Nezhat Medical Center

Background/Objectives: Fallopian tube endometriosis is frequently underreported due to its nonspecific presentation, limitations in imaging detection, and the fact that histologic diagnosis often requires the submission of the entire fallopian tube for microscopic analysis, which is not routinely performed. This study investigates the prevalence of fallopian tube endometriosis on histologic evaluation in patients undergoing laparoscopic salpingectomy for benign gynecologic conditions, and evaluates its association with intraoperative findings such as endometriomas, hydrosalpinx, and peri-tubal adhesions. Methods: A prospective cohort study was conducted from September 2021 to December 2024 at NYU Grossman Long Island School of Medicine, including 80 women ages 18-65 years undergoing unilateral or bilateral salpingectomy. Fallopian tubes were entirely submitted for histologic examination and were evaluated in cross-sections for presence of endometriosis. The association between the presence of fallopian tube endometriosis, the stage of endometriosis, the presence of endometriomas, hydrosalpinx, and tubal adhesions was analyzed, with significance defined as p < 0.05. Results: 47 women were found to have biopsy-proven pelvic endometriosis (58.75%). The prevalence of fallopian tube endometriosis was 42.50% (34/80) in the total study population and 72.34% (34/47) among patients with pelvic endometriosis. The most commonly involved layer was the serosa (75.5%), followed by the muscularis (46.9%) and mucosa (18.4%). Fallopian tube endometriosis was significantly associated with endometriomas (p < 0.0001), hydrosalpinx (p < 0.0001), and tubal adhesions (p < 0.0001). It was also strongly correlated with disease severity, with 92.9% of patients with stage 4 endometriosis exhibiting tubal involvement. Conclusions: Fallopian tube endometriosis is more prevalent than previously recognized and shows a strong association with advanced-stage endometriosis, endometriomas, hydrosalpinx, and tubal adhesions.

Retrospective clinical report to demonstrate the use of abdominal wall elevation device with closed technique direct entry with 3-mm port. An abdominal wall elevation device (LevaLap 1.0) was used during abdominal entry for laparoscopic and robotic gynecologic procedures. The primary outcomes were major vascular or visceral injury. Other events assessed included number of entry attempts, failed entry, and adverse events during entry. Descriptive statistics were used to characterize the patient population and the incidence of abdominal entry injuries or events. Tertiary hospital. Female patients undergoing laparoscopic gynecologic procedures with or without robotic assistance using an abdominal wall elevation device with direct entry technique from July 2023 to May 2024. Exclusion criteria were patients less than 18 years of age. Use of abdominal elevation device at initial entry. The elevation device was used in 25 patients with a 3-mm direct trocar. Entry was achieved on the first attempt in all cases. There were no major vascular, visceral injuries, or failed entry events. Use of a device to elevate the abdominal wall in a standardized fashion is feasible with direct entry using 3-mm port may help reduce the risk of retroperitoneal major vascular injury; however, larger comparative studies are required to confirm efficacy.

Endometriosis is characterized by the presence of endometrial glands and stroma in extrauterine sites. Our objective was to determine whether endometriotic lesions (ELs) from women with endometriosis have altered retinoid levels compared with their eutopic endometrium, and to test the hypothesis that defects in all-trans retinoic acid (ATRA) biosynthesis in EL is related to reduced expression of cellular retinol-binding protein type 1 (RBP1). Retinoids were evaluated by liquid chromatography-tandem mass spectrometry and high-performance liquid chromatography in eutopic endometrial biopsies (EBs) and ELs from 42 patients with pathologically confirmed endometriosis. The ATRA levels were reduced, whereas the retinol and retinyl ester concentrations were elevated in EL compared with EB tissue. Similar results were found in a mouse model of endometriosis that used green fluorescent protein-positive endometrial tissue injected into the peritoneum of syngeneic hosts to mimic retrograde menses. The ATRA biosynthesis in vitro in retinol-treated primary human endometrial stromal cell (ESC) cultures derived from ELs was reduced compared with that of ESCs derived from patient-matched EBs. Correspondingly, RBP1 expression was reduced in tissue and ESCs derived from EL versus EB. Rbp1(-/-) mice showed reduced endometrial ATRA concentrations compared with wild type, associated with loss of tissue organization and hypercellularity. These findings provide the first quantitative measurements of ATRA in human endometrium and endometriosis, demonstrating reduced ATRA in ectopic tissue and corresponding ESC cultures. Quantitation of retinoids in murine endometriosis and in Rbp1(-/-) mice supports the contention that impaired ATRA synthesis caused by reduced RBP1 promotes an "endometriosis phenotype" that enables cells to implant and grow at ectopic sites.

Retropubic Burch colposuspension has been considered by many to be the “gold standard” procedure for the treatment of female stress urinary incontinence for almost 40 years. Vancaillie and Schuessler introduced the laparoscopic approach to retropubic colposuspension in 1991. Numerous reports followed in subsequent years describing laparoscopic colposuspensions and their efficacy. Analysis of the outcomes of these various laparoscopic “Burch” colposuspensions is difficult because many of the techniques are not true Burch procedures but rather other modified retropubic colposuspensions. In this section, we describe the laparoscopic Burch colposuspension, including patient selection, preoperative evaluation, operative technique, possible complications, and efficacy. We review the efficacy of the laparoscopic Burch colposuspension studies that use the Burch—Tanagho procedure and compare these techniques to other popular anti-incontinence procedures. The many modified laparoscopic retropubic procedures are not addressed.

The adnexa are in an anatomic region in the pelvis that includes the ovaries, the fallopian tubes, and the structures within the broad ligament. The differential diagnosis of an adnexal mass is complex because of the wide spectrum of disorders that involve the adnexa. Most frequently, adnexal masses involve the ovary itself because of its inherent growth properties through ovulation and thus its propensity for neoplasia. During the evaluation of an adnexal mass, the picture may be further complicated as imaging does not always clearly delineate the adnexa from other nearby organs. An estimated 5% to 10% of women in the United States will undergo a surgical procedure for a suspected ovarian neoplasm during their lifetime. Although the majority of adnexal masses are benign in nature, the primary goal of the diagnostic evaluation is the exclusion of malignancy.

Since the advent of laparoscopic surgery in the 1980s, laparoscopic surgery has been popularized by surgeons throughout the world. However, routine laparoscopic surgery has been slow to catch on in one group of patients, that is, the pregnant patient. The responsibility of caring for two patients during one operation and the concern over potential harm to the unborn fetus due to the pneumoperitoneum and/or instrumentation are factors that have played a role in the delay of adapting laparoscopic surgery to the pregnant patient. However, recent evidence suggests that not only is laparoscopic surgery safe in the pregnant patient in all three trimesters, but it is also often preferable.