OBJECTIVE:Minimally invasive surgery (MIS) is quickly becoming standard in many benign pathologies and early-stage malignancies. We sought to compare the outcomes of robotic single-site hysterectomy (RSSH) versus laparoendoscopic single-site hysterectomy (LESS-H) in terms of operative time, estimated blood loss (EBL), length of hospital stay, pain scores, hysterectomy time, complications, conversion rates, and transfusion rates. DATA SOURCES:Our study was conducted following PRISMA guidelines. Our search included Web of Science, Medline, PubMed, Cochrane Library, ClinicalTrials.Gov and SCOPUS. We searched from each database's inception until July 1st 2024. STUDY ELIGIBILITY CRITERIA:We included all observational studies comparing RSSH and LESS-H. Operative time, estimated blood loss (EBL), length of hospital stay, VAS pain scores, incidence of blood transfusion, and intra-operative and postoperative complications were our predetermined outcomes. STUDY APPRAISAL AND SYNTHESIS METHODS:Statistical analysis was done using Review Manager Software v5.9.7. RESULTS:RSSH was associated with a longer operative time compared to LESS-H (MD = 16.02 min, 95% CI [-0.07, 32.11], P = 0.05), with significant heterogeneity (I² = 89%). Subgroup analysis showed significantly longer operative time with RSSH for benign cases (MD = 23.51 min, 95% CI [5.79, 41.22], P = 0.009; I² = 86%) but a non-significant shorter time for early-stage endometrial carcinoma cases (MD = -10.94 min, 95% CI [-28.53, 6.64], P = 0.22; I² = 0). RSSH was associated with modestly lower EBL compared to LESS-H (MD = -6.84 ml, 95% CI [-12.34, -1.34], P = 0.01; I² = 0), though the clinical importance of this small difference remains uncertain. There was no significant difference in length of hospital stay (MD = -0.05 days, 95% CI [-0.57, 0.46], P = 0.84), pain scores at 1 hour (MD = 1.55, P = 0.26) or 12 h (MD = -0.02, P = 0.91), operative time specific to hysterectomy (MD = 2.75 min, P = 0.72), or complication rates (risk ratio = 1.161, 95% CI [0.588, 2.291], P = 0.667). Conversion and transfusion rates were also comparable between the two techniques. CONCLUSION:RSSH showed modestly lower estimated blood loss but longer operative time in benign cases compared with LESS-H, with otherwise similar safety profiles; however, substantial heterogeneity and the observational nature of the evidence limit firm conclusions on superiority.

OBJECTIVE:We set out to systematically evaluate and compare the safety and efficacy outcomes of laparoscopic and vaginal approaches in uterosacral suspension. DATA SOURCES:We searched major databases using appropriate terms to find studies comparing laparoscopic (or robotic-assisted laparoscopic) versus vaginal techniques for the repair of pelvic organ prolapse (POP). We searched from each database's inception until January 01, 2024. METHODS OF STUDY SELECTION:We included studies of patients undergoing POP surgery via either vaginal or laparoscopic routes, with or without concomitant hysterectomy. Ultimately, 9 studies met our criteria. TABULATION, INTEGRATION, AND RESULTS:We conducted this meta-analysis utilizing Review Manager Software and OpenMeta [Analyst]. The laparoscopic group had a longer operative time (mean difference [MD] = 5.77 minutes, p = .02, I2 = 47%) and lower estimated blood loss (MD = -49.71 mL, p = .05, I² = 81%). The length of hospital stay was similar between groups (MD = -0.26 days, p = .28, I² = 97%). The recurrence rate of any POP was lower in the laparoscopic group (risk ratio [RR] = 0.53, p = .03, I² = 0%). There were no significant differences in anatomical success rate (RR = 1.06, p = .16, I² = 35%), dyspareunia (RR = 0.79 p = .5, I² = 0%), or postoperative POP quantification stages I (RR = 1.11, p = .31, I² = 60%), II (RR = 0.93, p = .77, I² = 0%), and III (RR = 0.54, p = .52, I² = 0%). Following subgroup analysis with only cases that did not include hysterectomy, the differences in operative time ([-3.26,9.77] [p = .11]; I² = 55%), and estimated blood loss ([-55.75,7.66]) [p =.14]; I² = 54%) were no longer statistically significant. CONCLUSION:Both techniques proved effective. Laparoscopic uterosacral ligament suspension (L-USLS) involved longer operative times and less blood loss than vaginal-USLS. Adjusting for concomitant hysterectomy eliminated differences in operative time, blood loss, and hospital stay. Both methods showed similar hospital stay lengths, urinary tract infection rates, transfusion needs, reoperation rates, readmission rates, dyspareunia, and postoperative POP quantification stages. L-USLS displayed lower POP recurrence and urinary retention rates. While L-USLS may have advantages with hysterectomy, particularly in reduced blood loss, vaginal-USLS is also viable without hysterectomy. Due to study heterogeneity and lack of large randomized controlled trial data, more rigorous studies are essential to better define these surgical options.

Although the removal of the adnexa technically removes more tissue, it may require less fine manipulation and dissection than cystectomy. Secondary to this, we sought to measure the effectiveness and safety of laparoendoscopic single-site surgery (LESS) versus conventional laparoscopy (CLS). We search six databases to find studies comparing LESS and CLS for ovarian lesions where removal of the entire ovary, with or without the fallopian tube, is necessary. Criteria used for study eligibility: both controlled trials and observational studies were included in this analysis. Study appraisal and synthesis methods: we used the Cochrane risk of bias assessment tool for the randomized clinical trials and the national heart, lung, and blood quality assessment tools for the observational studies. The statistical analysis was done using the review manager software. LESS showed a significantly longer operative time [mean difference (MD)=2.96 (-1.97, 7.90), p=0.24], but with moderate heterogeneity. Estimated blood loss was significantly lower for LESS [MD=-18.62 (-33.83, -3.42), p=0.02]. The length of patient hospital stay was comparable [MD=-0.02 (-0.50, 0.47), p=0.95]. Visual analog scale (VAS) pain scores at 24 hours [MD=0.23 (-0.09, 0.56), p=0.16] and 6 hours postoperatively [MD=0.15 (-0.04, 0.33), p=0.12] were similar. The LESS group required less postoperative analgesia [risk ratios (RR)=0.47 (0.32, 0.68), p=0.001]. The change in hemoglobin was comparable [MD=-0.11 (-0.26, 0.03), p=0.14]. Perioperative complications were higher in the LESS group [RR=2.236 (1.031, 4.851), p=0.04]. Compared with CLS, LESS required more operative time but resulted in significantly less blood loss and lower postoperative analgesic use. Hospital stays and VAS pain scores were similar. LESS had a higher incidence of perioperative complications, which questions the feasibility of its use in some situations.

IMPORTANCE:Following expansive legalization of cannabis in many parts of the United States, cannabis use in pregnancy has increased several fold. There is a pressing need to understand the maternal and neonatal outcomes associated with this exposure. OBJECTIVE:To quantify the maternal and neonatal outcomes of mothers using cannabis during pregnancy. DATA SOURCES:We searched five databases for all relevant observational studies, from each database's inception until March 1st 2024. STUDY SELECTION:Two reviewers separately screened the studies in duplicate. Our initial search yielded 5184 studies, of which 51 (0.98%) were included in our qualitative synthesis. DATA EXTRACTION AND SYNTHESIS:Our study adhered to PRISMA guidelines and independent extraction by two researchers was utilized. We used a 95% confidence interval and the random effects model, as there was significant heterogeneity between studies. RESULTS:The 51 included studies yielded a total population of 7,920,383 pregnant women. Cannabis consumption was associated with increased risks of low birth weight (RR = 1.69,95% CI = (1.34,2.14),P < 0.0001), small for gestational age (RR = 1.79,95% CI = (1.52, 2.1),P < 0.00001), major anomalies (RR = 1.81,95% CI = (1.48, 2.23),P < 0.00001), decreased head circumference (MD = -0.34,95% CI = (-0.57,-0.11),P = 0.004), birth weight (MD = -177.81,95% CI = (-224.72,-130.91),P < 0.00001), birth length (MD = -0.87,95% CI = (-1.15,-0.59),P < 0.00001), gestational age (MD = -0.21,95% CI = (-0.35,-0.08),P = 0.002), NICU admission (RR = 1.55,95% CI = (1.36,1.78),P < 0.00001), perinatal mortality (RR = 1.72,95% CI = (1.09,2.71),P = 0.02), and preterm delivery (RR = 1.39,95% CI = (1.23,1.56),P < 0.00001). Cannabis use was also associated with a decreased risk of gestational diabetes in pregnancy (RR = 0.64,95% CI = (0.55,0.75),P < 0.00001). CONCLUSIONS:Inclusion of the latest published data continues to show worse maternal and neonatal outcomes for mothers using cannabis in pregnancy.

Objective:Vaginal natural orifice transluminal endoscopic surgery (vNOTES) combines vaginal surgery with single-port laparoscopy, providing a minimally invasive technique designed to overcome the challenges in traditional vaginal surgery. Several authors have now described techniques for performing these procedures with robotic assistance (R-vNOTES). We aim to evaluate the surgical outcomes and the safety of R-vNOTES hysterectomy in patients with benign diseases. Data Sources:We searched six major databases from their inception through October 2024 for studies analyzing the surgical outcomes of hysterectomy by R-vNOTES in cases with benign gynecologic diseases. Study eligibility criteria:We included all primary research studies that included at least one of our selected outcomes and did not include surgeries for malignant conditions. Study appraisal and synthesis methods:Study quality was appraised using the National Heart, Lung, and Blood Institute quality assessment tools. Data synthesis was accomplished using OpenMetaAnalyst and RevMan software. Mean difference and 95% confidence intervals were used for continuous outcomes following inverse variance analyses. Dichotomous outcomes were analyzed using an odds ratio and 95% confidence intervals. Results:Ultimately 10 eligible studies were included in our synthesis, including two studies that compared the R-vNOTES technique to robot-assisted laparoscopic hysterectomy (RALH) performed for the same indications. Our overall pooled analysis demonstrated that the operation time of R-vNOTES was 142 minutes, with an estimated blood loss of 67 mL. The overall length of hospital stay among the included studies was 2.04 days. We found an approximate decrease of 1.4 grams of hemoglobin after surgery. The incidence of conversion was 1.3%, and the complication rate was 13.3%. We found, R-vNOTES was to have a shorter operative time (P<.001) and lower blood loss than RALH (P=.002), with no significant differences seen between the cohorts in total hospital stay (P=.29) or complication rates (P=.98). Conclusion:Initial data shows that R-vNOTES seems to be a feasible minimally invasive technique with comparable outcomes and a favorable safety profile. Compared to RALH, R-vNOTES was associated with a shorter operation time and less blood loss.

Study Objective Adnexal masses in pediatric patients are an uncommon pathology, and treatment often raises the question of whether Gynecologic surgeons (those graduating OBGYN residencies and associated fellowships) or Pediatric and general surgeons (those graduating general surgery or other non-obgyn residencies and fellowships) are better suited to perform the procedure. To compare gynecologic surgeons and pediatric surgeons regarding the surgical management of ovarian lesions, whether through laparotomy or laparoscopic procedures. Design We searched all major databases for relative studies comparing gynecologic surgeons and pediatric or general surgeons. We performed a systematic review of all available information. Setting Pediatric and adolescent patients suffering from ovarian lesions. Patients or Participants Pediatric and adolescent patients suffering from ovarian lesions. Interventions Surgical intervention by gynecologic surgeons vs. pediatric or general surgeons. Measurements and Main Results We found that the gynecologic surgeons had lower incidences of complications and recurrence rates than the pediatric surgeons. Additionally, the gynecologic surgeons had a larger number of ovarian-sparing surgeries and fewer laparoscopies converted to laparotomies. Also, hospital stay was shorter with gynecologic surgeons. The incidence of accidental tumor spillage was also higher among pediatric and general surgeons than it was with the gynecologic surgeons. Conclusion Gynecologic surgeons are superior to pediatric surgeons surgical management of pediatric and adolescent female patients with ovarian masses.

Study Objective Pelvic organ prolapse is a condition where pelvic organs descend into the vaginal canal due to weakened muscles. Uterosacral ligament suspension is a surgical procedure addressing POP by strengthening the support to the uterus. The two main approaches of USLS are vaginal and laparoscopic, with no consensus of which method is superior. We set out to systematically evaluate and compare the safety and efficacy outcomes of vaginal and laparoscopic approaches in POP. Design We searched all major databases to find all studies comparing vaginal to laparoscopic (or robotic assisted laparoscopic) techniques for the repair of POP. We included randomized controlled trials and observational studies. Setting Our initial search yielded 2459 papers. 17 papers ultimately qualified for our analysis. Patients or Participants Women undergoing vaginal or laparoscopic (including laparoscopic assisted robotic) repair of POP with or without hysterectomy. Interventions Vaginal or laparoscopic surgery. Measurements and Main Results The vaginal approach demonstrated significantly shorter operation times (MD= 15.07 [7.06, 23.08],(P = 0.002); however, patients in this group experienced prolonged hospital stays (MD=-0.41 [-0.82,-0.01], (P=0.05), higher blood loss (MD=-41.17 [-70.71,-11.64],(P=0.006), and a significantly higher rate of recurrence (OR=0.59 [0.46,0.76], (P=0.001). Both groups exhibited similar incidences of UTIs (OR=0.73[0.52,1.01], (P=0.06) and blood transfusions (OR=0.79 [0.38, 1.65], (P = 0.53), along with comparable rates of reoperation (OR= 0.84[0.58,1.22],(P=0.37) and readmission (OR=0.70 [0.39, 1.23], (P=0.21). The laparoscopic group showed significantly higher clinical and anatomical success rates (OR=4.94 [1.62, 15.07], (P=0.005), (OR= 3.56 [1.98, 6.40], (P=0.001) and a lower incidence of urinary retention (OR= 0.41 [0.22,0.74],(P=0.003). No discernible differences were observed in the incidence of ileus and dyspareunia between the two groups. Conclusion While the vaginal approach offers shorter operation times, our analysis shows it is associated with longer hospital stays, higher estimated blood loss, a higher rate of urinary retention and an increased rate of POP recurrence.

As vaginal natural orifice transluminal endoscopic surgery (vNOTES) and laparoscopic hysterectomy techniques both aim to decrease tissue injury, decrease postoperative morbidity and mortality, and improve patient's quality of life, we sought out to evaluate the safety and effectiveness of hysterectomy by vNOTES compared to conventional laparoscopic hysterectomy in women with benign gynecologic diseases. We used Scopus, Medline, ClinicalTrials.Gov, PubMed, and the Cochrane Library, searching from inception until September 1st 2023. We included all eligible articles that compared vNOTES hysterectomy to any conventional laparoscopic hysterectomy technique without robotic assistance for women with benign gynecologic pathology, and included at least one of our main outcomes. These outcomes included estimated blood loss (in ml), operation time (in minutes), length of hospital stay (in days), decrease in hemoglobin level (g/dL), visual analog scale (VAS) pain score on postoperative day one, opioid analgesic dose required, rate of conversion to another surgical technique, intraoperative complications, postoperative complications, and requirements of blood transfusion. We included RCTs as well as observational studies. Ultimately 14 studies met our criteria. Study quality of the RCTs was assessed using the Cochrane assessment tool, and the quality of the observational studies was assessed using the ROBINS-I tool. We analyzed data using RevMan 5.4.1. Continuous outcomes were analyzed using mean difference (MD) and 95% confidence intervals (CIs) under the inverse variance analysis method. Dichotomous outcomes were analyzed using OpenMeta[Analyst] with odds ratios (OR) and 95% CIs. Operative time and the length of hospitalization were shorter in the vNOTES cohort. We also found lower VAS scores, fewer postoperative complications and fewer blood transfusions in the vNOTES group. We found no difference in estimated blood loss, decrease in hemoglobin levels, analgesic usage, conversion rates or intraoperative complications. When in including the latest data, vNOTES techniques may have some advantages over conventional laparoscopic hysterectomy techniques.

ObjectiveAs the second most common surgery performed on women in the US, hysterectomy techniques are constantly examined for validity and superiority. The vaginal natural orifice transluminal endoscopic surgery (vNOTES) has increased in popularity since the first vNOTES hysterectomy was performed in 2012. We sought out to evaluate the safety and effectiveness of hysterectomy by vNOTES compared to conventional vaginal hysterectomy for various benign indications.Data sourcesWe searched Scopus, Medline, PubMed, ClinicalTrials.Gov, and the Cochrane Library. Our search included all studies from each respective database's inception until September 1st 2023.Study eligibility criteriaWe included eligible studies that compare vNOTES hysterectomy versus conventional vaginal hysterectomy for various benign indications, and included at least one of our preselected outcomes. The main outcomes were estimated blood loss (ml), operation time (min), length of hospital stay (d), Visual Analogue Scale Pain (VAS) score at Day 1, intraoperative complications, and postoperative complications.Study appraisal and synthesis methodsWe analyzed data of our continuous outcomes using RevMan 5.4.1. Continuous outcomes were analyzed using mean difference (MD) and 95% confidence intervals (CIs) under the inverse variance analysis method. We assessed the quality of the studies using the ROBINS-I assessment tool.ResultsWe found 4 eligible studies to include in our analysis. Surgeon declared estimated blood loss was found to be similar in both groups (MD=-44.70 [-99.97, 10.57] (P = 0.11)). Also, the total length of hospital stay (in days) was found to be comparable in both groups (MD=-0.16 [-1.62, 1.30], (P = 0.83)). We also found no other statistically significant difference between hysterectomy by vNOTES and vaginal hysterectomy in other studied outcomes, including the duration of the operation, the Visual Analogue Scale Pain (VAS) score after one day, intraoperative complications, and postoperative complications.ConclusionvNOTES seems to be associated with a non-significant lower surgeon declared estimated blood loss. We found no other significant differences in hospital stay, intraoperative, or postoperative outcomes. Further studies may clarify if other differences in safety or efficacy exist.

Conservative laparoscopic torsioning with or without cystectomy or oophoropexy has emerged as a promising approach for the management of ovarian torsion, particularly in pediatric populations. We sought to understand the efficacy of this approach. We comprehensively reviewed the relevant literature. We formulated a search strategy by combining keywords related to laparoscopic surgery, conservative management, and ovarian torsion in pediatric and adolescent populations. Data were retrieved from Web of Science, PubMed, Medline, Cochrane Library, and ClinicalTrials. The Gov and Scopus databases. Eligible articles met the following criteria: Involved pediatric or adolescent populations with ovarian or adnexal torsion and evaluating the use of any method of laparoscopic torsioning surgery. We included the following outcomes; recurrence, conversion to laparotomy, need for oophorectomy, mean time to the onset of symptoms, abdominal pain at the time of presentation, fever, and evidence of ovarian function on postoperative ultrasound. In our meta-analysis, conducted using OpenMeta[Analyst], we analyzed both continuous and dichotomous data with mean difference and risk ratio, respectively, along with 95% confidence intervals (CI). First, the incidence of recurrence was reported in five studies, where 17 cases experienced recurrence out of 391 cases experienced recurrence. Additionally, instances requiring open surgery were documented in five studies, with 22 out of 360 cases requiring this conversion to open surgery, resulting in a combined ratio of 0.051 [95% CI (0.018, 0.083), p=0.02]. Moreover, six studies provided data on cases necessitating oophorectomy, with 27 out of 437 cases requiring the procedure. Furthermore, the mean time from symptom onset to surgery was 51.9 h. Abdominal pain was prevalent at presentation, affecting 264 out of 324 patients. Fever was less frequently reported, with 19 out of 324 patients experiencing it. Finally, a high percentage of patients showed evidence of ovarian function on postoperative ultrasound, with a pooled proportion of 0.69. Our analysis performed the conservative management of ovarian torsion in young women. Recurrence occurred in 17 out of 391, and 22 out of 360 required conversion to open surgery. Furthermore, oophorectomy was necessary in 27 of 437 patients, and the mean time from symptom onset to surgery was 51.9 h. Abdominal pain was the most common symptom, affecting 264 out of 324 cases, whereas fever was less common.

Objective We aimed to investigate trends in residency program application and acceptance rates according to sex and race and ethnicity. Methods We collected data from the Journal of the American Medical Association Graduation Medical Education Reports. We extracted the data for 25 residency programs in the United States from 2005 to 2021 and conducted statistical analyses. Results Men were most matched for orthopedics (84.7%, 95% confidence interval [CI] 84.2%–85.1%), and women for oncology (78.7%, 95% CI 78.2%–79.2%). The most matched program was orthopedics for the White subgroup (43.5%, 95% CI 43.2%–43.9%), radiology for the Black subgroup (20%, 95% CI 18.9%–20.9%), general surgery for the Hispanic subgroup (11%, 95% CI 10.7%–11.2%), and internal medicine for the Asian subgroup (35.3%, 95% CI 34.9%–35.6%). Conclusion Match rates for women were lower than those for men in all programs except psychiatry, pediatrics, obstetrics and gynecology, and dermatology. Match rates were significantly lower for Black, Hispanic, and Asian subgroups than the White subgroup in all programs except for internal medicine, with the Asian subgroup being higher. We observed a significant increase in both application and acceptance rates for women and racial and ethnic minorities over the past 40 years.

Objective Ectopic pregnancy (EP) is an emergency frequently requiring laparoscopic intervention. We sought out to ascertain if Single-incision laparoscopic surgery (SILS) was a safe and effective method of treatment compared to conventional laparoscopic surgery (CLS) with multiple ports. Data Sources We searched six databases from their inception until 05/15/2024 for articles comparing the safety outcomes of SILS with CLS in managing women with EP. Study Eligibility Criteria We include all studies that evaluated the safety outcomes of SILS compared to CLS in patients with EP, and included at least one of our preselected outcomes. We included both RCTs and observational studies. Study Appraisal and Synthesis Methods We used Review Manager 5.4.1 and OpenMetaAnalyst software to analyze the extracted data. We used odds ratios in the dichotomous outcomes and mean difference in the continuous outcomes, as well as a fixed effects model in homogeneous outcomes and a random effects model in heterogeneous outcomes. We evaluated heterogeneity using the I2 and p-values. Methods of Study Selection Following the removal of duplicates we located 83 total studies. Using a two step screening process, we excluded non-english and animal studies, and included studies that were RCTs or observational studies that included at least one of our preselected outcomes. Ultimately 12 studies were included in our final synthesis. Results Our analysis showed a significant favoring of the SILS group in the pain VAS score (MD= -0.57, P < 0.01). However, we found no statistically significant difference between both procedures in the times of analgesics use (MD= -0.08, P = 0.19), intraoperative complications (OR=1.17, P = 0.8), postoperative complications (OR=1.02, P = 0.96), conversion to laparotomy (OR=1.4, P = 0.59), bowel injury (OR=1.42, P = 0.8), and postoperative fever (OR= 0.52, P = 0.42). Conclusion The use of SILS to treat ectopic pregnancy may reduce postoperative pain with similar rates of analgesic use. The incidence of intraoperative and postoperative complications was comparable. Furthermore, the rates of conversion to laparotomy, bowel injury, and postoperative fever were similar for both techniques. These results seem to show non-inferiority for the safety of SILS for treatment of EP when compared to CLS.

Objective First-generation and second-generation endometrial ablation (EA) techniques, along with medical treatment and invasive surgery, are considered successful lines of management for abnormal uterine bleeding (AUB). We set out to determine the efficacy of first and second-generation ablation techniques compared with medical treatment, invasive surgery and different modalities of the EA techniques themselves.Design Systematic review and network meta-analysis using a frequentist network.Data sources We searched Medline (Ovid), PubMed, ClinicalTrials.gov, Cochrane CENTRAL, Web of Science, EBSCO and Scopus for all published studies up to 1 March 2021 using relevant keywords.Eligibility criteria We included all randomised controlled trials (RCTs) that compared premenopausal women with AUB receiving the intervention of second-generation EA techniques.Data extraction and synthesis 49 high-quality RCTs with 8038 women were included. We extracted and pooled the data and then analysed to estimate the network meta-analysis models within a frequentist framework. We used the random-effects model of the netmeta package in R (V.3.6.1) and the ‘Meta-Insight’ website.Results Our network meta-analysis showed many varying results according to specific outcomes. The uterine balloon ablation had significantly higher amenorrhoea rates than other techniques in both short (hydrothermal ablation (risk ratio (RR)=0.51, 95% CI 0.37; 0.72), microwave ablation (RR=0.43, 95% CI 0.31; 0.59), first-generation techniques (RR=0.44, 95% CI 0.33; 0.59), endometrial laser intrauterine therapy (RR=0.18, 95% CI 0.10; 0.32) and bipolar radio frequency treatments (RR=0.22, 95% CI 0.15; 0.31)) and long-term follow-up (microwave ablation (RR=0.11, 95% CI 0.01; 0.86), bipolar radio frequency ablation (RR=0.12, 95% CI 0.02; 0.90), first generation (RR=0.12, 95% CI 0.02; 0.90) and endometrial laser intrauterine thermal therapy (RR=0.04, 95% CI 0.01; 0.36)). When calculating efficacy based only on calculated bleeding scores, the highest scores were achieved by cryoablation systems (p-score=0.98).Conclusion Most second-generation EA systems were superior to first-generation systems, and statistical superiority between devices depended on which characteristic was measured (secondary amenorrhoea rate, treatment of AUB, patient satisfaction or treatment of dysmenorrhoea). Although our study was limited by a paucity of data comparing large numbers of devices, we conclude that there is no evidence at this time that any one of the examined second-generation systems is clearly superior to all others.

OBJECTIVE: Because vaginal natural orifice transluminal endoscopic surgery and laparoscopic hysterectomy techniques both aim to decrease tissue injury and postoperative morbidity and mortality and to improve a patient's quality of life, we sought to evaluate the safety and effectiveness of a hysterectomy by vaginal natural orifice transluminal endoscopic surgery and compared that with conventional laparoscopic hysterectomy among women with benign gynecologic diseases. DATA SOURCES: We used Scopus, Medline, ClinicalTrials.Gov, PubMed, and the Cochrane Library and searched from database inception to September 1, 2023. STUDY ELIGIBILITY CRITERIA: We included all eligible articles that compared vaginal natural orifice transluminal endoscopic surgery hysterectomy with any conventional laparoscopic hysterectomy technique without robotic assistance for women with benign gynecologic pathology and that included at least 1 of our main outcomes. These outcomes included estimated blood loss (in mL), operation time (in minutes), length of hospital stay (in days), decrease in hemoglobin level (g/dL), visual analog scale pain score on postoperative day 1, opioid analgesic dose required, rate of conversion to another surgical technique, intraoperative complications, postoperative complications, and requirements for blood transfusion. We included randomized controlled trials and observational studies. Ultimately, 14 studies met our criteria. METHODS: The study quality of the randomized controlled trials was assessed using the Cochrane assessment tool, and the quality of the observational studies was assessed using the ROBINS-I tool. We analyzed data using RevMan 5.4.1. Continuous outcomes were analyzed using the mean difference and 95% confidence intervals under the inverse variance analysis method. Dichotomous outcomes were analyzed using OpenMeta[Analyst] and odds ratios and 95% confidence intervals were reported. RESULTS: The operative time and length of hospitalization were shorter in the vaginal natural orifice transluminal endoscopic surgery cohort. We also found lower visual analog scale pain scores, fewer postoperative complications, and fewer blood transfusions in the vaginal natural orifice transluminal endoscopic surgery group. We found no difference in the estimated blood loss, decrease in hemoglobin levels, analgesic usage, conversion rates, or intraoperative complications. CONCLUSION: When evaluating the latest data, it seems that vaginal natural orifice transluminal endoscopic surgery techniques may have some advantages over conventional laparoscopic hysterectomy techniques.

Objective: Recent data has brought into question the safety of minimally invasive techniques for radical hysterectomy in the treatment of early stage cervical cancer. After the publication of several new studies, we aimed to compare robotic radical hysterectomy (RRH) with open radical hysterectomy (ORH) in the management of women with early stage cervical cancer, while excluding minimally invasive cases performed without robotic assistance. Data Sources: We searched six databases from inception until 11/30/2021. The original search found 233 unique papers, and ultimately 35 studies, comprising 11,888 total radical hysterectomies, met criteria for our final analysis. We included all studies including the intervention of RRH for early stage cervical cancer, with the comparator of ORH. We included randomized clinical trials (RCTs), case-control, retrospective cohort, and prospective cohort. We included studies that had robotic and laparoscopic arms, but excluded any studies that did not specifically provide specific data as to each group. We analyzed continuous data using mean difference and a 95% confidence interval, while dichotomous data were analyzed using odds ratio and a 95% confidence interval. Results: We found that there was no significant difference between RRH and ORH regarding five-year Overall Survival (OR=1.28[0.66,2.46], (P = 0.46)), disease free survival (OR=0.94[0.77,1.14], (P = 0.51)), or recurrence (OR=0.92[0.75,1.13], (P = 0.44)) intraoperative complications (OR=0.75[0.55,1.02], (P = 0.07)), or mortality (OR=0.81[0.53,1.22], (P = 0.31)).We found that RRH was better than ORH in terms of estimated blood loss (MD=-397.95[-471.65,-324.24], (P < 0.001)), blood transfusion rate (OR=0.13[0.10,0.17], (P = 0.001), post-operative complications (OR=0.65[0.46,0.91], (P = 0.01)), and length of hospital stay (MD=-3.99[-4.67,-3.31], (P < 0.001)). While ORH was better than RRH regarding operation time (MD=15.34[2.21,28.47], (P = 0.02)) and number of resected lymph nodes (MD=-2.64[-4.12,-1.15], (P = 0.005)). Conclusions: The previously seen increase in cancer recurrence and decrease in survival no longer seem to be present when we consider the newest high-quality data and exclude non-robotic minimally invasive techniques. RRH was associated with less estimated blood loss, a lower transfusion rate, a shorter hospital stay, and fewer postoperative complications. ORH seems to be associated with a higher number of resected lymph nodes, and a shorter operative time.Trial registration details: Prospero Prospective Registration Number: CRD42022306991 Registration link: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=306991

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is associated with increased pregnancy complications. Despite effective vaccination strategies for the general population, the evidence on the safety and efficacy of Coronavirus disease 2019 (COVID-19) vaccinations in pregnancy is limited due to a lack of well-powered studies. The present study compares the maternal, neonatal, and immunological outcomes between vaccinated pregnant and unvaccinated pregnant women using a systematic review and meta-analysis approach. We included 37 studies with a total of 141,107 pregnant women (36.8% vaccinated) spread across all outcomes. Our evidence indicates a higher rate of cesarean section in the 1898 vaccinated pregnant women compared to the 6180 women who did not receive vaccination (OR = 1.20, CI = (1.05, 1.38), P = 0.007, I2 = 45%). Regarding immunological outcomes, the risk of SARS-CoV-2 infection during pregnancy or postpartum was significantly reduced in 6820 vaccinated pregnant women compared to 17,010 unvaccinated pregnant women (OR = 0.25, CI = 0.13–0.48, P < 0.0001, I 2 = 61%), as evident from qualitative assessment indicating significantly higher postpartum antibody titers compared to that observed in both unvaccinated mothers and mothers who have recently recovered from a SARS-CoV-2 infection. Our analysis represents high quality evidence showing that COVID-19 vaccination effectively raises antibody titers against SARS-CoV-2. This may confer protection against infection during pregnancy and the postpartum period. In addition to being protective against SARS-CoV-2, the vaccine was associated with decreased odds of preterm delivery. Furthermore, COVID-19 vaccination may also be associated with higher odds of cesarean section.

Objective Following compelling evidence that open techniques may be related to better survival and disease free survival rates, many gynecologic oncologists in the US have turned away from performing laparoscopic radical hysterectomy (LRH) and robotic radical hysterectomy (RRH) for the treatment of early-stage cervical cancer. While this may be warranted as a safety concern, there is little high-quality data on the head-to-head comparison of LRH and RRH and therefore little evidence to answer the question of where this decrease in patient survival is originating from. In our systematic review, we aimed to compare the complications and outcomes of LRH against those of RRH. Data Sources We searched PubMed, Cochrane CENTRAL, Medline, ClinicalTrials.Gov, SCOPUS, and Web of Science from database inception until February 1st, 2022. Methods of Study Selection A total of 676 studies were identified and screened through a manual three-step process. Ultimately 33 studies were included in our final analysis. We included all studies that compared LRH and RRH and included at least one of our selected outcomes. We included retrospective cohorts, prospective cohorts, case-control, and randomized clinical trials. Tabulation, Integration, and Results Data was independently extracted manually by multiple observers and the analysis was performed using Review Manager Software. PRISMA guidelines were followed. We analyzed homogenous data using a fixed-effects model, while a random-effects model was used for heterogeneous outcomes. We found that following RRH, women had a decreased hospital stay (MD = 0.80[0.38,1.21],(P < 0.002). We found no differences in estimated blood loss (MD = 35.24[-0.40,70.89],(P = 0.05), blood transfusion rate ((OR = 1.32[0.86,2.02],(P = 0.20), rate of post-operative complications (OR = 0.84[0.60,1.17],(P = 0.30), the operative time (MD = 6.01[-4.64,16.66],(P = 0.27), number of resected lymph node (MD = -1.22[-3.28,0.84],(P = 0.25) intraoperative complications (OR = 0.78[0.51,1.19],(P = 0.25), five-year overall survival (OR = 1.37[0.51,3.69],(P = 0.53), lifetime disease free survival (OR = 0.89[0.59,1.32],(P = 0.55), intraoperative and postoperative mortality (within 30 days) (OR = 1.30[0.66,2.54],(P = 0.44), and recurrence (OR = 1.14[0.79,1.64],(P = 0.50). Conclusions RRH seems to result in the patient leaving the hospital sooner after surgery. We were unable to find any differences in our ten other outcomes related to complications or efficacy. These findings suggest that the decreased survival seen in minimally invasive RH in previous studies could be due to factors inherent to both LRH and RRH. Prospero Prospective Registration Number CRD42022273727.

Recent evidence has shown an increase in recurrence and a decrease in overall survival in patients treated with laparoscopic radical hysterectomy (LRH) and robotic assisted radical hysterectomy (RRH) open techniques (ORH). In addition, several high quality trials were recently published regarding the laparoscopic treatment of early stage cervical cancer. We sought out to reassess the recurrence rates, overall survival, complications and outcomes associated with laparoscopic radical hysterectomy (LRH) techniques against open techniques (ORH) when robotic assisted techniques were excluded. We searched PubMed, Medline, Cochrane CENTRAL, SCOPUS, ClinicalTrials.Gov and Web of Science for relevant clinical trials and observational studies. We included all studies that compared with early stage cervical cancer receiving LRH compared with ORH. We included randomized clinical trials, prospective cohort, and retrospective cohort trials. We included studies that included LRH and RRH as long as data was available to separate the two arms. We excluded studies that combined LRH and RRH without supplying data to differentiate. Of 1244 total studies, we used a manual three step screening process. Sixty studies ultimately met our criteria. We performed this review in accordance with PRISMA guidelines. We analyzed continuous data using mean difference (MD) and a 95% confidence interval (CI), while dichotomous data were analyzed using odds ratio (OR) and a 95% CI. Review Manager and Endnote software were utilized in the synthesis. We found that when excluding RRH, the was no significant difference regarding 5-year overall Survival (OR = 1.24 [0.94, 1.64], (P = 0.12), disease free survival (OR = 1.00 [0.80, 1.26], (P = 0.98), recurrence (OR = 1.01 [0.81, 1.25], (P = 0.95), or intraoperative complications (OR = 1.38 [0.94, 2.04], (P = 0.10). LRH was statistically better than ORH in terms of estimated blood loss (MD = − 325.55 [− 386.16, − 264.94] (P < 0.001), blood transfusion rate (OR = 0.28 [0.14, 0.55], (P = 0.002), postoperative complication rate (OR = 0.70 [0.55, 0.90], (P = 0.005), and length of hospital stay (MD = − 3.64[− 4.27, − 3.01], (P < 0.001). ORH was superior in terms of operating time (MD = 20.48 [8.62, 32.35], (P = 0.007) and number of resected lymph nodes (MD = − 2.80 [− 4.35, − 1.24], (P = 0.004). The previously seen increase recurrence and decrease in survival is not seen in LRH when robotic assisted techniques are included and all new high quality is considered. LRH is also associated with a significantly shorter hospital stay, less blood loss and lower complication rate. Prospero Prospective Registration Number: CRD42022267138.

Background and Aim: The aim of this study was to evaluate the efficacy a 20% intravenous fat emulsion therapy in women suffering from recurrent pregnancy loss or recurrent implantation failure (RPL/RIF) who are undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). Materials and Methods: We searched Cochrane Library, ISI Web of Science, MEDLINE, ClinicalTrials.gov, PubMed, and Scopus using relevant keywords during February 2020 for randomized controlled trials (RCTs) comparing the therapy versus placebo or no intervention in women suffering from RPL/RIF and undergoing IVF/ICSI. Results: We included five RCTs with 840 patients. The intravenous fat emulsion therapy was significantly effective in increasing clinical pregnancy rates compared to the control group (risk ratios [RR] = 1.48, 95% confidence intervals [CI] [1.23, 1.79], P < 0.001). Furthermore, ongoing pregnancy and live birth rates were significantly higher with 20% intravenous fat emulsion therapy RR = 1.71, 95% CI [1.27, 2.32], P = 0.005 and RR = 1.85, 95% CI [1.44, 2.38], P < 0.001. Despite the statistically significant differences, the quality of evidence was only considered moderate, and this was primarily due to high risk of bias in the included RCTs. Conclusion: Our review provides a moderate level of evidence that intravenous fat emulsion therapy is effective in improving reproductive outcomes among women with RPL/RIF performing IVF/ICSI techniques. Further, investigation is required to ascertain optimal dosage and timing of administration. Relevance for Patients: Women suffering from RPL or RIF may wish to consider discussing with their reproductive endocrinologist the addition of a 20% fat emulsion therapy to planned IVF or ICSI cycles, which may improve outcomes.