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Namazi G, Gupta S, Einarsson JI. Deep Pelvic Side Wall Anatomy; A Case of Laparoscopic Management of Vaginal Vault Fistula to the Presacral Area. J Minim Invasive Gynecol 2021. [DOI: 10.1016/j.jmig.2021.09.439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Gupta S, King LP, Ajao MO, Einarsson JI. Very Low Rates of Ureteral Injury in Laparoscopic Hysterectomy Performed by Fellowship-Trained Minimally Invasive Gynecologic Surgeons. J Minim Invasive Gynecol 2021. [DOI: 10.1016/j.jmig.2021.09.446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Tomassetti C, Johnson NP, Petrozza J, Abrao MS, Einarsson JI, Horne AW, Lee TTM, Missmer S, Vermeulen N, Zondervan KT, Grimbizis G, De Wilde RL. An International Terminology for Endometriosis, 2021. Facts Views Vis Obgyn 2021; 13:295-304. [PMID: 34672510 PMCID: PMC9148705 DOI: 10.52054/fvvo.13.4.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background Different classification systems have been developed for endometriosis, using different definitions for the disease, the different subtypes, symptoms and treatments. In addition, an International Glossary on Infertility and Fertility Care was published in 2017 by the International Committee for Monitoring Assisted Reproductive Technologies (ICMART) in collaboration with other organisations. An international working group convened over the development of a classification or descriptive system for endometriosis. As a basis for such system, a terminology for endometriosis was considered a condition sine qua non. Objectives The aim of the current paper is to develop a set of terms and definitions on endometriosis that would be the basis for standardisation in disease description, classification and research. Materials and Methods The working group listed a number of terms relevant to be included in the terminology, documented currently used and published definitions, and discussed and adapted them until consensus was reached within the working group. Following stakeholder review, further terms were added, and definitions further clarified. Although definitions were collected through published literature, the final set of terms and definitions is to be considered consensus-based. After finalisation of the first draft, the members of the international societies and other stakeholders were consulted for feedback and comments, which led to further adaptations. Results A list of 49 terms and definitions in the field of endometriosis is presented, including a definition for endometriosis and its subtypes, different locations, interventions, symptoms and outcomes. Endometriosis is defined as a disease characterised by the presence of endometrium-like epithelium and/or stroma outside the endometrium and myometrium, usually with an associated inflammatory process. Conclusions The current paper outlines a list of 49 terms and definitions in the field of endometriosis. The application of the defined terms aims to facilitate harmonisation in endometriosis research and clinical practice. Future research may require further refinement of the presented definitions. What is new? A consensus based international terminology for endometriosis for clinical and research use.
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Vermeulen N, Abrao MS, Einarsson JI, Horne AW, Johnson NP, Lee TTM, Missmer S, Petrozza J, Tomassetti C, Zondervan KT, Grimbizis G, De Wilde RL. Endometriosis classification, staging and reporting systems: a review on the road to a universally accepted endometriosis classification. Facts Views Vis Obgyn 2021; 13:305-330. [PMID: 34672508 PMCID: PMC9148706 DOI: 10.52054/fvvo.13.3.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background In the field of endometriosis, several classification, staging and reporting systems have been developed. However, endometriosis classification, staging and reporting systems that have been published and validated for use in clinical practice have not been systematically reviewed up to now. Objectives The aim of the current review is to provide a historical overview of these different systems based on an assessment of published studies. Materials and Methods A systematic Pubmed literature search was performed. Data were extracted and summarised. Results Twenty-two endometriosis classification, staging and reporting systems have been published between 1973 and 2021, each developed for specific and different purposes. There is still no international agreement on how to describe the disease. Studies evaluating different systems are summarised showing a discrepancy between the intended and the evaluated purpose, and a general lack of validation data confirming a correlation with pain symptoms or quality of life for any of the current systems. A few studies confirm the value of the Enzian system for surgical description of deep endometriosis. With regards to infertility, the endometriosis fertility index has been confirmed valid for its intended purpose. Conclusions Of the 22 endometriosis classification, staging and reporting systems identified in this historical overview, only a few have been evaluated, in 46 studies, for the purpose for which they were developed. It can be concluded that there is no international agreement on how to describe endometriosis or how to classify it, and that most classification/staging systems show no or very little correlation with patient outcomes. What is new? This overview of existing systems is a first step in working towards a universally accepted endometriosis classification.
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Moawad GN, Klebanoff JS, Tyan P, Einarsson JI. COVID-19: A Surgical Perspective for when the curve flattens. Facts Views Vis Obgyn 2020; 12:129-131. [PMID: 32832927 PMCID: PMC7431197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
At the present time it is clear that our global healthcare community was not prepared to face the COVID-19 pandemic. Hospitals in the hardest hit areas have been transformed to COVID centres. Surgical societies have recommended postponing non-emergency surgery, and have given recommendations for triaging the ever- growing backlog of patients. However, simply resuming these non-emergency surgeries may lead the healthcare system into a second disaster. If healthcare policymakers around the world do not systematically consider how to resume normal surgical services, hospitals will be quickly overwhelmed, vital resources will be depleted, and patients and providers alike will face an increased exposure risk. This perspective serves to highlight certain aspects of returning to normal that physicians and hospital administrators alike must consider to avoid potential catastrophe.
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Affiliation(s)
- GN Moawad
- Department of Obstetrics and Gynecology, The George Washington University, Washington, DC
| | - JS Klebanoff
- Department of Obstetrics and Gynecology, The George Washington University, Washington, DC
| | - P Tyan
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, The University of North Carolina, Chapel Hill, NC
| | - JI Einarsson
- Division of Minimally Invasive Gynecologic Surgery Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, MA
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Kim R, Dmello M, Clark NV, Ajao M, Einarsson JI, Cohen SL. 2538 Current Methods of Tissue Extraction in Minimally Invasive Surgical Treatment of Uterine Fibroids. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Ajao MO, Cohen SL, Kohli N, Einarsson JI. Feasibility of Outpatient Combined Laparoscopic Apical and Vaginal Prolapse Repair. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kim R, Pepin K, Einarsson JI. Laparoscopic Excision of Transmural Rectal Endometriosis. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Ajao MO, Cox MKB, Cohen SL, Einarsson JI. Major Complications of 1099 Laparoscopic Hysterectomies. Report from a Single Academic Center. J Minim Invasive Gynecol 2016. [DOI: 10.1016/j.jmig.2016.08.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ajao MO, Cox MKB, Meurs E, Goggins ER, Oliveira Brito LG, Einarsson JI, Cohen SL. Recurrence of Symptoms After Hysterectomy in Patients with Adenomyosis. J Minim Invasive Gynecol 2016. [DOI: 10.1016/j.jmig.2016.08.711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Sandberg EM, Cohen SL, Jansen FW, Einarsson JI. Laparoscopic Myomectomy as a New Standard: An Analysis of Risk Factors for Conversion. J Minim Invasive Gynecol 2016; 22:S62. [PMID: 27679293 DOI: 10.1016/j.jmig.2015.08.165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- E M Sandberg
- Gynaecology, Leiden University Medical Center, Leiden, Zuid Holland, Netherlands
| | - S L Cohen
- Gynaecology (Minimally Invasive Surgery), Brigham and Women's Hospital, Boston, Massachusetts
| | - F W Jansen
- Gynaecology, Leiden University Medical Center, Leiden, Zuid Holland, Netherlands
| | - J I Einarsson
- Gynaecology (Minimally Invasive Surgery), Brigham and Women's Hospital, Boston, Massachusetts
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Cohen SL, Senapati S, Gargiulo AR, Srouji SS, Tu FF, Solnik J, Hur HC, Vitonis A, Jonsdottir GM, Wang KC, Einarsson JI. Dilute versus concentrated vasopressin administration during laparoscopic myomectomy: a randomised controlled trial. BJOG 2016; 124:262-268. [PMID: 27362908 DOI: 10.1111/1471-0528.14179] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine if higher-volume, fixed-dose administration of vasopressin further reduces blood loss at the time of minimally invasive myomectomy. DESIGN Randomised multicentre clinical trial. SETTING Tertiary-care academic centres in the USA. POPULATION Women undergoing conventional laparoscopic or robot-assisted laparoscopic myomectomy. METHODS All participants received the same 10-unit (U) dose of vasopressin, but were randomly assigned to one of two groups: (i) received 200 ml of diluted vasopressin solution (20 U in 400 ml normal saline), and (ii) received 30 ml of concentrated vasopressin solution (20 U in 60 ml normal saline). MAIN OUTCOME MEASURES The primary study outcome was estimated blood loss; the study was powered to detect a 100-ml difference. RESULTS A total of 152 women were randomised; 76 patients in each group. Baseline demographics were similar between groups. The primary outcome of intraoperative blood loss was not significantly different, as measured by three parameters: surgeon estimate (mean estimated blood loss 178 ± 265 ml and 198 ± 232 ml, dilute and concentrated groups respectively, P = 0.65), suction canister-calculated blood loss, or change in haematocrit levels. There were no vasopressin-related adverse events. CONCLUSION Both dilute and concentrated vasopressin solutions that use the same drug dosing demonstrate comparable safety and tolerability when administered for minimally invasive myomectomy; however, higher volume administration of vasopressin does not reduce blood loss. TWEETABLE ABSTRACT This randomised trial failed to show benefit of high-volume dilute vasopression.
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Affiliation(s)
- S L Cohen
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - S Senapati
- Division of Gynecological Pain and Minimally Invasive Surgery, NorthShore University HealthSystem, Evanston IL & Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - A R Gargiulo
- Division of Reproductive Endocrinology and Infertility, Brigham and Women's Hospital, Boston, MA, USA
| | - S S Srouji
- Division of Reproductive Endocrinology and Infertility, Brigham and Women's Hospital, Boston, MA, USA
| | - F F Tu
- Division of Gynecological Pain and Minimally Invasive Surgery, NorthShore University HealthSystem, Evanston IL & Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - J Solnik
- Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - H-C Hur
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - A Vitonis
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - G M Jonsdottir
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - K C Wang
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - J I Einarsson
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, MA, USA
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Fuchs N, Manoucheri E, Verbaan M, Einarsson JI. Laparoscopic management of extrauterine pregnancy in caesarean section scar: description of a surgical technique and review of the literature. BJOG 2014; 122:137-40. [DOI: 10.1111/1471-0528.13060] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2014] [Indexed: 11/29/2022]
Affiliation(s)
- N Fuchs
- Division of Minimally Invasive Gynecologic Surgery, Obstetrics and Gynecology; Brigham and Women's Hospital; Boston MA USA
| | - E Manoucheri
- Division of Minimally Invasive Gynecologic Surgery, Obstetrics and Gynecology; Brigham and Women's Hospital; Boston MA USA
| | - M Verbaan
- Division of Minimally Invasive Gynecologic Surgery, Obstetrics and Gynecology; Brigham and Women's Hospital; Boston MA USA
| | - JI Einarsson
- Division of Minimally Invasive Gynecologic Surgery, Obstetrics and Gynecology; Brigham and Women's Hospital; Boston MA USA
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Burger NB, Brölmann HAM, Einarsson JI, Langebrekke A, Huirne JAF. Effectiveness of abdominal cerclage placed via laparotomy or laparoscopy: systematic review. J Minim Invasive Gynecol 2012; 18:696-704. [PMID: 22024258 DOI: 10.1016/j.jmig.2011.07.009] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Revised: 07/13/2011] [Accepted: 07/22/2011] [Indexed: 11/28/2022]
Abstract
Preterm delivery remains a primary cause of neonatal morbidity and mortality. One cause of preterm birth is cervical incompetence. In women with a shortened or absent cervix or in those in whom previous vaginal cerclage failed, abdominal cerclage may be recommended. We performed a systematic literature search of PubMed, EMBASE, and the Cochrane database. Thirty-one eligible studies were selected. Six studies (135 patients) reported on the laparoscopic approach, and 26 (1116 patients) on the abdominal approach. Delivery of a viable infant at 34 weeks of gestation or more varied from 78.5% (laparoscopic) to 84.8% (abdominal). Second-trimester fetal loss occurred in 8.1% (laparoscopic) vs 7.8% (abdominal), with no reported third-trimester losses (laparoscopic) vs 1.2% (abdominal). We conclude that abdominal cerclage is associated with excellent results as treatment of cervical incompetence, with high fetal survival rates and minimal complications during surgery and pregnancy. Further studies are needed to differentiate which method is superior.
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Affiliation(s)
- N B Burger
- Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands.
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Abstract
BACKGROUND Benign cystic teratomas are relatively common tumors in reproductive age women, but can occur at any age. While the incidence of malignant elements in a teratoma is low (approximately 1-2%), the survival of patients with immature teratoma is poor. Definitive diagnosis is mandatory. CASE We describe a case of a 13-year-old African American female, gravida 0, presenting with a large pelvic mass, determined to be a benign cystic teratoma by intra-operative frozen section. However, due to the size of the tumor and the preponderance of neural elements we performed a full surgical staging procedure (excluding hysterectomy and complete removal of adnexa). The final pathology report revealed foci of immature neural tissue, with a final diagnosis of an immature cystic teratoma Stage Ia. CONCLUSION Foci of immature neural elements can be readily missed on frozen section, especially with a large tumor. Full surgical staging at the time of initial laparotomy is justified when encountering an apparently mature cystic teratoma with a preponderance of neural elements on frozen section.
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Affiliation(s)
- J I Einarsson
- Department of Obstetrics and Gynecology, Section of Pediatric and Adolescent Gynecology, Baylor College of Medicine, Houston, Texas 77030, USA
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Einarsson JI, Young A, Tsien L, Sangi-Haghpeykar H. Perceived proficiency in endoscopic techniques among senior obstetrics and gynecology residents. J Am Assoc Gynecol Laparosc 2002; 9:158-64. [PMID: 11960040 DOI: 10.1016/s1074-3804(05)60124-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVES To assess current training methods in laparoscopic surgery employed in United States obstetrics and gynecology residency programs, level of proficiency in various minimally invasive surgery procedures amongst senior obstetrics and gynecology residents, and ways in which training in minimally invasive surgery can be improved. DESIGN Survey (Canadian Task Force classification III). SETTING Accredited obstetrics and gynecology programs in the United States. SUBJECTS All fourth-year residents in accredited obstetrics and gynecology programs in the United States. INTERVENTION Residents received a survey regarding their perceived proficiency performing various laparoscopic procedures and the type of training they received in these techniques. MEASUREMENTS AND MAIN RESULTS Responses were received from 133 programs (52.4%) and 295 residents (26.8%). Of these, 67% of residents thought emphasis on laparoscopic surgery training should be increased or greatly increased; 87% thought laparoscopic skills were important for building a successful practice. Formal teaching methods were clearly associated with improved perception of proficiency, and those with higher perception of proficiency expected to perform more laparoscopic procedures after graduation. Residents lacked perceived competency in most advanced laparoscopic procedures. CONCLUSION Residents seem to benefit significantly from a formal curriculum in minimally invasive surgery, but they do not feel competent performing some advanced procedures on graduation. In our opinion, more emphasis should be placed on training in laparoscopic surgery in United States obstetrics and gynecology programs.
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Affiliation(s)
- J I Einarsson
- Baylor College of Medicine, 6550 Fannin, Suite 901, Houston, TX 77030, USA
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