove-Port Platform for Ovarian Teratoma Resection in Laparoscopic Single-Site Surgery

A New Silicon Sling Device for Traction During Robotic Gynecologic Surgery

One of the challenges of robotic gynecologic surgery is the appropriate traction of the organs and other structures surrounding the surgical field. We developed a novel traction device, Ureteral suspension was successfully and safely performed using We have developed a novel device,

Port-Site Metastasis in Gynecological Malignancies

Minimally invasive oncologic surgery has become the standard of care in many gynecologic cancers. While laparoscopic surgery provides many benefits to patients, such as faster recovery, there are unique challenges associated with minimally invasive techniques. Port-site metastasis is a rare complication after laparoscopic oncologic surgery in management of gynecologic malignancies. We present the case of a 44-year-old female with isolated port-site recurrence following laparoscopic radical hysterectomy with node-negative, clinical stage IB1 cervical adenocarcinoma. In addition, we provide an updated review of the literature on management and oncologic outcomes of port-site metastasis. Port-site metastasis prevention necessitates a better understanding of underlying risk factors and pathophysiology in order to optimize outcomes. Future studies are needed on risk-reducing strategies and standardization of management for port-site metastasis.

Strategies and Outcomes of Total Laparoscopic Hysterectomy for Large Uterine Cervical Fibroids

To present the methods and outcomes of total laparoscopic hysterectomy with debulking surgery for large cervical fibroids. This is a single-center study. Twenty-one women who underwent total laparoscopic hysterectomy between October 1, 2012 and November 30, 2020 for large cervical fibroids (diameter ≥10 cm) based on a diagnosis by magnetic resonance imagining were enrolled. Conventional total laparoscopic hysterectomy for large cervical fibroids was initially attempted. If this could not be completed, debulking surgery, such as enucleation of large cervical fibroids or cervical amputation, was performed during total laparoscopic hysterectomy. Total laparoscopic hysterectomy could be completed in all 21 patients with large cervical fibroids without blood transfusion. Conventional total laparoscopic hysterectomy was performed in four patients (19%), and 17 patients (81%) required debulking surgery at the time of total laparoscopic hysterectomy. The median diameter of the major axis of the cervical fibroid, uterine weight, intraoperative blood loss, and operative time were 12 cm, 750 g, 100 mL, and 191 min, respectively. Total laparoscopic hysterectomy for large cervical fibroids, although minimally invasive, requires a high level of laparoscopic skill. However, our data suggests that total laparoscopic hysterectomy for large cervical fibroids can be feasible, with an acceptable level of blood loss, by performing debulking surgeries such as enucleation of large cervical fibroids or cervical amputation.

Vaginal Closure Before Colpotomy with an Endo-Stapler to Prevent Tumor Spillage in Laparoscopic Surgery for Gynecological Malignancy

The aim of this study was to define new techniques for performing vaginal closure with endo-staplers to prevent tumor spillage during laparoscopic surgeries for endometrial cancer and early stage cervical cancer. Thirteen patients were retrospectively studied for the use of endo-staplers for vaginal closure before colpotomy during laparoscopic surgeries for endometrial cancer and early stage cervical cancer to prevent tumor spillage. There were no short-term or any long-term complication related to the use of the endo-staplers for colpotomy in the surgeries included in this study. Use of the endo-staplers to close the vagina before colpotomy according to the technique described is safe and feasible, with prevention of gross spillage of any malignant cells in the peritoneal cavity or vagina, which will further have a favorable oncologic outcome.

Challenges to Intraoperative Evaluation of Endometrial Cancer

Intraoperative evaluation of the uterus has been reported to predict risk of lymph node spread in endometrial cancer. Four criteria have been prospectively validated by the Mayo Clinic; histopathology, grade, tumor size, and depth of myometrial invasion. The objective of this study is to assess the accuracy of intraoperative evaluation in a university-affiliated teaching setting. This study was a retrospective chart review of 105 cases of endometrial cancer who underwent robotic-assisted staging from January 2016 through December 2017. Seventy-five cases were included. The mean age was 65 y and mean body mass index was 33 kg/m We conclude the Mayo Clinic Criteria cannot be universally adopted until all four criteria can be validated through a prospective study that includes institutions that have variable resources.

New Peritoneal Traction Device for Laparoscopic Paraaortic Lymphadenectomy

The development of devices that can be used to tract organs or other structures and secure an appropriate surgical field during laparoscopic surgery is clinically important. We developed a novel traction stitch, the Peritoneal traction was successfully and safely achieved using the

Factors Influencing CRP levels in Laparoscopic and Robotic Total Hysterectomy

Patients with high postoperative C-reactive protein levels are known to have a high risk of complications such as intestinal injuries than those with low levels. However, the factors that influence postoperative C-reactive protein levels in patients without complications are unknown. In this study, we aimed to determine the factors affecting postoperative C-reactive protein levels in patients undergoing laparoscopic and robotic total hysterectomy. We conducted a retrospective cohort study of patients who had undergone laparoscopic or robotic total hysterectomy for uterine fibroids, adenomyosis, or cervical neoplasia. The study was conducted between July 2016 and December 2022 at our hospital. In total, 185 patients underwent laparoscopic or robotic total hysterectomy during the relevant period. Of these, 180 patients were included, excluding 3 who underwent laparotomy, 1 who developed an abscess, and 1 who did not have a postoperative blood draw. The measured outcome was the C-reactive protein level on the first postoperative day. Patient age, body mass index, operative time, blood loss, and uterine weight were deemed the possible influencing factors. Multiple regression analysis was performed to evaluate the influence of these factors on the postoperative C-reactive protein values. Statistical significance was defined as a Patients' body mass index and operative time were found to be associated with first postoperative day C-reactive protein levels in uncomplicated cases.

Robotic-Assisted Surgery for the Treatment of Breast and Cervical Cancers

Robotic-assisted surgery facilitates the performance of numerous, complex procedures, namely conferring precision, flexibility, and control that is otherwise unavailable with conventional laparoscopy; and compared to open surgery, robotic-assisted surgery is ostensibly associated with fewer complications, reduced intraoperative complications, and shorter hospital stay duration. Nevertheless, the American College of Obstetricians and Gynecologists and the Food and Drug Administration have criticized the pervasive acceptance of robotic-assisted surgery, given the absence of randomized clinical trial data compared to traditional laparoscopy and open procedures, not to mention the increased surgical cost. While the research data continue to be borne out, surgeons should exercise considerable discretion in selecting the surgical approach from which their patients would derive the greatest clinical benefit.

Feasibility of Laparoscopic Para-Aortic Lymphadenectomy for Locally Advanced Cervical Cancer

Radiological evaluation of para-aortic lymph node metastasis in patients with locally advanced cervical cancer (LACC) possess the risk of missing microscopic metastasis. We commenced laparoscopic para-aortic lymphadenectomy (Lap-PAN) on patients with LACC for surgical staging in 2016. We assessed the feasibility of Lap-PAN in patients with LACC. We retrospectively reviewed the records of 31 patients with LACC who were staged at International Federation of Gynecology and Obstetrics (FIGO) 2009 IIB to IVA without enlargement of the para-aortic lymph nodes who underwent radiation therapy in our hospital between January 1, 2011 and December 31, 2018. The postoperative outcomes of Lap-PAN were analyzed, and distinct parameters for each patient, including sites of recurrence and disease-free survival, were compared between the Lap-PAN (n = 12) and no surgery (n = 19) groups. The average operation time for Lap-PAN was 167 min, and the estimated blood loss was less than 50 ml in all patients. There were no perioperative complications. The average number of excised lymph nodes was 25, and no pathological metastases were observed. There was no difference in disease-free survival rates between the Lap-PAN and no surgery groups (p = 0.42). During the follow-up period, there were two cases of recurrence in the cervix in the Lap-PAN group, and three and four cases of lung and para-aortic lymph node recurrence, respectively in the no-surgery group. Lap-PAN was safely performed as a pretherapeutic staging method for LACC without worsening patient prognosis. Although Lap-PAN requires a high level of skill, it may be a method to avoid excessive radiation for LACC.

Prospective Study on the Use of Endo-Stapler for Enclosed Colpotomy to Prevent Tumor Spillage in Gynecologic Oncology Minimally Invasive Surgeries

This is a prospective trial of the endo-stapler application for vaginal closure before colpotomy in cases of carcinoma endometrium and carcinoma cervix, managed by minimally invasive surgery with due consideration of its surgical technique and short-term oncologic follow-up outcomes. This was a prospective, single center study completed between March 1, 2020 and December 31, 2022. A total of 62 patients (43 cases of carcinoma endometrium and 19 cases of carcinoma cervix) were recruited for the study. Oncologic survival outcomes at the end of 1 and 2 years were documented. There were no major intraoperative bowel, urinary, or vascular injuries. None of the cases required conversion to laparotomy peroperatively. Our study had 8 patients with carcinoma endometrium (8/43) and 7 patients of carcinoma cervix (7/19) who have completed 24 months of follow-up without any recurrence to date. Endo-stapler application for enclosed colpotomy to prevent tumor spillage is a futuristic step in gynecologic oncology cases managed by laparoscopy.