Objective: The goal of this article, and its accompanying figure and video, is to review laparoscopic management of interstitial pregnancy, using both cornual resection and cornuostomy techniques. The text, figure, and video focus on 2 cases demonstrating, step-by-step, laparoscopic management of interstitial pregnancy using cornual resection and cornuostomy techniques.

Gynecologic surgeries are often complex interventions that require extensive communication and planning to ensure favorable patient outcomes. Many gynecologic surgery patients present with a vast range of systemic comorbidities that need adequate workups and plans for care prior to undergoing anesthesia. Enhanced recovery after surgery (ERAS) protocols are vital for organizing patient-centered discussions preoperatively, allowing the patient, anesthesia, and surgical teams to address all clinical concerns directly to minimize perioperative risks. A multidisciplinary approach in preoperative patient-management decisions helps optimize the care of each patient's comorbidities and medications and is essential to ensure best patient outcomes. (J GYNECOL SURG 39:278)

The field of urogynecology has blossomed since its inception to include a broad range of procedures. Various anesthetic methods have evolved in tandem with the diversity of procedures, from office-based procedures under local anesthesia to complex reconstructions under general anesthesia. These anesthetic techniques can provide intraoperative coverage and often postoperative analgesia as well. The push for same-day discharge surgeries and the rise of robotic surgical techniques makes patient selection and optimization even more important in the current practice environment. This review focuses on anesthetic techniques and patient considerations for urogynecologic surgery. (J GYNECOL SURG 39:266)

Objective: This article reviews the epidemiology, diagnosis, and management of vaginal vault dehiscence, and illustrates a 5-step surgical approach to laparoscopic vault repair.

Chronic postoperative pain (also known as chronic postsurgical pain) is pain that occurs post-surgery and extends beyond the tissue-healing process, lasting for at least 3 months. Risk factors for the development of chronic postoperative pain include demographic/lifestyle, genetic, psychologic, and clinical factors (comorbidities, surgical factors, anesthesia/analgesia factors), as well as perioperative pain (preoperative and postoperative pain). In addition, there are several conditions that occur postoperatively leading to propagation of chronic postoperative pain, such as anterior cutaneous nerve entrapment, incisional neuromas, pudendal neuralgia, and ilioinguinal neuralgia. Clinicians should focus on identifying risk factors and mitigating them to decrease the incidence of chronic postoperative pain. (J GYNECOL SURG 20XX:000)

Objective: This study evaluated outcomes following hysterectomies performed for benign indications in surgeries that meet criteria for complexity, compared to those that did not. Materials and Methods: This retrospective study of hysterectomies performed for benign indications compared outcomes in surgeries deemed complex versus noncomplex . Surgery was defined as complex if one or more of the following factors were present: uterine weight >250 g; surgical history of 2 prior cesarean deliveries; or prior laparoscopy or laparotomy for abdominal myomectomy, endometriosis resection, lysis of adhesions, or other surgery on a pelvic organ. Surgeon-level factors were evaluated, including minimally invasive hysterectomy (MIH) use, postoperative length of stay (LOS), and complication rates. Results: From January 2017 to August 2021, 833 women had hysterectomies for benign indications; 603 hysterectomies were complex. These hysterectomies by low-volume surgeons were more likely to have complications than by high-volume surgeons (15.6% versus 5.4%; p < 0.001). These operations by high-volume surgeons were more-frequently MIH (83.4% versus 48.7%; p = 0.009), had fewer blood losses ≥500 mL (1.2% versus 8.0%; p < 0.001), and were less likely to need overnight admissions (74.9% versus 94.5%; p < 0.001). Conclusions: Complex hysterectomies performed for benign indications by high-volume gynecologic surgeons lead to fewer complications and shorter LOS, and are more likely to be performed with a minimally invasive approach. (J GYNECOL SURG 39:229)

Objective: Shear-wave elastography (SWE) can be used to obtain quantitative information about tissue stiffness. This study compared SWE measurements of patients with adenomyosis, leiomyoma, and normal myometrium. Materials and Methods: This study included 56 women who were scheduled to undergo hysterectomy. Measurements of the uterine myometrium and leiomyomas, if any, of the patients were preoperatively collected through SWE. A total of 69 SWE measurements were included. Postoperatively, the patients were categorized according to the results of histopathologic examinations: group 1 included patients with normal myometrium; group 2 included those with adenomyosis; and group 3 included those with leiomyomas. The Emean values of the kPa obtained from the SWE measurements were compared with the histopathologic results. Results: The SWE measurements of groups 2 and 3 were significantly higher than those of group 1. There were no significant differences between groups 2 and 3 in mean SWE measurements. The success rate of SWE in differentiating normal myometrium and adenomyosis was 92%, with a sensitivity of 93.1% and a specificity of 82.1%. Conclusion: This study revealed that using ultrasound elastography to diagnose adenomyosis is successful in distinguishing that condition from normal myometrium, but SWE is not useful for distinguishing adenomyosis leiomyoma. (J GYNECOL SURG 39:177)

Objective: Hospital readmission rates and unscheduled patient contacts, such as in the emergency department (ED), are frequent quality measures for hospitals and surgical centers. This study identified complaints leading patients to present to the ED within 30 days of same-day gynecologic surgery as well as possible interventions to decrease the rate of those visits. Materials and Methods: At a tertiary-care center with a level I trauma service and dedicated women's hospital, this retrospective chart review covered all cases of women over 18 who had same-day discharge gynecologic surgery and presented to the ED within 30 days of that discharge. Data were collected regarding chief complaint(s), ED workups, management, and dispositions. A χ 2 test was used to determine the significance of categorical variables. Results: Of 1880 same-day discharge gynecologic surgeries, there was a 3.5% 30-day ED presentation rate. Top 5 complaints were: (1) pain; (2) subjective fevers/chills; (3) vaginal bleeding; (4) urinary symptoms; and (5) shortness of breath. There was a statistically significant difference in postoperative ED-visit rates in gynecologic surgery defined by the study ( p = 0.03). Conclusions: The current authors' hospital system overall had postoperative ED visits at a rate consistent with previously published data. This study highlighted the need for improvement in specific areas, such as improved postoperative pain management, treatments to reduce urinary symptoms, patient education on normal postoperative vaginal bleeding, and communication on bleeding precautions. (J GYNECOL SURG 39:130)