Transvaginal natural orifice transluminal endoscopic surgery for ectopic pregnancy.

AIMS: This study aims to describe our transvaginal natural orifice transluminal endoscopic surgery (vNOTES) technique for ectopic pregnancy that can be performed using conventional laparoscopic equipment with the addition of a self-constructed pessary port and to evaluate the safety, feasibility, and outcomes of the technique. METHODS: This is a retrospective study evaluating outcomes of patients who underwent vNOTES for ectopic pregnancy (n = 21) between August 2019 and April 2021. RESULTS: Twenty-one patients underwent vNOTES as intended without any intraoperative complications. Three patients (14.3%) were nulliparous, 16 patients (76.2%) had no history of vaginal delivery, and 13 patients (61.9%) had a history of at least one cesarean delivery. Eight patients (38.1%) had a history of previous abdominal surgery other than cesarean section. The mean duration of surgery was 43.4 ± 12.6 min. The mean visual analog scale scores for pain were 2.45 ± 1.13 at 2 h after surgery, 0.45 ± 0.83 at 12 h after surgery, and 0.18 ± 0.36 at 24 h after surgery. The median duration of postoperative hospital stay was 1 day (range, 1-2). There were no postoperative complications within 30 days after surgery. CONCLUSIONS: vNOTES can be performed in an existing laparoscopy setup with the addition of a self-constructed pessary port. vNOTES is a safe and effective surgical treatment option for ectopic pregnancy, even in patients who have not had a vaginal delivery and have had multiple abdominal surgeries.

Prediction of clinical outcomes in women with placenta accreta spectrum using machine learning models: an international multicenter study.

INTRODUCTION: Placenta accreta spectrum is a major obstetric disorder that is associated with significant morbidity and mortality. The objective of this study is to establish a prediction model of clinical outcomes in these women. MATERIALS AND METHODS: PAS-ID is an international multicenter study that comprises 11 centers from 9 countries. Women who were diagnosed with PAS and were managed in the recruiting centers between 1 January 2010 and 31 December 2019 were included. Data were reanalyzed using machine learning (ML) models, and 2 models were created to predict outcomes using antepartum and perioperative features. ML model was conducted using python® programing language. The primary outcome was massive PAS-associated perioperative blood loss (intraoperative blood loss ≥2500 ml, triggering massive transfusion protocol, or complicated by disseminated intravascular coagulopathy). Other outcomes include prolonged hospitalization >7 days and admission to the intensive care unit (ICU). RESULTS: 727 women with PAS were included. The area under curve (AUC) for ML antepartum prediction model was 0.84, 0.81, and 0.82 for massive blood loss, prolonged hospitalization, and admission to ICU, respectively. Significant contributors to this model were parity, placental site, method of diagnosis, and antepartum hemoglobin. Combining baseline and perioperative variables, the ML model performed at 0.86, 0.90, and 0.86 for study outcomes, respectively. Ethnicity, pelvic invasion, and uterine incision were the most predictive factors in this model. DISCUSSION: ML models can be used to calculate the individualized risk of morbidity in women with PAS. Model-based risk assessment facilitates a priori delineation of management.

Prediction of success of uterus-preserving management in women with placenta accreta spectrum (CON-PAS score): A multicenter international study.

OBJECTIVE: To create a model for prediction of success of uterine-preserving procedures in women with placenta accreta spectrum (PAS). METHODS: PAS-ID is a multicenter study that included 11 centers from 9 countries. Women with PAS, who were managed between January 1, 2010 and December 31, 2019, were retrospectively included. Data were split into model development and validation cohorts, and a prediction model was created using logistic regression. Main outcome was success of uterine preservation. RESULTS: Out of 797 women with PAS, 587 were eligible. Uterus-preserving procedures were successful in 469 patients (79.9%). Number of previous cesarean sections (CS) was inversely associated with management success (adjusted odds ratio [aOR] 0.02, 95% confidence interval [CI] 0.001-3.63 with five previous CS). Other variables were complete placental invasion (aOR 0.14, 95% CI 0.05-0.43), type of CS incision (aOR 0.04, 95% CI 0.01-0.25 for classical incision), compression sutures (aOR 2.48, 95% CI 1.00-6.16), accreta type (aOR 3.76, 95% CI 1.13-12.53), incising away from placenta (aOR 5.09, 95% CI 1.52-16.97), and uterine resection (aOR 102.57, 95% CI 3.97-2652.74). CONCLUSION: The present study provides a prediction model for success of uterine preservation, which may assist preoperative and intraoperative decisions, and promote incorporation of uterine preservation procedures in comprehensive PAS protocols.

Is ursodeoxycholic acid crucial for ischemia/reperfusion-induced ovarian injury in rat ovary?

PURPOSE: Ursodeoxycholic acid is frequently used in cholestatic liver diseases. Also, it protects hepatocytes against oxidative stress induced by hydrophobic bile acids. We investigated the anti-oxidative effect of ursodeoxycholic acid on ischemia/reperfusion injury after ovarian de-torsion in rats. METHODS: We designed five study groups. Group 1 (n = 6): Sham-operated group; group 2 (n = 6): torsion group; group 3 (n = 6): torsion and ursodeoxycholic acid, group 4 (n = 7): torsion/de-torsion group; and group 5 (n = 7): torsion/de-torsion and ursodeoxycholic acid. After that, ovarian samples were obtained and examined histologically and tissue levels of malondialdehyde were measured. RESULTS: Follicular degeneration, edema and inflammatory cells were significantly decreased in groups 3 and 5 in comparison with groups 2 and 4. Also, groups 4 and 5 were compared in terms of vascular congestion and hemorrhage and these were found to be significantly decreased in group 5. In addition, levels of malondialdehyde were significantly decreased in groups 3 and 5 in comparison with groups 2 and 4. CONCLUSIONS: We concluded that ursodeoxycholic acid might be useful to protect the ovary against ischemia and reperfusion injury.

Effect of spaced training with a box trainer on the acquisition and retention of basic laparoscopic skills.

OBJECTIVE: To investigate whether basic laparoscopic skills acquired via structured spaced training on a box trainer persist after 6 months. METHODS: In a prospective study undertaken at the Ege University School of Medicine (Izmir, Turkey) between January 1, 2012, and June 1, 2013, 22 gynecology residents without previous laparoscopy experience were randomly assigned (1:1) to receive training with a box trainer (1 hour per week for 4 weeks) or to a control group. At baseline and at 5 weeks, residents' performance was assessed via the salpingectomy module of LapSim. The box trainer group was reassessed for skills retention 6 months later. RESULTS: The box trainer group performed significantly better than the control group in time (P=0.01) and economy of movement (P=0.001) at the final test. Error scores did not differ significantly. Deterioration between final and retention tests in the box trainer group were recorded in time (P=0.041), instrument path length (P=0.013), and instrument angular path (P=0.075). However, time and economy of movement scores were better at the retention assessment than at baseline (P=0.008 and P=0.003, respectively). CONCLUSION: Structured training with a box trainer improved laparoscopic skills, but deterioration was evident within 6 months. This deterioration should be considered when planning laparoscopic training programs.