Current opinion in obstetrics & gynecology
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Curr. Opin. Obstet. Gynecol. · Aug 2016
ReviewConsiderations for minimally invasive gynecologic surgery in obese patients.
The purpose is to review the key anatomical and physiological changes in obese patients and their effects on preoperative, intraoperative, and postoperative care and to highlight the best practices to safely extend minimally invasive approaches to obese patients and provide optimal surgical outcomes in this high-risk population. ⋯ Given significantly improved patient outcomes, minimally invasive approaches to gynecological surgery should be considered for all obese patients with particular attention given to specific perioperative considerations and appropriate referral to an experienced minimally invasive surgeon.
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Since its first description in 2003, the endometrial scratching procedure has been the topic of over 1000 studies. This procedure, used to improve endometrial receptivity for assisted reproduction, is accessible - any gynecologist can easily perform it - and has been adapted into clinical routine by some reproductive units. However, the available data are controversial, and no biological plausibility exists to support the use of this intervention. This study aims to critically review the existing data, focusing on the last 2 years, regarding the efficiency of endometrial scratching. ⋯ Overall, data from properly designed and powered randomized controlled studies demonstrate no beneficial effect of this intervention that is based on unknown biological effects. Endometrial scratching produces pain, costs money, and the side-effects of systematic scratching in the production of Asherman syndrome remain to be seen. Think before scratching.
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Curr. Opin. Obstet. Gynecol. · Aug 2016
ReviewAdvantages of robotics in benign gynecologic surgery.
The purpose of this article is to review the literature and discuss the advantages of robotics in benign gynecologic surgery. ⋯ Advances in robotic technology such as the single-site platform and telesurgery, have the potential to revolutionize the field of minimally invasive gynecologic surgery. Higher quality evidence is needed to determine the advantages and disadvantages of robotic surgery in benign gynecologic surgery. Conclusions on the benefits and risks of robotic surgery should be made with caution given limited data, especially when compared with other routes. Route of surgery selection should take into consideration the surgeons' skill and comfort level that allows for the highest level of safety and efficiency. Ultimately, the robotic device is an additional minimally invasive surgical tool that can further the goal of minimizing laparotomy in gynecology.
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To review updated information on the influence of endometrial scratching on IVF. ⋯ Endometrial scratching performed in the preceding cycle is associated with improved clinical pregnancy and live birth rates in women with recurrent implantation failure, but not in unselected subfertile women undergoing IVF. Most of the current literature are underpowered and at high risk of bias.
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Curr. Opin. Obstet. Gynecol. · Jun 2016
ReviewHysteroscopic polypectomy for women undergoing IVF treatment: when is it necessary?
The objectives of the present review are to discuss the role of endometrial polyps in infertility and to analyze the evidence for hysteroscopic polypectomy prior to IVF. ⋯ Hysteroscopic polypectomy is a minimally invasive procedure with little risk of complication and therefore should be performed prior to IVF to optimize chances for successful implantation.