Exploring the Evolution of Robotic Surgery in Obstetrics and Gynecology: Past, Present, and Future Perspectives.

Robotic surgery has emerged as a transformative technology in obstetrics and gynecology, offering enhanced precision and minimally invasive techniques for various procedures. This paper explores the evolution of robotic surgery in obstetrics and gynecology, examining its historical development, current applications, and prospects. Through a comprehensive review of the literature and case studies, we highlight the benefits of robotic surgery, including reduced trauma, improved patient outcomes, and increased surgeon capabilities. However, cost, training requirements, and regulatory concerns hinder widespread adoption. Continuing technological innovation is expected to enhance the efficacy and applicability of robotic-assisted procedures. Collaboration between healthcare professionals, researchers, and industry stakeholders is essential to address these challenges and ensure optimal patient care. By embracing the opportunities presented by robotic surgery while addressing associated challenges, practitioners and researchers can contribute to the continued advancement of this transformative technology in obstetrics and gynecology.

An Incidental Diagnosis of Herlyn-Werner-Wunderlich Syndrome in a Young Female: A Case Report of a Rare Entity.

Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome, a rare genetic condition of the urogenital system, is characterized by distinctive features such as ipsilateral renal agenesis, obstructed hemivagina, and uterus didelphys. It is also referred to as Herlyn-Werner-Wunderlich (HWW) syndrome. Its clinical manifestations include dysmenorrhea, consistent abdominal pain, and infrequent periods. It is typically diagnosed after menarche. We report a case of a 20-year-old female who was admitted to the casualty ward following a road accident. She was Incidentally found to have uterine didelphys with hemorrhagic cystic lesion and left renal agenesis on ultrasonography (USG). She also had gallbladder stones, along with the findings mentioned above. Clinicians should exclude HWW syndrome in cases where uterine didelphys and unilateral renal agenesis coexist. Prompt identification and treatment of the condition can help avoid potential untoward pregnancy-related issues in the future.

First-Trimester Pregnancy Loss Due to Condyloma Acuminata: A Twisted Tale of Gravidity.

The human papillomavirus can induce condyloma acuminata, a benign papillomatous squamous growth with a fibrovascular core that arises in the vaginal canal. These illnesses typically afflict women who are fertile and are frequently encountered during pregnancy, manifesting with a variety of symptoms. The influences of hormones and vaginal secretions cause the lesion to expand quickly during pregnancy. Viral infections are known to be one risk factor for threatening abortions. Infection with human papillomavirus (HPV) during pregnancy has been associated with a risk for spontaneous abortion, preterm delivery, and abnormalities in the placenta. There are many therapeutic approaches available to address the disease; however, it is still unclear which one is the most successful. Additionally, organogenesis is crucial throughout the first trimester, and treatment during this period may elevate the risk of spontaneous abortion. Here, we describe the case of a young woman who experienced vaginal lesions during the first trimester of her pregnancy.

Prophylactic Use of Uterine Artery Embolization to Decrease Bleeding in Laparoscopic Myomectomy: A Case Report.

Uterine fibroids, or leiomyomas, are the most frequent benign tumors affecting the female reproductive system, particularly during the reproductive years. The case report that follows presents the diagnosis and treatment of uterine fibroids in a female patient. The 33-year-old female patient in this instance arrived at the tertiary rural hospital with an abnormally large, bloated belly. Upon examination and imaging, it was discovered that the patient had multiple fibroids growing inside her uterus. Here, we present a successful management of uterine leiomyoma with laparoscopic myomectomy where we performed uterine artery embolization before surgical management in order to minimize blood loss during surgery. The case highlights the significance of collaboration between gynecologists, surgeons, and interventional radiologists. Thanks to their combined expertise, the patient was given a variety of treatment options, such as minimally invasive treatments, surgical interventions, and medication therapy. Decision considerations included the consequences of fibroids and the patient's age and desire to preserve fertility. The effect of fibroids on her life expectancy is taken into account. This case emphasizes how important it is to embolize the uterine arteries before having a myomectomy to cure large uterine leiomyomas successfully.

Therapeutic Management of Giant Uterine Fibroid: A Case Report.

The most common benign tumor that affects female reproductive system is a uterine fibroid or leiomyomas, especially during their reproductive years. The prevalence is around 20-40% women in the age group of 14-45 years. The following case report proffers the diagnosis and management of a female diagnosed with uterine fibroids. In this case a 45-year-old woman presented to the tertiary rural hospital with an unusually large distended abdomen which on examination and imaging revealed a big fibroid growing inside the uterus. The case highlights the significance of a collaborative approach involving gynecologists, interventional radiologists, and surgeons. Their combined expertise provides patients with various treatment options: medical management, minimally invasive procedures, and surgical interventions. During the decision-making process, factors such as the patient's age, desire for fertility preservation, and impact of fibroids on her quality of life are taken into account. This particular case showcases successful pre-hysterectomy uterine artery embolization of large uterine leiomyoma while emphasizing the importance of personalized care and shared decision making for optimal patient outcomes.

Primary Fallopian Tube Carcinoma Presenting as a Broad Ligament Fibroid: A Rare Case.

Primary fallopian tube carcinomas (PFTCs) are quite rare with the incidence ranging from 0.3% to 1.1% amongst all the gynaecological malignancies. Here, we present a rare case of a 44-year-old female (parity-2, live-2 and abortion-2), with one previous classical caesarean section and one vaginal birth after caesarean section (VBAC), bilateral tubal ligation done referred to our gynaecology OPD with complaints of pain in the abdomen since the past six days. The patient also had complaint of spotting per vagina for the past two months. Her ultrasonography and contrast-enhanced CT abdomen and pelvis were suggestive of broad ligament fibroid, which turned out to be a PFTC. Primary fallopian tube malignancies are so rare that this entity may be missed in routine clinical practice and surprisingly noticed during operative procedure or on histopathology reports. Thus, one must be aware of this rare clinical entity and keep it in mind while taking patients on the operating table.

Novel Advances in the Role of Selective Estrogen Receptor Modulators in Hormonal Replacement Therapy: A Paradigm Shift.

Estrogen is a key regulatory hormone in the functioning of a female reproductive system. Estrogen hormone regulates many complex physiological processes, which has its role in reproduction and skeletal and cardiovascular systems by acting on estrogen receptors alpha (ERα) and beta (ERß), which are nuclear transcription factors. Selective estrogen receptor modulators (SERMs) are now being used to treat bone loss, breast carcinoma, and menopausal symptoms, metabolic neurodegenerative because of their characteristics that allow them to function as both estrogen agonists and antagonists, depending on the target tissue. First-generation SERMs, such as Tamoxifen, are used in the management protocol for breast cancer, which is estrogen receptor (ER-positive). Raloxifene is a second-generation SERM that is a valuable adjunct used to treat and prevent osteoporosis in postmenopausal women and prevent compression fractures of the vertebral column. Novel SERM molecules are on the horizon, proven more potent and efficacious in preventing and treating osteoporosis. These include Ospemifene, lasofoxifene, bazedoxifene and arzoxifene. The benefits of Raloxifene versus that of Bazedoxifene are under trial. Despite their therapeutic benefits and actions, these medications are not without adverse effects, such as thromboembolic disorders. Increased risk of uterine cancer has been linked to Tamoxifen. This article delves into the world of SERMs, including their development and discovery. The newer SERMs in late development, ospemifene, lasofoxifene, bazedoxifene, and arzoxifene, are described in detail.

A Case of Chemical Pregnancy in a Female With Turner Syndrome.

Turner syndrome (TS) is a genetic anomaly that is characterized by the absence of an X chromosome, either completely or partially. Primary amenorrhea, short stature, webbed neck, cubitus valgus, and a little intellectual disability are some of the characteristics. Infertility is also one of the most common clinical symptoms of TS-affected females. With the advent of assisted reproductive technology (ART), chances of childbearing possibilities for TS females have risen. Infertility issues in females with TS are challenging, but they can be managed with proper counseling and ART by artificial implantation, oocyte donation, and others. This case report aims to present the case of a 27-year-old female who had not attained her menarche and wanted to conceive. She was diagnosed with TS on the basis of clinical and laboratory investigations. The patient was, thereafter, treated for infertility by oocyte donation and conceived successfully.

Type 2 Diabetes Mellitus in Patients With Polycystic Ovary Syndrome.

Polycystic ovary syndrome (PCOS) is a multisystemic disorder usually seen in females who are in their reproductive age (15-49 years of age). PCOS exhibits insulin resistance and hyperinsulinemia, which make it a pre-diabetic state. The syndrome has many overt changes, like dyslipidemia and hypertension, which increase the risk of cardiovascular diseases. There is also an increased risk of development of hepatic steatosis. Resistance to insulin, increased amount of insulin, and dysfunction of beta-cells are frequent in PCOS, although they are not the only cause for diagnosis. Type 2 diabetes and glucose resistance may result from total or compared insulin insufficiency, which can happen if the beta cells' compensatory response slows down. Pregnancy challenges such as miscarriage, gestational diabetes mellitus (DM), hypertensive disorders of pregnancy, more excellent rates of cesarean birth, and abnormalities in fetal development may be more common in women with PCOS. In studies investigating the glucose-insulin system compared to control groups with similar age and weight, glycemic intolerance, which includes both decreased glucose tolerance and type 2 diabetes, was more common in PCOS women. In the short-term therapy of insulin resistance in PCOS, the potential use of insulin-sensitizing medications has recently been studied. Controlled studies have demonstrated that metformin treatment can lower fasting and stimulate plasma insulin levels by encouraging body weight reduction. These findings provide insulin-sensitizing drugs as a unique method in treating ovarian hyperandrogenism and irregular ovulation in PCOS and indicate a new prescription for Metformin. They further assert that long-term metformin treatment may assist in addressing insulin resistance, reducing the risk of type 2 diabetes and cardiovascular-related disease in people who take it.

Air Embolism: A Rare Lethal Complication of Hysteroscopy in a Young Woman Undergoing Infertility Workup.

Compared to operative hysteroscopy, diagnostic hysteroscopy rarely leads to issues. However, one very uncommon yet potentially fatal complication is air embolism, with an incidence rate of three in 17,000 cases. This report describes an unexpected complication discovered during diagnostic hysteroscopy surgery. In the course of routine infertility testing, a 29-year-old woman underwent a diagnostic hysteroscopy under general anesthesia. Intraoperatively, her end-tidal carbon dioxide (EtCO2) levels decreased, oxygen saturation dropped, and heart rate increased, leading the anesthesiologists and critical care team to terminate the procedure and manage her further. Subsequent transesophageal echocardiography confirmed the diagnosis of air embolism. She was managed with 100% oxygen and inotropes and cardiopulmonary resuscitation but despite aggressive medical interventions, her condition did not improve, and she unfortunately passed away. To diagnose, prevent, and manage the potentially devastating consequences associated with diagnostic hysteroscopy, gynecologists and surgical teams must maintain vigilance. The focus should be on proper patient selection, optimal surgical techniques, and the use of high-quality equipment to mitigate the risk of air embolism.

Successful Pregnancy Outcome in an Operated Case of Budd-Chiari Syndrome Having Fetal Growth Restriction: A Twisted Tale of Gravid.

Budd-Chiari Syndrome (BCS) primarily affects women in the reproductive age group, with an ever-increasing incidence in the general population. Due to its rarity, it is not known precisely how a pregnancy progresses in a woman with BCS and what can happen to the baby. A rare condition known as Budd-Chiari syndrome causes the hepatic veins in the liver to constrict and become blocked. The challenges in pregnancy, such as decreasing hepatic function, a rise in thrombotic and bleeding events, or ascites, have historically made pregnancy inappropriate in these people. Here, we present a case of an unbooked 24-year-old female, a known case of treated BCS with 36 weeks and three days gestation period. She was referred from a peripheral hospital to our hospital's emergency department because of having fetal growth restriction. By presenting this rare case, we expect more extensive studies will be conducted on the effect of pregnancy on BCS and the effect of BCS on pregnancy which will help obstetricians to turn this rare possibility of conception into a fair possibility.

Deep Vein Thrombosis as a Rare Post-procedural Complication After Uterine Artery Embolization: A Case Report.

When a patient is undergoing uterine artery embolization (UAE) which is considered a modality that is safer than surgical management for abnormal uterine bleeding (AUB), one must acknowledge as a surgeon the existence of rare but serious complications such as deep vein thrombosis (DVT). We encountered such a case where a 34-year-old female (para-3 living-3) with AUB and severe anemia because of heavy bleeding required multiple blood transfusions and was treated with UAE. The procedure was uneventful and the patient was discharged. However, later she presented with DVT of the right lower limb which was promptly managed with an inferior vena cava filter implant and thrombolysis, which prevented life-threatening sequelae such as pulmonary embolism and, potentially, death. Therefore, one must be vigilant about such complications despite UAE being a safer alternative to surgical management for gynecological complaints.

Unveiling the Unprecedented: An Astonishing Rarity of Metoclopramide Hydrochloride-Triggered Nystagmus in a Pregnant Woman.

Metoclopramide hydrochloride is a widely used medication for the treatment of gastrointestinal disorders such as nausea, vomiting, and gastroparesis. However, it has been associated with extrapyramidal side effects (EPS) such as tardive dyskinesia, nystagmus, and other locomotive disorders on rare occasions. These reactions are commonly seen in children and females, particularly in young people. In this article, we report a rare case of a 15-week pregnant woman who was prescribed metoclopramide hydrochloride in view of nausea and vomiting, which was later diagnosed as vomiting in pregnancy not relieved with first-line medications, and has later developed drug-induced nystagmus, highlighting its unpredictable nature and shortcomings of management in the pregnant woman. This article will draw the attention of obstetricians and gynecologists to wisely prescribe metoclopramide hydrochloride for treating nausea and vomiting in pregnant women.

Filling the Gaps in Oncofertility Care by Addressing Challenges Faced by Patients and Providers.

With enhanced technology and upcoming treatment strategies in the cancer field, the survival rates of patients have increased. We have now reached a stage in the treatment of cancer where we not only address the disease but also address complications that arise due to the disease and the side effects that present in the post-survival population due to its treatment. One of the primary consequences after oncotherapy is infertility, which is a major reason for distress for patients' post-survival, as they are afraid they may be deemed as less desirable, be rejected by their existing partner, or cannot grapple with the fact that they cannot have children of their own. This can be avoided by the implementation of proper oncofertility practices. The subject of oncofertility involves interactions between experts in the domains of cancer diagnosis, therapy, fertility preservation, and reproductive health. It attempts to investigate and broaden the possibilities for cancer survivors' reproductive future in order to suit their needs according to their ethical religious and sociocultural beliefs. However, these practices are often not implemented effectively due to ineffective doctor-patient communication, lack of knowledge, or partial knowledge of clinicians themselves regarding fertility care. This leads to a feeling of insecurity among clinicians hence resulting in them not referring patients. Lack of awareness among doctors of different oncofertility procedures available especially for patient groups like women and younger patients, hence leading to reduced referral in these groups. Improper coordination across health departments, patient ignorance regarding procedures, financial instability especially in a country with a lower sociodemographic index like India, and neglect or less importance given to the related ethical, social, and legal issues. In this article, we cover the effects of cancer and cancer treatment on fertility, the options available to adult and pediatric cancer patients to preserve their fertility like oocyte/ovarian tissue cryopreservation in females and sperm cryopreservation in males, techniques undergoing experimental studies that could be implemented in the future like spermatogonial stem culture and transplantation of testicular tissue, the obstacles that we face that hinder the proper implementation of such practices and what measures can we take to overcome these obstacles to improve patient care and be better healthcare providers.

Postabortal Bleeding: A Diagnostic Dilemma Resolved As Arteriovenous Malformation and Successfully Managed With Uterine Artery Embolization.

Uterine arteriovenous malformations (AVM) are rare and may be missed in routine clinical practice, often concealing their existence until dire consequences emerge. This potentially lethal condition can manifest abruptly, with torrential postabortal bleeding, as a grim reminder of its risky nature. Here, we present a rare case of para 1, living 1, abortion 2, initially subjected to dilatation and evacuation due to a missed abortion at a peripheral healthcare facility, subsequently developing torrential bleeding despite all the conservative measures. So she was referred to our hospital in view of heavy vaginal bleeding following the earlier instrumentation; the differential diagnosis of molar pregnancy and AVM was made clinically. As per speculum examination, the presence of remnants of abortion was seen, and the possibility of an invasive mole was suspected. Ultrasonography with color Doppler showed uterine AVM, which was further confirmed by magnetic resonance imaging (MRI). In order to save her life while preserving the uterus, a multidisciplinary approach was involved in managing this patient, consisting of interventional radiologists to perform uterine artery embolization (UAE).

Bell's Palsy Unmasked: A Compelling Case Study of Facial Nerve Palsy During Pregnancy.

Facial paralysis occurs more frequently in pregnant individuals, affecting them two to four times more often than those who are not pregnant, making it the most frequent unilateral cranial nerve pathology in pregnancy. This case report describes a 29-year-old primigravida's presentation, examination, and treatment of left-sided (unilateral) facial nerve palsy during 32 weeks of gestation. Concerns regarding possible underlying reasons were raised when the patient suddenly developed left-side facial weakness. We examined her history, clinical assessment, and diagnosis methods, which included laboratory and neuro-imaging tests. The difficulties of managing this illness during pregnancy are explored, taking into account the well-being of the developing fetus and mother. There are several causes for facial nerve palsy during pregnancy, including idiopathic causes, vascular problems, and viral infections. Here, we emphasize the value of a multidisciplinary approach comprising obstetricians, neurologists, and other medical professionals to guarantee the best possible care. The paper also underscores the necessity for prompt diagnosis and suitable interventions to reduce problems and foster a successful outcome. This case report adds to the limited literature on facial nerve palsy in pregnancy by highlighting individualized medical care and teamwork in addressing this uncommon but serious condition.

Association of bilirubin and malondialdehyde levels with retinopathy in type 2 diabetes mellitus.

INTRODUCTION: Bilirubin as an antioxidant and malondialdehyde (MDA) as an oxidant have been shown to be associated with various complications of type 2 diabetes mellitus (DM). AIMS AND OBJECTIVES: The aim was to measure the levels of serum bilirubin and MDA in type 2 DM patients with and without diabetic retinopathy (DR) and to correlate them with severity of DR. MATERIALS AND METHODS: A total number of 120 subjects out of which 40 were controls without type 2 DM and the rest 80 were type 2 DM patients were included in the study. Of those 80 diabetics, 44 patients did not have DR and 36 patients had DR. RESULTS: The total bilirubin, direct bilirubin, indirect bilirubin were higher in controls as compared to cases (P = 0.017, 0.033, 0.024). Serum MDA levels were found to be higher in diabetics as compared to controls (P = 0.00). The values of all the three parameters, that is, total bilirubin, direct bilirubin and indirect bilirubin were lower in patients with retinopathy as compared to those without retinopathic changes (P = 0.00, 0.020, and 0.007). Subjects were assigned to quartiles based on serum total bilirubin concentration. The prevalence of DR was significantly lower among persons with the highest bilirubin quartile compared to those with the lowest quartile. The severity of DR was inversely proportional to the total bilirubin levels (P = 0.001). The multiple logistic regression analysis showed total bilirubin to be associated with prevalence of DR (P = 0.035). CONCLUSIONS: The levels of total bilirubin were significantly lower in patients with DR and also in the late stages of retinopathy as compared to those without retinopathy and in controls but MDA levels did not show any association with DR.