Objectives: This study aimed to identify whether cefazolin plus metronidazole at time of benign hysterectomy decreases surgical site infection (SSI) rates compared to cefazolin alone. Methods: A retrospective observational study was performed of all patients who underwent elective nononcologic laparoscopic hysterectomy with a single surgeon from July 2022 through November 2024 before and after universal addition of metronidazole to standard cefazolin prophylaxis to evaluate the rate of a sensitive measure of SSI, as defined by either documented exam findings of purulent drainage, localized erythema, or tenderness at the vaginal cuff or abdominal incisions, as well as by antibiotic prescription for a site-specific indication within 30 days. Results: Of the 55 hysterectomies performed during the study period, 48 were included in the final analysis, and the rate of SSI decreased in the post-intervention group from 27.8% (5/18; 95% confidence interval [CI], 9.7%–53.5%) to 3.3% (1/30; 95% CI, 0.1%–17.2%) ( p = 0.022). Conclusions: The addition of metronidazole to cefazolin for antibiotic prophylaxis prior to benign hysterectomy was associated with a decreased rate of a sensitive measure of SSIs in this cohort.
Pelvic organ prolapse (POP) is commonly treated with sacrocolpopexy or native tissue repairs, but mesh-related complications and recurrence remain concerns. We describe a novel mesh-free uterine-preserving technique, Laparoscopic Psoas–Round Ligament Fixation (Rotundum Hitch, RH). This prospective single-center study included women with symptomatic uterine prolapse (POP-Q stage II–IV) who underwent laparoscopic RH. The round ligaments were mobilized bilaterally and fixed to the ipsilateral psoas fascia using nonabsorbable sutures. Patients were evaluated at 6 weeks, 6 months, and 12 months. Primary outcomes were procedural feasibility and perioperative safety. Secondary outcomes included POP-Q measurements, UDI-6 scores, and recurrence. Twenty women underwent RH, and all procedures were completed laparoscopically without conversion. Mean operative time was 45 ± 9 minutes, with minimal blood loss and no major intraoperative complications. One urinary tract infection and one transient postoperative thigh discomfort resolved with conservative management. At 12 months, 18 patients were available for follow-up; 17 (94.4%) maintained anatomical success (POP-Q stage < II). Significant improvements were observed in POP-Q measurements, including point C, and UDI-6 scores improved significantly ( p < 0.001). Laparoscopic psoas–round ligament fixation appears to be a feasible and safe mesh-free uterine-preserving technique with encouraging short-term anatomical and functional outcomes. Larger comparative studies with longer follow-up are needed to evaluate long-term durability.
Objective: To compare clinical outcomes and recurrence predictors in women operated for dermoid cysts via laparotomy or laparoscopy. Methods: Between January 2015 and June 2024, 189 women underwent surgery for ovarian dermoid cysts. After excluding cases with hysterectomy/bilateral oophorectomy ( n = 23) and those with discrepant pathology ( n = 13), 153 patients with preserved reproductive organs and confirmed mature teratoma were eligible. Recurrence data were available for 133 women (laparotomy: n = 70; laparoscopy: n = 63). Clinical characteristics, cyst features, and perioperative outcomes were compared. Logistic regression was performed to identify independent predictors of recurrence. Results: Mean age was 28.8 ± 7.9 years. The overall recurrence rate was 9.8% ( n = 13), with no significant difference between laparoscopy (11.1%) and laparotomy (8.6%; p = 0.243). Bilateral cysts were more frequent among recurrence cases (28.6% vs. 10.0%, p = 0.052). Multivariate regression showed a borderline association with younger age (odds ratio [OR]: 0.917, 95% CI: 0.834–1.009, p = 0.076), while bilaterality had an elevated OR (OR: 6.089, 95% CI: 0.506–73.260, p = 0.155) but did not reach statistical significance. Conclusion: Despite higher intraoperative rupture rates in laparoscopy, recurrence risk was comparable to laparotomy. Bilaterality and younger age may represent potential risk factors, though not independently predictive. Laparoscopy remains a safe, fertility-preserving option for dermoid cyst management.
Objective: To determine if there is a relationship between patient-reported bowel symptoms (bloating, bowel changes with menses, rectal pain/dyschezia) and endometriosis findings at the time of surgery. Design: Retrospective cohort study. Setting: Multi-hospital health system of Catholic Health in Long Island, NY. Participants: Patients who underwent excisional endometriosis surgery between October 2020 and February 2025. Results: A total of 391 patients were included in the study. Seventy percent of patients reported at least one gastrointestinal (GI) symptom. Deep endometriosis (DE) was identified in 31% of patients. The American Association of Gynecologic Laparoscopists (AAGL) stage was distributed as follows: I (103, 26%), II (100, 26%), III (61, 16%), and IV (127, 32%). A histological diagnosis of endometriosis was positive in 325 patients (83.1%). There was a statistically significant relationship between the following GI symptoms and location of endometriosis in the posterior cul-de-sac peritoneum: bloating (adjusted odds ratio [aOR]: 3.07, 95% confidence interval [CI]: 1.58–5.94), bowel changes with menses (aOR: 1.84, 95% CI: 1.03–3.30), rectal pain and/or dyschezia (aOR: 2.58, 95% CI: 1.06–6.28). When regression analysis was applied, there was no statistically significant association between GI symptoms and DE. Conclusions: The distribution of AAGL stage in our study suggests that complex surgical findings are common in the endometriosis referral population. There remains a lack of clear understanding around the relationship between patient-reported bowel symptoms and the location and AAGL stage of disease. It follows that any patient with endometriosis regardless of symptoms should be expected to have a more severe and surgically complex disease process. When surgical management is considered, they should be triaged to a surgeon who specializes in endometriosis.
Intrauterine devices (IUDs) are frequently used in the field of gynecology and are often in place at the time of pelvic surgery. However, there are no guidelines for management of an IUD during surgery in which a uterine manipulator is used. Some surgeons may always insert a new IUD, and others may only replace if visibly displaced. We conducted a retrospective chart review of patients who had a laparoscopic excision of endometriosis surgery with the use of a uterine manipulator and had an IUD in place from 2019 to 2024. Of 76 patients who met inclusion criteria, 16 (21.1%) had their IUD displaced. Of those 16, 12 (75.0%) were noted intraoperatively, and 4 (25.0%) were diagnosed within 6 months postoperatively. The RUMI ® manipulator was less likely to be associated with displacement than other manipulators. Surgeons should consider counseling about the risk of displacement and can consider either proactive IUD replacement or replacement only if visibly displaced as options.
Vestibulodynia, a form of vulvodynia, is defined as a chronic pain disorder of the vestibule, which may lead to symptoms such as dyspareunia and sexual dysfunction in affected women. The anterior obturator artery perforator (aOAP) flap is a pedicled fasciocutaneous perforator flap that represents a safe and effective method for vulvovestibular reconstruction for a variety of indications. This article aims to explore the therapeutic potential of the aOAP-flap in select cases of vestibulodynia unresponsive to other treatment methods. Two young women underwent surgical therapy with the aOAP-flap after having exhausted various unsuccessful conservative, minimally invasive, and surgical treatment options. A summarized overview of surgical technique, treatment course, patient experience, and outcomes is described. A substantial postoperative improvement of pain and sexual function was observed, with no occurrence of complications during a 1-year follow-up. The clinical experience described in this study shows that the applicability of the aOAP-flap may safely and effectively extend to patients suffering from refractory vestibulodynia, as exemplified by these two cases.
Background: Despite an increase in the performance of minimally invasive hysterectomy, opioid overprescribing postoperatively is common and can contribute to chronic long-term use. This study evaluated local/regional patterns of immediate opioid use after benign hysterectomy and identified quality gaps in physician prescribing practices. Methods: A retrospective chart review was conducted on all hysterectomies performed for benign indications at two tertiary care hospitals between January and December 2019. The primary outcome was opioid use in morphine milligram equivalents (MMEs) within the first 24 hours after surgery. Secondary outcomes were opioid prescribing patterns in different patient populations and length of hospital stay. A survey on opioid prescribing practices was conducted among gynecological providers. Results: A total of 669 patient records were reviewed between January and December 31, 2019. Median opioid use <24 hours following benign hysterectomy was 10 and 15MMEs, at respective sites. Nearly 30% of patients used no opioids postoperatively, 97% were opioid na & iuml;ve. The presence of at least one postoperative pain diagnosis significantly increased opioid use from 10.9 MME to 22.5 MME (p < 0.001). Postoperative opioid use was lower overall with a minimally invasive approach to hysterectomy (p = 0.009 total MME). Gynecological attendings were more likely than trainees to evaluate for risks of opioid dependency before prescribing. Conclusion: Patients undergoing hysterectomy for benign indications used minimal to no opioids in the immediate in-hospital postoperative period. Future directions are needed to investigate the role for integrated perioperative risk assessments to guide opioid prescribing.
Objective: To evaluate the effect of structured hands-on simulation training on obstetrics and gynecology (OB/GYN) residents' knowledge, confidence, and procedural preference for vaginal natural orifice transluminal endoscopic surgery (vNOTES). Methods: This prospective, observational study was conducted between July and August 2022 at a single tertiary medical center. Twelve fourth-year OB/GYN residents completed a didactic online curriculum on adnexectomy and hysterectomy via vNOTES, followed by three monthly hands-on simulation labs using box trainers under direct faculty supervision. Residents' confidence in key surgical steps and procedural preferences was assessed with pre- and post-simulation surveys. Faculty procedural assessments were recorded for each simulation. Results: A total of 49 procedural assessments were completed, including 23 adnexectomies and 26 hysterectomy procedures. Competence was achieved in hysterectomy and adnexectomy by 5 out of 12 and 2 out of 12 residents, respectively. Seven residents completed feedback surveys before and after the simulations. Residents reported a 33% increase in confidence performing anterior and posterior colpotomy. Confidence in transecting the uterosacral ligaments increased from 71% to 85% after simulations. Confidence in transecting the uterine artery via vNOTES doubled from 14% to 28% compared with the laparoscopic approach following simulation. Confidence in performing adnexectomy increased by 15% after simulation; however, there was a 14% reduction in the preference for choosing vNOTES for hysterectomy. Conclusions: Hands-on simulation in vNOTES enhances residents' knowledge and confidence in performing key surgical steps of adnexectomy and hysterectomy. These findings support the integration of vNOTES simulation into residency training programs to improve surgical proficiency.
Background: Digital solutions are increasingly integrated into gynecological services to improve efficiency and reduce avoidable cancellations. A smartphone-dependent home urine dipstick pathway was proposed as part of a quality improvement initiative to reduce same-day cancellations of urodynamic investigations. Understanding patient access to and confidence with digital technology is essential for successful implementation. Objective: To evaluate smartphone ownership, digital confidence, and familiarity with QR code technology among patients attending a urogynecology service and to assess readiness for a smartphone-based diagnostic pathway. Methods: A cross-sectional survey was conducted among adult patients attending urogynecology outpatient clinics at a UK district general hospital between May and July 2025. The survey assessed smartphone ownership, self-reported confidence using smartphones (5-point Likert scale), quick response code (QR code) familiarity, and acceptability of digital components of care. Age-stratified analyses were performed. Results: Of 156 patients invited, 108 participated (69.2%). Overall, 92 participants (85.2%) owned a smartphone. Ownership declined significantly with age (p < 0.001), from 100% in patients aged <50 years and 97.4% in those aged 50-69 years to 67.4% in those aged >= 70 years. Mean smartphone confidence scores and QR code familiarity also decreased significantly with increasing age (p < 0.001). Overall, 39.8% of participants met predefined criteria, indicating a potential need for additional support or alternative pathways. Conclusion: While smartphone access is high in urogynecology patients, significant age-related disparities in digital confidence and QR familiarity may limit equitable implementation. Quality improvement initiatives introducing smartphone-dependent pathways should incorporate flexible, inclusive strategies to prevent digital exclusion.
Introduction: We observed at our hospital that patients were using more opioids postoperatively than reported in the literature. We evaluated the efficacy of adding suzetrigine preoperatively to our enhanced recovery after surgery (ERAS) protocol, which utilizes premedication (acetaminophen, celecoxib, and pregabalin), then intraoperative subcutaneous liposomal bupivacaine followed by scheduled oral acetaminophen and ibuprofen postoperatively. Patients also have oxycodone as needed for breakthrough pain. The goal of this quality improvement project was to reduce postoperative opioid use at our hospital by 50%. Materials and Methods: We conducted an ambispective quality improvement project that included all patients who underwent total laparoscopic hysterectomy over a 1-year period. We then added suzetrigine to the other routine premedications. Patient medical records were evaluated for demographics, surgical characteristics, opioid type and dose, pain scores, length of stay, and complications. Opioids were converted to oral morphine dose equivalents. Results: In total, 68 patients were included within the preintervention and after-intervention cohorts. Mean opioid usage was lower in the postintervention group (13.3 mg vs. 28.5 mg, p < 0.001). After intervention, patients were five times more likely to decline opioids ( p < 0.001) without any concomitant increase in pain scores. Furthermore, after the intervention, patients were 24 times more likely to be discharged on the day of surgery ( p < 0.001). Discussion: The addition of suzetrigine to our ERAS protocol was associated with significant reductions in postoperative opioid use and mean pain scores. The quality improvement project met its stated goal of reducing postoperative opioid use by 50%.
Aim: To evaluate perioperative antithrombotic management strategies and their effects on hemoglobin change and postoperative outcomes in women undergoing gynecologic surgery. Methods: This retrospective study included women aged >= 18 years who underwent gynecologic surgery while receiving long-term antithrombotic therapy between December 2022 and December 2024. Patients were categorized according to perioperative management strategies, including continuation, temporary interruption, or bridging. The primary outcome was perioperative hemoglobin change and the need for blood transfusion. Secondary outcomes included thromboembolic events, surgical complications, and intensive care unit admission. Statistical analysis was performed using nonparametric and categorical tests, with a significance threshold of p < 0.05. Results: Seventy-three women were included. The mean age was 59.5 years, and obesity and hypertension were common. Most surgeries were classified as high bleeding risk. Hemoglobin values were available for 59 patients. Hemoglobin decrease ranged from minimal change in the bridging group to greater declines in those with prolonged interruption, but no statistically significant difference was identified among management strategies. Postoperative complications occurred in 9.6% of patients, including one pulmonary embolism. Three patients required transfusion, and no major cardiovascular events were observed. Conclusions: Different perioperative antithrombotic strategies were not associated with statistically significant differences in blood loss or postoperative complications; however, these findings should be interpreted cautiously given the limited sample size and subgroup distribution. The results should be considered hypothesis-generating rather than definitive, and individualized decision-making based on thromboembolic and bleeding risk remains essential in gynecologic surgery.
The purpose of this video is to demonstrate the posterior colpotomy approach for removal of a fibroid specimen during a laparoscopic myomectomy. The surgery took place in an academic hospital with a minimally invasive gynecologic surgeon. A 30-year-old G0 female with a fibroid planning a laparoscopic myomectomy. She had a history of a spontaneous abdominal wall infection requiring excision with general surgery which was complicated by delayed wound healing. She was consented for posterior colpotomy specimen extraction rather than extension of a port site given this history. Intervention: We describe our approach to creation of a posterior colpotomy to remove a fibroid during a laparoscopic myomectomy. After performing the myomectomy, we kept a uterine manipulator in place to antevert the uterus and placed a laparoscopic specimen retrieval bag in the posterior fornix of the vagina. Laparoscopic monopolar scissors were used to palpate the bag in the posterior cul de sac and make an incision overlying the bag between the uterosacral ligaments. The bag was advanced into the pelvis and the specimen was placed into the bag. We then laparoscopically sewed the colpotomy site. While not as commonly performed as it is often easier and faster to extend and close an abdominal incision, existing research suggests that posterior colpotomy extraction represents a safe, practical, and sometimes preferable approach. This video highlights one such implementation of this useful tool for surgeons to employ and discusses existing research on the safety and outcomes of this approach.
Introduction: Sciatic nerve endometriosis is a rare but debilitating form of deep infiltrating endometriosis (DIE) that typically presents with cyclical, refractory sciatica. Management requires meticulous surgical planning and a multidisciplinary approach to achieve both neurological relief and fertility preservation.Case Presentation: A 37-year-old nulligravid patient presented with severe, debilitating left-sided sciatica unresponsive to hormonal treatment. Transvaginal ultrasound and pelvic magnetic resonance imaging revealed a large nodule reaching the left obturator internus and piriformis muscles. A complete laparoscopic excision was performed. Complete excision of the nodule infiltrating the obturator internus muscle was achieved, followed by nerve neurolysis.Conclusion: Complete laparoscopic excision offers a safe and effective treatment for sciatic nerve endometriosis, providing excellent symptom relief. This video highlights the necessary anatomical landmarks and surgical technique for safe neurolysis in the context of DIE.
Introduction: Preoperative diagnostic modalities include serum tumor marker level (CA 125) and imaging, both of which suffer from low sensitivity and specificity. The serum tumor marker CA 125 is not specific. Preoperative diagnosis of an ovarian tumor remains problematic. Suspected early ovarian tumors, unlike other malignancies, are seldom diagnosed via needle or punch biopsy. The greatest concern about ovarian tumor biopsy is that this procedure results in tumor leakage or rupture, with subsequent intraperitoneal spreading of cancer cells if the tumor is malignant, leading to upstaging. Hence, intraoperative frozen section examination plays a crucial role in the management of complex ovarian masses.Aim and Objective: Primary objectives are (1) to estimate the diagnostic accuracy of frozen section in diagnosing ovarian cancer in women presenting with suspicious pelvic mass as verified by paraffin section. (2) To estimate the accuracy of the final diagnosis of malignancy in a subgroup of women with a frozen section result of either borderline or cancer. The secondary objective is to determine whether the RMI 2 (Risk of Malignancy Index 2) can avoid frozen section.Results: The overall accuracy of frozen sections in the present study was 88.23%. Intraoperative consultation was concordant in 45 cases and discordant in 6 cases. Out of six discordant cases, four lesions were underdiagnosed, two lesions were overdiagnosed. The overall underdiagnosis rate was 7.84%, and overdiagnosis rate was 3.92%. Of the 25 patients with a benign diagnosis at frozen section, 96% (24/25) of patients had benign diagnoses, and 4% (1/25) patients had borderline ovarian lesions at final diagnosis. Of the 15 patients with borderline ovarian lesion on frozen sections, 33.3% (5/15) of cases were discordant with the final histopathology. 13.3% (2/15) of patients were diagnosed to have benign lesion at the final diagnosis; both patients were overtreated and underwent staging laparotomy in the primary setting. 20% (3/15) of patients were diagnosed to have malignant lesion at final diagnosis. All the intraoperative malignant diagnoses on frozen section were confirmed by the final histopathology. Sensitivity and specificity of the frozen section analysis for benign, borderline, and malignant ovarian masses were 92.3% and 96%, 90.9%, and 87.5% and 78.5% and 100%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of the RMI 2 score in diagnosing malignant ovarian lesions were 60%, 61.54%, 60%, and 61.54%, respectively.Conclusion: Intraoperative frozen section diagnostic accuracy rates were high in diagnosing benign and malignant ovarian lesions and were relatively low for borderline ovarian neoplasms. RMI 2 is a reliable preoperative tool in differentiating complex ovarian masses, but it cannot completely replace intraoperative frozen section.
Cervical cancer is the fourth most common cancer in women worldwide and is most frequently diagnosed in women who are between the ages of 35 and 44, with the incidence rates increasing nearly 2% each year in women ages 30-44. Standard surgical management of early-stage cervical cancer routinely involves hysterectomy. However, the prevalence of cervical cancer in young patients and the social shift of women electing to delay childbearing has created a reproductive dilemma. With the arrival of the radical vaginal trachelectomy in the late 1980s, patients with early-stage cervical cancer now had an option for fertility preservation. Over time, fertility-sparing surgeries for cervical cancer patients have become increasingly conservative while maintaining comparable oncologic outcomes. This surgical review examines the variety of fertility-sparing procedures available for early-stage cervical cancer in the context of their oncologic and reproductive outcomes.
Objective: To evaluate initial outcomes of laparoscopic pectopexy combined with laparoscopic colporrhaphy for symptomatic pelvic organ prolapse during the surgeons' learning curve. Material and Methods: The first 50 patients operated on between 8/2017 and 10/2020 for symptomatic vaginal vault or uterine prolapse POP-Q (Pelvic Organ Prolapse Quantification System) stage >= 2 were included. Data were collected retrospectively from medical records. The primary outcome measure was relief of prolapse symptoms; secondary outcome measures were anatomical results and perioperative complications at similar to 4 months follow-up. Results: The relief of prolapse-related symptoms was achieved in the resolution of sensation of bulge in 74%, in voiding difficulty 89.7%, and in defecation difficulty 65.4%. De novo defecation symptoms developed in 4.2%. The mean operative time was 205 +/- 50.3 minutes (111-400), and the mean EBL was 101 +/- 74.7 mL (10-400). Simplified POP-Q classification measurements significantly improved postoperatively: Ba 3.84 +/- 2.57 cm, C/D 8.86 +/- 3.70 cm, Bp 2.42 +/- 3.20 cm (p < .001). Complications included three urinary tract infections, one bladder injury, one symptomatic seroma, and one aspiration pneumonia. Anatomical recurrence rates were 4% at the apex, 31.3% after laparoscopic anterior colporrhaphy, 33.3% after laparoscopic posterior colporrhaphy, and 16.7% after combined posterior colporrhaphy techniques. Conclusion: Initial experience with laparoscopic pectopexy and colporrhaphy demonstrates favorable anatomical and symptomatic outcomes with low complication rates, even during the early phase of the learning curve. Concomitant repair of vaginal walls appears critical to optimal symptom relief. However, results are less favorable than in expert-level series, highlighting the need for further prospective evaluation.
Study Objective: This study aims to determine if the presence of endometriosis decreases the probability of adnexal torsion. We hypothesize that the presence of endometriosis is associated with a lower risk of ovarian torsion.Methods: A retrospective case-control study was performed. Study population included patients who underwent emergent surgery for suspected adnexal torsion from January 2014 to August 2023. The medical record was reviewed to obtain demographic information, preoperative symptoms, patient history, and intraoperative findings. Pathology results were reviewed when applicable. A convenience sample was utilized due to limited number of cases. A post hoc power analysis was calculated.Results: A total of 160 patients underwent surgery for suspected adnexal torsion, with 118 (73.8%) found to have torsion, while 42 (26.2%) did not. Preoperative history of endometriosis was associated with lower torsion risk (odds ratio [OR] = 0.30, 95% confidence interval [CI]: 0.11-0.77). Endometriomas were not found in any of the torsion cases compared with 5 (11.9%) of the nontorsion cases (p = 0.001). Intraoperative findings suggestive of endometriosis in the torsion group were superficial without ovarian involvement. Adhesions between the adnexa and the pelvic side wall were linked to lower torsion risk (OR = 0.06, 95% CI: 0.02-0.17).Conclusion: A preoperative diagnosis of endometriosis was associated with lower odds of having adnexal torsion. Furthermore, five (3%) endometriomas were found in total, all in nontorsion patients. Our data show that patients with endometriosis have a lower risk of adnexal torsion, particularly if they have ovarian involvement. The presence of pelvic adhesions between the adnexa and pelvic side wall was also associated with a lower risk of adnexal torsion.
Background: Pelvic organ prolapse (POP) impairs quality of life. When conservative measures fail, surgery is indicated. We evaluated laparoscopic anterior perineal suspension with bilateral pectineal ligament fixation (LAPSPL), which reconstructs the anterior suspension axis to support the bladder and uterus.Methods: A single-center retrospective cohort of women with stage III-IV POP who underwent LAPSPL at Hanoi Medical University Hospital (May 2022-March 2025) was included. A mesh shaped to mimic the pubocervical fascia was fixed to the anterior cervico-vaginal wall; lateral arms were anchored to the bilateral pectineal (Cooper's) ligaments. Primary outcomes were anatomical correction (Baden-Walker stage; cystocele grade). Secondary outcomes included operative metrics, complications, pelvic floor symptoms (Pelvic Floor Distress Inventory [PFDI]-20), quality of life (Pelvic Floor Impact Questionnaire [PFIQ]-7), and recurrence.Results: Ninety-three patients (mean age 66.4 years; parity 3.5; BMI 21.6) were included. Preoperatively, 41.9% had stage III and 58.1% stage IV POP. Postoperatively, stages 0, I, II, and III were 44.1%, 48.4%, 4.3%, and 3.2%, respectively; no stage IV. Cystocele improved from 57.0% grade III/2.2% grade IV to 1.1% grade III/0% grade IV. Mean operative time was 90.7 minutes. One intraoperative bladder seromuscular injury occurred (1.1%). Postoperative events were urinary dysfunction 4.3%, bowel dysfunction 2.2%, and chronic pain 3.2%; no mesh rejection. PFDI-20 and PFIQ-7 declined to 16.4 and 14.2, respectively, at 6 months. Over 14.4 months' mean follow-up, recurrence was 3.2%.Conclusions: LAPSPL is a safe, minimally invasive option for advanced POP that achieves anatomical restoration, symptom relief, and quality-of-life gains with low complications and early recurrence. Comparative studies with longer follow-up are needed.
Objectives: We aimed to evaluate the feasibility of performing gynecological laparoscopic surgeries under spinal anesthesia (SA) and compare the anesthetic parameters and patient satisfaction between SA and general anesthesia (GA) in gynecological laparoscopic surgeries. Methods: This prospective, single-blinded, randomized clinical trial included 80 women indicated for laparoscopic surgery. Participants were randomly assigned to two groups of 40 each, SA and GA, and outcomes were compared between them. Results: Respiratory rate and mean arterial blood pressure were generally lower in the GA group than in the SA group (p > 0.05). During surgery, the SA group experienced more complications than the GA group (p < 0.05). There was no significant difference between the two groups in the incidence of hypertension, bradycardia, restlessness, dyspnea, abdominal pain, respiratory depression, and chills during surgery (p > 0.05). Post-Anesthesia Care Unit (PACU) recovery time was significantly longer in the GA group (p = 0.001). The prevalence of chills and restlessness as PACU complications was significantly higher in the GA group than in the SA group (p = 0.001). Surgeons' satisfaction levels were significantly higher with GA (p < 0.05). Conclusion: Although SA and GA showed no significant differences, SA appears more satisfactory for gynecological surgeons performing laparoscopic procedures. However, the best anesthesia choice depends largely on the type of surgery and the patient's condition.
