Perioperative Outcomes of Major Laparoscopic Surgery for Benign Gynecologic Conditions and the Role of Body Mass Index

Tuboplasty

Nolan W et al., 2026 · Textbook of Minimally Invasive Gynecologic Surgery

Knowledge of OBGYN Residents of Fertility Awareness Based Methods of Family Planning

Damba-Cunningham E et al., 2025 · J Restorative Reprod Med · Free to read

Fertility awareness-based methods (FABM) of family planning have increased in popularity in recent years. The effectiveness of various methods can vary substantially and can be user dependent. For various reasons, there is a bias in OBGYN physicians against the use of FABMs for family planning. However, once educated about the methods of FABMs, this bias improves. There is limited regarding the education dedicated to FABM use in residency. We hypothesized that the residency education obtained regarding FABMs would be insufficient in preparing resident OBGYNs in effectively counseling patients regarding FABMs. a 16-question survey was created via SurveyMonkey and was sent to all ACGME accredited OBGYN residency programs for distribution to current residents. The survey was administered from October 2023 to December 2023. 125 responses were collected. Less than 40% of residents received formal training in regards to FABMs. Respondents indicated they felt most comfortable describing the calendar method to patients (68% respondents agree or strongly agree when queried if they could describe the method). 79.5% of respondents could not describe mucus-only, hormone monitoring, or sympto-thermal methods of family planning. When questioned if they were prepared to counsel postpartum patients who refused contraception regarding FABM, 58% of respondents indicated they could not assist their patients. Despite increased use in recent years and multiple options for FABM use, resident education in the application and use of FABMs is lacking. Additionally, residents indicated they are most familiar with the least effective methods (calendar method) which would likely be a significant detriment to their patients.

Results of the live survey in Las Vegas, 2008, and the response of the AAGL

Pasic RP et al., 2009 · J Minim Invasive Gynecol

Laparoscopic management of endometriosis: comprehensive review of best evidence

Yeung PP Jr et al., 2009 · J Minim Invasive Gynecol

To provide a comprehensive review of the best evidence available in the laparoscopic management of endometriosis for pain and/or fertility and to provide practical recommendations based on this information. Review article of randomized controlled trials. Women with endometriosis. A systematic search was performed of the Cochrane Library and MEDLINE database for randomized controlled trials relating only to laparoscopic management of endometriosis. The information from 7 Cochrane review articles and 35 original randomized trials is presented in a clinically relevant question-and-answer format. Awareness of endometriosis as a disease with substantial morbidity is vitally important. Laparoscopic treatment of endometriosis is beneficial for reducing pain and improving fertility. Laparoscopic presacral neurectomy, but not laparoscopic uterosacral nerve ablation, is a useful adjunct to conservative surgery for endometriosis in patients with a midline component of pain. Preoperative hormonal suppression with gonadotropin-receptor hormone analogue may be helpful in decreasing endometriosis disease scores. Postoperative hormonal suppression with either a gonadotropin-receptor hormone analogue or progestin (including the levonorgestrel intrauterine system) may be helpful in reducing pain and increasing time to recurrence of symptoms. Excisional cystectomy is the preferred method to treat endometrial cysts for both pain and fertility and may be aided by the use of mesna and initial circular excision. An absorbable adhesion barrier (Interceed), 4% icodextrin solution (Adept), and a viscoelastic gel (Oxiplex/AP, FzioMed, Inc., San Luis Obispd, CA; not available in the United States) are safe and effective products to help prevent adhesions in laparoscopic surgery to treat endometriosis.

Association between body mass index and dysmenorrhea in women with endometriosis: a systematic review and meta-analysis

Apelian S et al., 2026 · Gynecologic and obstetric investigation

Dysmenorrhea is a debilitating symptom in patients with endometriosis, contributing significantly to disease burden. While the relationship between body mass index (BMI) and dysmenorrhea in these patients is unclear, emerging evidence suggests BMI may be correlated with pain in the presence of endometriosis. This systematic review and meta-analysis aimed to evaluate the association between BMI and dysmenorrhea in women with endometriosis. We systematically searched PubMed, Scopus, Web of Science, and Google Scholar from inception to November 15, 2024. Eligible studies for this review included original observational articles reporting outcomes related to the prevalence of dysmenorrhea in relation to body weight in patients with confirmed endometriosis. Data for a two-way contingency table were extracted from the articles, and odds ratios (ORs) for the association between BMI categories and dysmenorrhea were calculated. These individual ORs were pooled using a random-effects model. Six studies involving 2,274 women with endometriosis were included. The meta-analysis revealed that underweight individuals with endometriosis had significantly higher odds of experiencing dysmenorrhea compared to non-underweight patients (OR = 1.38, 95% CI = 1.05 to 1.80, I² = 0.00%) or to those with normal weight (OR = 1.39, 95% CI = 1.05 to 1.83, I² = 0.00%). No significant association was found between dysmenorrhea and overweight or obese individuals. Sensitivity analyses showed variability in the findings based on the exclusion of certain studies. No publication bias was detected in the analysis. There was an association between underweight status and dysmenorrhea in endometriosis. We speculate that managing weight and nutrition may be useful in mitigating dysmenorrhea symptoms. However, due to the study limitations, prospective trials are needed to test the ability of diet to alleviate pain.

Adiposity and Endometriosis Severity and Typology

Byun J et al., 2020 · J Minim Invasive Gynecol · Free full text on PubMed Central

Prior research has collectively shown that endometriosis is inversely related to women's adiposity. The aim of this study was to assess whether this inverse relationship holds true by disease severity and typology. Cross-sectional study among women with no prior diagnosis of endometriosis. Fourteen clinical centers in Salt Lake City, UT, and San Francisco, CA. A total of 495 women (of which 473 were analyzed), aged 18-44 years, were enrolled in the operative cohort of the Endometriosis, Natural History, Diagnosis, and Outcomes (ENDO) Study. Gynecologic laparoscopy/laparotomy regardless of clinical indication. MAIN Participants underwent anthropometric assessments, body composition measurements, and evaluations of body fat distribution ratios before surgery. Surgeons completed a standardized operative report immediately after surgery to capture revised American Society for Reproductive Medicine staging (I-IV) and typology of disease (superficial endometriosis [SE], ovarian endometrioma [OE], and deep infiltrating endometriosis [DIE]). Linear mixed models, taking into account within-clinical-center correlation, were used to generate least square means (95% confidence intervals) to assess differences in adiposity measures by endometriosis stage (no endometriosis, I-IV) and typology (no endometriosis, SE, DIE, OE, OE + DIE) adjusting for age, race/ethnicity, and parity. Although most confidence intervals were wide and overlapping, 3 general impressions emerged: (1) women with incident endometriosis had the lowest anthropometric/body composition indicators compared with those without incident endometriosis, (2) women with stage I or IV endometriosis had lower indicators compared with women with stage II or III, and (3) women with OE and/or DIE tended to have the lowest indicators, whereas women with SE had the highest indicators. Our research highlights that the relationship between women's adiposity and endometriosis severity and typology may be more complicated than prior research indicates.

Epidemiology of complications associated with gynecological laparoscopy procedures in Ukraine: results a multicenter study

Salmanov AG et al., 2024 · Wiadomosci lekarskie (Warsaw, Poland : 1960)

To estimate the frequency of complications during laparoscopic gynecologic surgery for benign diseases in women and identify associated risk factors in Ukraine. Materials and A multicenter, prospective cohort study was performed in gynecological departments from 10 regional hospitals of Ukraine between January 1, 2020, to December 31, 2022. The study included gynecologic laparoscopies for benign diseases in women performed at these hospitals. To identify risk factors and variables associated with complications, crude and adjusted odds ratios were calculated with unconditional logistic regression. Surveillance was performed during 30 days after gynecological laparoscopy procedures. A total of 14,440 laparoscopic surgeries were performed, 2,340 (16.2%) complications cases were observed. Of all complication's cases, 74.9% were detected after hospital discharge. The overall frequency of major complications was 5.04%, and that of minor complications was 11.2%. The most frequently reported complications types were serious bleeding complications (20.6%), intestinal perforation (17.9%), mild anemia (16.7%), severe anemia (transfusion) (16.1%), failed laparoscopy (9.3%), minor bleeding complications (8.3%), postoperative hematoma (6.7%), urinary tract infection (5.6%), and fever (5.0%). The level of technical difficulty and existence of prior abdominal surgery, and obesity were associated with a higher risk of complications associated with gynecological laparoscopy procedures. Results this study suggest a high frequency of complications associated laparoscopic gynecologic surgery in Ukraine. Greater technical difficulty and prior surgery were factors associated with a higher frequency of complications.

Female obesity is negatively associated with live birth rate following IVF: a systematic review and meta-analysis

Sermondade N et al., 2019 · Human reproduction update · Free full text on PubMed Central

A worldwide increase in the prevalence of obesity has been observed in the past three decades, particularly in women of reproductive age. Female obesity has been clearly associated with impaired spontaneous fertility, as well as adverse pregnancy outcomes. Increasing evidence in the literature shows that obesity also contributes to adverse clinical outcomes following in vitro fertilization (IVF) procedures. However, the heterogeneity of the available studies in terms of populations, group definition and outcomes prevents drawing firm conclusions. A previous meta-analysis published in 2011 identified a marginal but significant negative effect of increased female body mass index (BMI) on IVF results, but numerous studies have been published since then, including large cohort studies from national registries, highlighting the need for an updated review and meta-analysis. Our systematic review and meta-analysis of the available literature aims to evaluate the association of female obesity with the probability of live birth following IVF. Subgroup analyses according to ovulatory status, oocyte origin, fresh or frozen-embryo transfer and cycle rank were performed. A systematic review was performed using the following key words: ('obesity', 'body mass index', 'live birth', 'IVF', 'ICSI'). Searches were conducted in MEDLINE, EMBASE, Cochrane Library, Eudract and clinicaltrial.gov from 01 January 2007 to 30 November 2017. Study selection was based on title and abstract. Full texts of potentially relevant articles were retrieved and assessed for inclusion by two reviewers. Subsequently, quality was assessed using the Newcastle-Ottawa Quality Assessment Scales for patient selection, comparability and assessment of outcomes. Two independent reviewers carried out study selection and data extraction according to Cochrane methods. Random-effect meta-analysis was performed using Review Manager software on all data (overall analysis), followed by subgroup analyses. A total of 21 studies were included in the meta-analysis. A decreased probability of live birth following IVF was observed in obese (BMI ≥ 30 kg/m2) women when compared with normal weight (BMI 18.5-24.9 kg/m2) women: risk ratio (RR) (95% CI) 0.85 (0.82-0.87). Subgroups analyses demonstrated that prognosis was poorer when obesity was associated with polycystic ovary syndrome, while the oocyte origin (donor or non-donor) did not modify the overall interpretation. Our meta-analysis clearly demonstrates that female obesity negatively and significantly impacts live birth rates following IVF. Whether weight loss can reverse this deleterious effect through lifestyle modifications or bariatric surgery should be further evaluated.