The statement of the Asia-Pacific Association for Gynecologic Endoscopy and Minimally Invasive Therapy for LACC study Chyi-Long Lee, Kuan- Gen Huang, Joo- Hyun Nam, Peter C Lim, Felix Wong Wu Shun, Keen Whye Lee, Hiroyuki Kanao, Yoichi Aoki, Nobuhiro Takeshima, Wachyu Hadisaputra, Zhiqing Liang, Wisit Supakarapongkul, Kung-Liahng Wang Gynecology and Minimally Invasive Therapy 2019 8(3):91-93

Sentinel lymph nodes in endometrial cancer update 2018 Ibrahim A Abdelazim, Mohannad Abu-Faza, Gulmira Zhurabekova, Svetlana Shikanova, Bakyt Karimova, Mukhit Sarsembayev, Tatyana Starchenko, Gulmira Mukhambetalyeva Gynecology and Minimally Invasive Therapy 2019 8(3):94-100 There are no established data about lymphadenectomy during treatment of endometrial cancers (ECs) and to what extent lymphadenectomy should be performed. In addition, retroperitoneal lymphadenectomy increases the intraoperative and postoperative complications. Sentinel lymph node (SLN) mapping has the lowest costs and highest quality-adjusted survival. SLN is the most cost-effective strategy in the management of low-risk ECs. Women staged with SLN mapping were more likely to receive adjuvant treatment compared with women staged with systemic lymphadenectomy. This review article designed to evaluate the diagnostic accuracy and the methods of SLN detection in ECs.

Ovarian cystectomy: Stitching or cauterizing – A comparison study of anti-mullerian hormone level pre- and postoperatively Eddy Hartono, Edwin Budipramana, Nusratuddin Abdullah, Telly Tessy Gynecology and Minimally Invasive Therapy 2019 8(3):101-105 Objective: This study aimed to analyze the influence of laparoscopic management in an ovarian cyst as measured by serum anti-Mullerian hormone (AMH) levels, by comparing cautery and suturing techniques. Subjects and Methods: This prospective cohort study was conducted in the Department of Obstetrics and Gynecology, Faculty of Medicine Hasanuddin University/Dr. Wahidin Sudirohusodo Hospital, and several private hospitals in Makassar, Indonesia, from January 1, 2016, to January 31, 2018. A total sample of 90 subjects diagnosed with ovarian cysts underwent cystectomy by laparoscopy. Serum AMH level was examined in all participants both preoperatively and 1-month postoperatively. Participants were divided into two groups based on cautery and suturing techniques used in the surgery. Serum AMH levels obtained were statistically analyzed and compared between cautery and suturing groups. P < 0.05 was considered statistically significant. Results: The research result indicated a significant decrease of AMH level in each sample groups using cautery and suturing techniques; however, it was not significantly different if both methods were statistically compared (mean AMH: 1.13 ± 0.34 and 1.02 ± 0.15, with P> 0.05). Both the groups showed a greater decrease with a significant result in endometriotic cyst type and when adhesion was present during laparoscopy (P < 0.05). Other parameters such as unilateral/bilateral cyst and variety of cyst size were not showing significant differences (P > 0.05). Conclusions: This study showed that serum AMH levels clearly decreased after operative laparoscopy for different types of ovarian cysts in female patients; however, there is no significant difference regardless of surgical procedures.

Interventions and quality of life in stress urinary incontinence Deeksha Pandey, Chaitanya Maturi, Bhanu Pratap Singh Dhakar, Gazal Jain, Keerti Kyalakond Gynecology and Minimally Invasive Therapy 2019 8(3):106-112 Introduction: Stress urinary incontinence (SUI), though is more prevalent than many chronic diseases, has remained largely underreported and underdiagnosed condition. We aimed to find the improvement in the quality of life (QoL) of women with SUI after individual interventions, namely mid-urethral sling (MUS), pelvic floor muscle training (PFMT), and no treatment/control group, as primary treatment modalities. Materials and Methods: This was a prospective interventional case–control study conducted at a university teaching hospital, over a period of 2 years. Parous women with at least one vaginal delivery, attending the gynecology outpatient department, were encouraged to fill the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form. Those with SUI were divided into three arms (MUS, PFMT, and no treatment/control group), according to the informed decision for choice of management. Baseline QoL was documented for all with King's Health Questionnaire. QoL was again recorded after 3 months of the start of treatment and was compared with the baseline. Results: In our study cohort, the prevalence of SUI was 15.2%, with a consultation rate of only 30.7%. MUS surgery improves QoL significantly in women with SUI, followed by PFMT. We found 100% symptomatic relief, high rate of improvement in QoL with minimal easy to manage complications, in the surgical intervention arm. PFMT, though has a positive impact on QoL, requires continuous motivation, as 22% discontinued. Without treatment, QoL in SUI patients remained more or less the same. Conclusion: The help-seeking behavior (consultation rate) for SUI is poor. MUS (surgical arm) had 100% symptom relief in 3-month follow-up. MUS showed the best results in terms of QoL improvement, followed by PFMT in SUI in our study. It is important not only to educate women about the problem but also to encourage them to seek treatment and indicate that it is a treatable condition.

Ambulatory MiniArc precise sling under local anesthesia for stress urinary incontinence: Feasibility and outcome Miriam Campos-Delgado, Cecilia Quetglas-Muñoz, Marc Barahona-Orpinell, Amparo García-Tejedor, Jordi Ponce-Sebastià Gynecology and Minimally Invasive Therapy 2019 8(3):113-117 Aims: The aim of the study is to assess the feasibility of ambulatory stress urinary incontinence (SUI) surgery using the MiniArc Precise single-incision urethral sling without increasing the number of complications. Settings and Design: This was a retrospective observational study of prospectively collected data carried out in a Tertiary Referral Hospital in Barcelona, Spain. Materials and Methods: Forty patients diagnosed with SUI or stress predominant mixed urinary incontinence (MUI) treated surgically between November 2011 and November 2013. The MiniArc Precise® sling was inserted under local anesthesia in the ambulatory setting. Statistical Analysis Used: Descriptive statistics included frequencies and percentages for categorical variables and mean and range for quantitative variables. The statistical package used was SPSS version 17.0. Results: Urodynamic studies showed SUI in 78% of cases and stress predominant MUI in 17%. Clinical findings included SUI in 56% of cases and MUI in 44%, with positive stress tests in all participants. The mean intraoperative pain (1–10 Visual Analog Scale) was 2. All patients were satisfied with the use of local anesthesia in the outpatient setting. Perioperative complications did not occur. One case of urinary retention and two cases of urinary tract infection (UTI) developed within this 1st month after operation and were successfully managed conservatively. Midterm complications included eight cases of UTI and four de novo urge incontinence. Conclusions: Placement of the MiniArc Precise sling under local anesthesia is a feasible and safe technique, which when carried out by an experienced surgeon allows to be done as an outpatient basis without increasing the rate of postprocedural complications.

Evaluation of endometrial receptivity by measuring HOXA-10, HOXA-11, and leukemia inhibitory factor expression in patients with polycystic ovary syndrome Mustafa Kara, Seda Sabah Ozcan, Turhan Aran, Ozlem Kara, Neziha Yilmaz Gynecology and Minimally Invasive Therapy 2019 8(3):118-122 Context: Polycystic ovary syndrome (PCOS) is an important cause of infertility. In women with PCOS have increased rate of spontaneous abortion and reduced rate of conception. HOXA–10 and HOXA–11 are proteinous products of homeobox gene group and play an important role during implantation. Aims: The aim of this study was to evaluate endometrial receptivity by measuring HOXA–10, HOXA–11, and leukemia inhibitory factor (LIF) gene expressions in women with PCOS. Settings and Design: A tertiary referral center. Materials and Methods: This study was conducted on reproductive age women with abnormal uterine bleeding without sonographically proven anatomical reason. Endometrial sampling procedures were done in proliferative phase using low-pressure endometrial suction device to exclude endometrial pathology. HOXA–10, HOXA–11, and LIF gene expressions were measured from endometrial sampling material. Blood sample was taken to measure serum estradiol level on the day of endometrial sampling. Statistical Analysis Used: Statistical analysis was performed using SPSS software version 17 (SPSS Inc., Chicago, IL, USA). Mann–Whitney U-test was used to compare the variables. Results: A total of 53 patients were included in this study. Study group consisted of 33 patients with PCOS. Gene expressions of HOXA–10, HOXA–11, and LIF were significantly lower in patients with PCOS (P < 0.05). Conclusions: This study results showed that in patients with PCOS have decreased gene expression of HOXA-10, HOXA-11, and LIF which might contribute PCOS-related infertility.

Hand-Assisted laparoscopic hysterectomy for large uterine fibroids Yuki Miyabe, Naohiro Kanayama Gynecology and Minimally Invasive Therapy 2019 8(3):123-128 Background: In recent years, laparoscopic hysterectomy (LH) has increasingly been used in total hysterectomy for uterine fibroids. In our department, approximately 95% of total hysterectomies for benign uterine disease are performed by LH; however, in the 5% patients for whom LH is contraindicated, how to provide minimally invasive surgery was a challenge. Methods: To avoid open surgery with a large vertical midline incision, we introduced a hand-assisted LH (HALH), whereby a lower abdominal transverse incision of 8 cm was made above the pubic symphysis apart from an incision needed for the operating port for laparoscopy. Results: The procedure was performed on five patients between January 2015 and February 2016. The mean weight of the resected uteri was 1382 g, and the mean estimated blood loss was 541 ml. No patients required allogeneic blood transfusion, and there were no complications. Recovery was rapid and postoperative progress was good. Conclusion: HALH is a procedure that avoids traditional open surgery using a large vertical midline incision in patients for whom LH is contraindicated and for those with large uterine fibroids.

Bladder safety during natural orifice transluminal endoscopic surgery hysterectomy in the patients with extensive vesicouterine adhesion Tanitra Tantitamit, Teerayut Temtanakitpaisan, Chyi-Long Lee Gynecology and Minimally Invasive Therapy 2019 8(3):129-131 Adhesion at the vesicouterine fold presents a great challenge when performing hysterectomy through transvaginal natural orifice transluminal endoscopy surgery (NOTES) in women with a history of cesarean section. An attempt to lyse adhesions often prolongs the procedure and may inadvertently result in cystostomy. The purpose of this report is to demonstrate a safe technique for the lysis of vesicouterine adhesions during NOTES hysterectomy. We present the cases of two patients with a history of cesarean section. Severe adhesions at the vesicouterine peritoneum were encountered in both cases, and one patient had an extensive adhesion involving lower half of the uterus. Although the lateral approach is sufficient in most cases, it does not allow a surgeon to approach the peritoneal cavity if there is extensive adhesion. In cases such as these, direct dissection of the adhesion on the uterus is required.

Uterine arteriovenous malformation treated by hysteroscopic excision Tae Hee Kim, Nam Kyeong Kim, Seul Ki Kim, Jung Ryeol Lee, Byung Chul Jee, Yong Beom Kim, Seok Hyun Kim Gynecology and Minimally Invasive Therapy 2019 8(3):132-134 Uterine arteriovenous malformation (AVM) is a vascular hamartoma of the myometrium that mostly results from uterine tissue damage. Herein, we report a case of uterine AVM managed successfully by hysteroscopy. The patient had an induced abortion and subsequent persistent vaginal spotting and irregular active vaginal bleeding. Ultrasonography showed a 3.5 cm × 2.9 cm heterogeneous lesion in the endometrial cavity with increased vascularity. Symptoms were monitored without uterine artery embolization to avoid complications that may affect a future pregnancy. However, 10 days later, she presented with active vaginal bleeding. Hysteroscopic endometrial mass excision was performed. Her postoperative hemoglobin level and vital signs were stable. Biopsy of the excised mass revealed AVM. Her postoperative vaginal bleeding decreased significantly, and outpatient ultrasonography 1 month later showed no abnormal findings. This case confirms the feasibility and safety of hysteroscopic management of uterine AVMs. The hysteroscopic technique should be prioritized for managing uterine AVMs.

Sentinel pelvic lymph node dissection by natural orifices transvaginal endoscopic surgery approach after indocyanine green dye detection in early endometrial cancer of posthysterectomy patient Wint Thida Htay, Chen- Ying Huang, Chyi- Long Lee Gynecology and Minimally Invasive Therapy 2019 8(3):135-137 There was a case of 57-year-old female who was done the natural orifices transvaginal endoscopic surgery (NOTES) hysterectomy and bilateral salpingo-oophorectomy for benign disease. However, her biopsy result was Grade 1 endometrioid adenocarcinoma, and she was incidentally diagnosed as endometrial cancer. She was uneventful apart from that finding. She underwent the sentinel pelvic lymph node dissection with indocyanine green-guided NOTES approach for complete staging. This technique may be helpful to maximize the complete staging in early endometrial cancer as well as it can minimize the morbidity-related lymphadenectomy. In conclusion, in spite of a new technique for NOTEs, it can be safe and cost-effective for patients.