Background:Previous retropubic surgery, such as laparoscopic Burch colpo-suspension, can significantly alter the anatomy of the space of Retzius due to fibrosis and scarring. These changes increase the technical difficulty and risk of complications during subsequent retropubic procedures, particularly midurethral sling placement. Objectives:To demonstrate the feasibility and safety of laparoscopic-assisted tension-free vaginal tape (TVT) placement in a patient with recurrent stress urinary incontinence (SUI) following prior colpo-suspension. Participant:A 74-year-old woman with recurrent SUI following laparoscopic Burch colpo-suspension performed five years previously. Intervention:Retropubic TVT placement was performed under simultaneous laparoscopic guidance at a tertiary gynaecological centre. Intraoperative laparoscopy enabled visualisation of the retropubic space, revealing significant fibrosis and distorted anatomy. Needle passage and sling positioning were performed under direct visualisation. Because extensive retropubic dissection reduced the usual tissue support of the tape, it was temporarily secured with a rapidly absorbable suture to maintain its position without increasing suburethral tension. Conclusions:Laparoscopic-assisted TVT placement is a feasible and safe approach in patients with prior retropubic surgery. Direct visualisation allows identification of altered anatomical planes, facilitating controlled needle passage and potentially reducing the risk of complications. What is New?:This video demonstrates the importance of avoiding blind needle insertion in patients with prior colposuspension and highlights laparoscopic guidance as a valuable strategy to improve safety during retropubic sling procedures.
Background:Consensus is lacking regarding the relative safety and oncological outcomes of minimally invasive compared to abdominal hysterectomy. Objectives:To estimate complications and survival rates of minimally invasive hysterectomy (MIH) (i.e., laparoscopic or robotic assisted) compared to total abdominal hysterectomy (TAH) for endometrial and cervical cancer. Methods:A systematic quantitative review of randomised controlled trials (RCTs) comparing MIH with TAH for the treatment of endometrial or cervical cancer. Medline-PubMed, Cochrane Library, Scopus, ongoing clinical trials and the grey literature were searched until December 1, 2024. Main Outcome Measures:Complications, overall survival (OS), disease-free survival (DFS), and disease-specific survival (DSS) rates. Results:Twenty-nine RCTs enrolling 6,127 patients were included. The risk of bladder injury was higher in the MIH group [risk ratio (RR): 1.84, 95% confidence interval: (CI): 1.03-3.29, I2: 0%), as was the risk of vaginal injury (RR: 12.39, 95% CI: 1.61-95.29, P=0.02, I2: 0%) but the risk of wound dehiscence was lower (RR: 0.32, 95% CI: 0.13-0.83, P=0.02, I2: 13%) compared to abdominal hysterectomy. Among cervical cancer patients, the risk for blood transfusion was significantly lower with the MIH (RR: 0.42, 95% CI: 0.21-0.84, P=0.01, I2: 0%). Among endometrial cancer patients, the OS, DFS, and DSS were comparable between routes of hysterectomy. In contrast, the overall the OS and DFS rates were lower for minimally invasive compared to abdominal hysterectomy (0.94, 95% CI: 0.90-0.98, P=0.005, I2:0 %) and (0.89, 95% CI: 0.84-0.94, P<0.001, I2: 0%) respectively. Conclusions:Bladder and vaginal injuries are higher with minimally invasive compared to abdominal hysterectomy. Survival rates for endometrial cancer are comparable but for cervical cancer, minimally invasive hysterectomy is associated with poorer survival outcomes and this should be taken into account when counselling patients and deciding upon the route of hysterectomy. What is New?:TAH has superior survival outcomes compared to minimally invasive hysterectomy.
Background:Interstitial thermal ablation represents a uterine-sparing alternative for symptomatic fibroid management. Transvaginal ultrasound-guided myolysis enables precise targeting and real-time monitoring of the ablation zone. Objectives:To illustrate the feasibility and immediate intraoperative response of transvaginal ultrasound-guided interstitial myolysis for the treatment of uterine fibroids. Participant:A 36-year-old multiparous woman with persistent abnormal uterine bleeding and pelvic pain related to a known uterine fibroid seeking a uterus-preserving treatment. Previous treatments, including levonorgestrel-releasing intrauterine system and oral therapy with relugolix, estradiol, and norethisterone had failed. Intervention:Transvaginal ultrasound revealed a retroverted, enlarged uterus with a posterior type 2-5 fibroid measuring 45×37×49 mm (volume: 42.4 cm³). Under conscious sedation, a 16G-27 cm microwave antenna was transvaginally inserted and repositioned within the fibroid under continuous ultrasound guidance. Ablation was delivered in four cycles at 20 W for a total duration of 194 seconds, with a cumulative net energy delivered of 3.3 kJ calculated by the device, while continuously assessing safety margins and tissue response. Immediate ultrasound evaluation showed a 42.7% volume reduction (from 42.4 to 24.3 cm³), loss of fibroid definition, and partial collapse, consistent with effective devascularisation. No complications occurred, and the patient was discharged the same day. At 4-month follow-up, fibroid volume reduction was sustained (41.7%), with complete symptom control under the previously ineffective hormonal therapy. Conclusions:Transvaginal interstitial myolysis offers a minimally invasive, uterine-sparing treatment option for selected patients with symptomatic fibroids. Real-time ultrasound monitoring enables precise ablation and immediate confirmation of treatment efficacy. What is New?:This video documents the immediate volumetric response of a uterine fibroid following transvaginal ultrasound-guided myolysis.
Caesarean scar defects, known as isthmocele, are increasingly recognized in women with secondary infertility, yet hysterosalpingographic (HSG) criteria remain poorly defined. We describe a reproducible HSG feature, the “pocket sign,” observed in seven women with prior caesarean delivery. This finding appears as contrast pooling in the anterior lower uterine segment near the internal cervical os. In all cases, it correlated with transvaginal ultrasound and hysteroscopic findings. Although non-specific and not diagnostic, the pocket sign may serve as an adjunctive indicator prompting further evaluation. Given anatomical variability and intrinsic limitations of HSG, multimodal imaging remains essential.
Background: In patients with colorectal endometriosis the optimal surgical approach for excising disease remains unknown. Objectives: To compare the safety and efficacy of classic colorectal resection with mini-laparotomy and extracorporeal specimen removal and anastomosis formation (CLS) and colorectal resection with natural orifice specimen (bowel segment) extraction (NOSE), which is performed entirely in the abdominal cavity. Methods: This is a single centre, retrospective observational study of 161 cases of colorectal endometriosis. Women underwent laparoscopic excision of deep endometriosis with segmental bowel resection between 2015 and 2023. Main Outcome Measures: Hospital stay, complication rate, infectious issues, pain measured on a 10 cm visual analogue scale (VAS) and quality of life [derived from Knowles-Eccersley-Scott-Symptom (KESS)] questionnaire were the outcomes of interest. Results: No differences in post-operative pain or bowel quality of life at 3 months were observed between CLS and NOSE surgical treatment of colorectal endometriosis (mean VAS score 2 vs. 1, (P=0.62) and mean KESS score 12.3 vs. 10.7 (P=0.28). No clinically significant differences between techniques for intra-abdominal sepsis were seen as judged by C-reactive protein elevation and bacterial contamination from peri-operative cultures. Conclusions: NOSE and CLS procedures appear comparable in safety and efficacy for removing colorectal endometriosis. Randomised trials are needed to compare these techniques. What is New? The NOSE technique for removing colorectal endometriosis is not associated with poorer safety, inflammatory, infective or efficacy outcomes compared to the classical CLS approach. Randomised controlled trials are needed to compare these techniques.
Background:Outpatient hysteroscopy is a common procedure, but pain can lead to failure and poor patient experience, especially in women without previous vaginal delivery and postmenopausal women. Objectives:To compare the use of music during outpatient hysteroscopy with oral pre-procedural analgesia or no pain control intervention on perioperative and postoperative pain. Methods:A randomised controlled trial was conducted at the outpatient hysteroscopy service of the University of Cagliari between December 2024 and June 2025. Women undergoing outpatient hysteroscopy were allocated to a music group (pre-defined instrumental relaxing music without lyrics, delivered through a Bluetooth speaker throughout the procedure), an oral premedication analgesia group (ibuprofen 200 mg + paracetamol 1000 mg, 90 min pre-procedure), or a control group (no pre-pharmacological or music-based analgesic support). A 5-mm hysteroscope and standardised vaginoscopic "no-touch" technique were used. Main Outcome Measures:The primary outcome was maximum pain on a 0-10 visual analogue scale (VAS) intraoperatively (T0) and 30 minutes post-procedure (T1). Secondary outcomes included operative time, successful procedural completion, and complications. A pre-specified subgroup analysis was performed to explore potential treatment-by-previous vaginal delivery status (no previous vaginal delivery vs. women with a previous vaginal delivery) and menopausal status (reproductive age vs. menopause) interactions. Results:Two hundred sixty-four women were randomised; 88 to intraprocedural music, 89 to pre-operative analgesia, and 87 to no pain control intervention. Peak intraoperative pain did not differ across groups (VAS mean ± standard deviation: 3.4±1.0 in the music group, 3.5±1.45 in the oral premedication group, and 3.6±0.9 in the control group; P=0.35). Post-procedural pain at 30 minutes was also similar across groups (1.5±1.4, 1.5±1.5, and 1.7±1.1, respectively; P=0.24). Operative time was comparable across groups (mean: 3.2, 3.1, and 3.2 minutes; P=0.13). Procedure completion rates did not differ between groups (P=0.62), and no complication rates or drug-related adverse events were observed. In exploratory analyses across the overall cohort, women with no previous vaginal delivery (n=82) reported higher intra-procedural pain scores than women with a previous vaginal delivery (n=182) (VAS 4.1±0.9 vs 3.2±0.9; P=0.032). Similarly, postmenopausal women (n=76) reported higher pain scores than women of reproductive age (n=188) (VAS 4.0±0.9 vs. 3.4±0.9; P=0.023). Conclusions:The use of intraoperative music or pre-procedural analgesia with oral ibuprofen-paracetamol does not reduce pain compared with standard outpatient hysteroscopy. What is New?:Intraoperative music and oral analgesia during outpatient hysteroscopy are not more effective than standard hysteroscopy for reducing pain associated with outpatient hysteroscopy.
Background: Rectal endometriosis is a severe form of deep endometriosis affecting up to 12% of patients, causing significant pain and bowel dysfunction. The optimal surgical approach can be individually tailored based on lesion size and localization as assessed by preoperative imaging. Objectives: To compare the postoperative and long-term clinical results of two alternative surgical approaches to symptomatic rectal endometriosis. Methods: A retrospective single-centre study of 115 patients who had surgical resection of rectal endometriosis either by complete nodular resection (CNR) (n=55) or segmental rectal resection (SRR) (n=60). The surgical approach was indicated based on #Enzian related presurgical transvaginal sonography. #Enzian C1-2 lesions were planned for CNR, and #Enzian C3 lesion for SRR. Postoperative pain and satisfaction data were collected. Main Outcome Measures: Satisfaction and change in pre-operative and post-operative pain symptoms and overall improvement in symptoms, urinary and bowel dysfunction measured at follow-up and complications following surgery. Results: 68/115 (59%) women provided follow up data. There were significant reductions in dysmenorrhoea, dyspareunia and dyschezia following surgical resection compared to pre-operative levels in both groups (P≤0.001). Patients treated with CNR had significantly lower postoperative defecation dysfunction compared to SRR (12.1% vs. 42.9%, P=0.007) and lower postoperative C-reactive protein (CRP) levels (P<0.001), but satisfaction and complication rates were comparable between the two surgical approaches. One case of leakage occurred following SRR and no cases of fistulisation or bowel stenosis were observed. Conclusions: CNR and SRR are both safe and effective in treating symptomatic rectal endometriosis. CNR may be associated with lower postoperative defecation dysfunction rates and lower postoperative CRP levels. What is New? Complete nodular mucosa-sparing resection of rectal endometriosis seems to be feasible and potentially efficacious in lesions up to 3 cm. Compared to SRR, CNR may be associated with less post-operative defecation dysfunction.
Abdominal actinomycosis is an uncommon infection that may mimic malignancy or inflammatory bowel disease, leading to delayed diagnosis. Retained intrauterine devices (IUDs) have been associated with pelvic and abdominal actinomycosis. We report four women with prolonged IUD use presenting with non-specific abdominal symptoms and varied radiological findings, including abdominal wall, pelvic and hepatic abscesses. Diagnosis was supported by microbiological and/or histopathological findings. Management included IUD removal, prolonged antibiotic therapy and, in one case, surgery. These cases highlight the diagnostic challenges of abdominal actinomycosis and the importance of considering the diagnosis in women with long-term IUD use.
Background: Uterine fibroids are common among reproductive-aged women, with notable racial disparities in disease burden and outcomes. Myomectomy is a fertility-sparing surgical treatment associated with variable transfusion risk. Objectives: To evaluate racial disparities and identify risk factors for blood transfusion in patients undergoing myomectomy, and to develop a predictive model for high-risk patients. Methods: This retrospective cohort study used the American College of Surgeons National Surgical Quality Improvement Project (2018-2022) to identify women aged 18-55 years who underwent myomectomy. Patients with malignancy or bleeding disorders were excluded. Multivariable logistic regression was used to assess transfusion predictors and racial disparities. Main Outcome Measures: Incidence and predictors of perioperative blood transfusion; model performance for transfusion prediction. Results: Among 6,154 patients, 604 (9.8%) required transfusion. Non-Hispanic Black patients accounted for 74.3% of transfusion cases (vs. 52.0%, P<0.001) and had over twice the adjusted odds of transfusion compared to Non-Hispanic White patients [adjusted odds ratio (aOR): 2.1, 95% confidence interval: 1.6-2.7]. Preoperative anaemia (aOR: 8.5), abdominal approach (aOR: 4.7), and fibroid burden (>250 grams) (aOR: 2.0) were also significant. The predictive model demonstrated excellent discrimination (area under the receiver operating characteristic curve: 0.79). Conclusions: Non-Hispanic Black patients face higher transfusion risks during myomectomy, even after adjusting for clinical factors. Interventions targeting anaemia and prioritising minimally invasive approaches may reduce these disparities. What is New? This study explores recent racial disparities in blood transfusion among myomectomy patients and assesses how these patterns have evolved in recent years using a nationally representative surgical dataset.
“Buddy operating” is a subtype of dual operating described in the Clark model, where two surgeons of comparable proficiency collaborate during complex procedures. Potential benefits include improved surgical efficacy and safety, shared intraoperative decision making, enhanced skill development, and improved surgeon wellbeing. However, implementation must be justified given resource constraints and potential impacts on surgical training. We propose that buddy operating should be selectively applied to clearly defined complex cases, supported by governance frameworks, structured protocols, and outcome monitoring. Importantly, buddy operating must be distinguished from supervisory training. Future research should evaluate its effects on clinical outcomes, cost-effectiveness, surgeon health, and access to training opportunities.
Arteriovenous shunts (AV-shunts) whilst rare, can complicate intrauterine surgical procedures leading to severe vaginal bleeding. We present the case of a 29-year-old woman who experienced sudden, torrential vaginal bleeding 10 days following a hysteroscopic resection and curettage of a placental remnant after vaginal delivery. Ultrasonographic evaluation with power doppler demonstrated a post-traumatic AV-shunt. Tamponading the shunt for 36 hours utilising an intra-uterine inflated Foley catheter successfully controlled the bleeding and led to complete resolution of the AV-shunt. Accurately differentiating an AV-shunt from other hyper vascular entities, such as enhanced myometrial vascularity or arteriovenous malformations, is essential, due to the important differences in therapeutic management strategies.
Background:Obturator nerve compression is an uncommon cause of groin and medial thigh pain. Ganglion cysts extending into the obturator foramen are rare and usually managed via open or orthopaedic approaches. Robotic neuropelveology offers high-definition access to pelvic neurovascular structures and may facilitate nerve-preserving excision. Objectives:To demonstrate a robotic pelvic approach to the obturator foramen for excision of a ganglion cyst inseparable from the obturator nerve, and to highlight multidisciplinary (MDT) planning in atypical neuropathic pelvic pain. Participant:A 47-year-old woman presented with left groin/medial thigh pain and impaired leg function. MRI showed a 16-mm lobulated ganglion cyst arising from the undersurface of the left hip joint and extending into the left obturator foramen, inseparable from the obturator nerve with neurogenic oedema in obturator externus/adductor muscles. Intervention:After MDT planning with radiology, neurosurgeon, neuropelveology and gynaecology surgeon, a joint robotic procedure was performed. Key steps: develop an avascular pelvic sidewall plane via the lumbosacral space; dissect caudally to the obturator canal with minimal traction; identify the obturator nerve and vein and perform nerve-sparing neurolysis; perform controlled cystotomy and evacuate gelatinous contents for decompression; deroof the ganglion and remove the cyst wall to reduce recurrence. Conclusions:Robotic access to the obturator foramen can enable minimally invasive, nerve-preserving decompression and excision of selected pelvic nerve compression lesions, supported by MDT planning, with symptomatic and motor improvement. What is New?:A stepwise robotic route to the obturator canal for a ganglion cyst inseparable from the obturator nerve, demonstrating MDT-enabled management of rare neuropathic pelvic pain.
Background:For women who undergo fertility-sparing treatment for early cervical cancer, transabdominal cerclage (TAC) may be considered to prevent adverse obstetric outcomes due to cervical insufficiency. Laparoscopic-TAC (LPS-TAC) is now preferred over conventional transabdominal approaches because of decreased pain and bleeding, shorter hospitalisation and quicker recovery. However, a systematic, precise approach to performing LPS-TAC during pregnancy is necessary to overcome the lack of uterine manipulation and minimise complications such as bleeding and pregnancy loss. Objectives:To demonstrate the surgical technique of post-conceptional LPS-TAC. Participant:A 33-year-old woman with a history of FIGO stage IA1 squamous cervical cancer treated with fertility-sparing surgery. She had suffered a foetal loss after an emergency Caesarean section at 28 weeks because of uterine rupture. In her next pregnancy she presented at 10 weeks gestation with an ultrasound diagnosis of cervical shortening (14 mm). Intervention:The patient underwent LPS-TAC at a tertiary referral center. The operating time was 51 minutes, and blood loss was minimal. Intraoperative transvaginal ultrasound was used to guide the cerclage placement. No perioperative complications occurred; the hospital stay was two days. Elective C-section was performed at 34+6 weeks with hysterotomy above the tape, which was left in situ. Conclusions:LPS-TAC during pregnancy represents a feasible minimally invasive option for selected patients with cervical insufficiency, particularly those with a history of prior cervical surgery. Intraoperative ultrasound may assist in identifying the internal cervical os, facilitating safe tape placement and minimising the risk of membrane injury during pregnancy. What is New?:Intraoperative ultrasound guidance may support safe identification of the internal cervical os and optimal tape placement when performing LPS-TAC during pregnancy in patients with previous fertility-sparing treatment for cervical cancer.
Background:Urinary tract endometriosis affects fewer than 6% of patients with endometriosis, with ureteral involvement representing the second most common site of disease (9-23%). The condition is often asymptomatic, which may result in silent loss of renal function. Surgical intervention is required in cases of ureteral obstruction. Ureteroneocystostomy is indicated for distal ureteral disease, particularly when ureterolysis is insufficient or vascular compromise is present. The Lich-Gregoir technique is an extravesical approach to ureteral reimplantation into the bladder. Objectives:To present a step-by-step demonstration of robot-assisted ureteral reimplantation using the Lich-Gregoir technique following excision of a parametrial and vaginal endometriosis nodule. Participant:A 47-year-old nulliparous woman presented with dysuria, deep dyspareunia, and dyschezia. Imaging revealed a left parametrial endometriosis nodule extending to the vagina, causing distal ureteral obstruction and grade III hydronephrosis. Intervention:This narrated video demonstrates the surgical management of severe ureteral endometriosis, including ureterolysis, safe nodule excision, and ureteral reimplantation using the Lich-Gregoir technique. Reimplantation was preferred to segmental resection or ureterolysis due to distal stenosis, proximity to the bladder, and the depth of disease infiltration. The patient remained asymptomatic at follow-up visits at 1 and 6 months. Retrograde cystography performed 3 weeks postoperatively showed no leakage. Conclusions:Robot-assisted Lich-Gregoir ureteral reimplantation represents a feasible and reproducible option for distal ureteral endometriosis. The robotic platform may facilitate precise and complex reconstructive procedures. What is New?:The case illustrates the role of robotic surgery in complex pelvic endometriosis, demonstrates the feasibility of integrating ureteroneocystostomy with simultaneous excision of parametrial and vaginal endometriosis.
This retrospective, single-centre cohort study evaluated the Four-Clamp Technique for primary laparoscopic access in 45 morbidly obese women (body mass index ≥40 kg/m2) undergoing gynaecological procedures at a tertiary centre between January 2015 and August 2025. The technique utilised four symmetrically positioned towel clamps to allow omnidirectional traction to achieve stable abdominal wall elevation before direct trocar insertion. First-attempt success was achieved in 39 (86.7%) of patients, with overall success in 42 (93.3%) women. No major vascular or visceral injuries occurred. Ten (22.2%) minor complications occurred: trocar-site or clamp-site bleeding (4, 8.9%), minor omental injury (3, 6.6%), subcutaneous emphysema (2, 4.4%), and extraperitoneal insufflation (1, 2.2%). Mean time to intraperitoneal access was 74±18 seconds. Target intra-abdominal pressure was maintained at 12-14 mmHg. The Four-Clamp Technique may represent a feasible and reproducible method for primary laparoscopic access in morbidly obese patients in this single-centre cohort; however, prospective comparative studies are warranted to confirm these preliminary findings.
Background:In recent years, robotic surgery has gained traction across multiple disciplines, establishing a new minimally invasive paradigm. After the Da Vinci® (Intuitive, Sunnyvale, California) patent expired, several platforms with increasingly digital interfaces entered the market. Robotic surgery may represent a bridge between laparoscopy and digital surgery through interfaces that enable integration with emerging technologies. Among platforms, the Toumai robotic system (Medbot-Microport, Shanghai, China) features a single-arm cart with four arms, a three-dimensional console, and a split-view "picture-in-picture" function enabling communication with image-guided surgical technologies. This functionality is particularly valuable for indocyanine green (ICG)-guided sentinel lymph node (SLN) mapping in gynaecologic oncology. Objectives:We present for the first time, a step-by-step video demonstration of SLN dissection for endometrial malignancies using the Toumai robotic system. Participant:A postmenopausal patient with uterine-confined endometrial carcinoma undergoing total hysterectomy, bilateral salpingo-oophorectomy, and bilateral SLN biopsy. Intervention:The technique includes: 1) ICG injection; 2) robotic trocar placement; 3) docking; 4) pelvic retroperitoneal access; 5) switch to split-view mode; 6) identification of the SLN critical view of safety by developing pararectal and paravesical spaces; 7) introduction of an ICG-capable camera through an accessory trocar; 8) activation of near-infrared visualisation after switching off the robotic light source; 9) SLN identification and dissection; 10) safe extraction. Conclusions:The digital interface of the Toumai system integrates adjunctive technologies, illustrating how next-generation robotics expand the feasibility of SLN dissection in endometrial cancers. What is New?:The Toumai platform enables SLN dissection even in the absence of an in-house integrated ICG endoscopic camera.
Background: There is no standardisation of the degree of parametrial dissection and excision with hysterectomy in the presence of deep endometriosis (DE). Objectives: To apply an anatomical classification of dorso-lateral parametrectomy to hysterectomy for DE and correlate with postoperative complications and functional outcomes. Methods: Women with histologically confirmed DE who underwent hysterectomy with varying degrees of parametrectomy were retrospectively identified. Dorso-lateral parametrectomy was classified as follows: superficial (medial to presacral fascia), deep type 1 (beyond the presacral fascia), type 2 (caudal to medial rectal artery), and type 3 (laterally and deeply the hypogastric fascia). Statistical analysis was performed to correlate the degree of parametrial dissection with operative complications and functional outcomes at 6 months. Main Outcome Measures: Incidence of intra- and postoperative complications; changes in gastrointestinal, urinary, and sexual function; pain improvement. Results: Eighty-nine patients underwent parametrectomy with hysterectomy: superficial extended hysterectomy (EH) with superficial parametrectomy (EHSP, n=52), deep EH with deep parametrectomy type 1 (EHDP1, n=19), deep type 2 (EHDP2, n=12), and deep type 3 (EHDP3, n=6). Eight patients (8.9%) had intraoperative complication of which 5/52 (9.6%) underwent EHSP, 1/19 (5.3%) EHDP1, 2/12 (16.7%) EHDP2. Bladder voiding dysfunction occurred in 11 patients (12.3%) with higher incidences of 6/19 (31.6%) undergoing EHDP1 and 1/6 (16.7%) EHDP3 (P=0.016). Pain outcomes significantly improved across all groups (P<0.001). Conclusions: This classification of parametrectomy at the time of hysterectomy for DE offers a framework for assessing surgical complexity and outcomes. While substantial pain relief is observed, bladder dysfunction remains a significant concern, especially when parametrectomy extends beyond the presacral fascia. What is New? This classification for modified radical hysterectomy provides a method to standardise the description of parametrectomy for DE, facilitating more precise correlations between the extent of disease in the parametria and functional outcomes.
