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OBJECTIVE: To evaluate the effectiveness of additional low-pressure pulmonary recruitment in reducing postoperative shoulder pain. METHODS: A double-blind randomized controlled trial was conducted at Srinagarind Hospital between May 2021 and October 2021. Forty patients who underwent laparoscopic gynecologic surgery were randomized into either an intervention group that received additional low-pressure pulmonary recruitment (30 cmH2O) (n=20) or a control group (n=20). Shoulder pain was evaluated using a numerical rating scale from 0 to 10, 24, and 48 hours after the operation. RESULTS: The mean±standard deviation of shoulder pain at 24 hours after the operation of both the intervention and control groups were 2.10±2.27 and 1.45±1.73 points, respectively. The shoulder pain at 48 hours after the operation of the intervention and control groups were 1.15±1.46 and 0.85±1.73 points, respectively. There were no statistical differences in the mean difference between the two groups at 24 and 48 hours after operation (P=0.49; 95% confidence interval [CI], -0.61 to 1.91 and P=1.00; 95% CI, -0.96 to 1.56, respectively). No statistically significant differences were observed in additional analgesic medications used in either group, such as intravenous morphine or oral acetaminophen. CONCLUSION: Additional low-pressure pulmonary recruitment to reduce shoulder pain after laparoscopic surgery for benign gynecologic diseases did not show a significant benefit compared to the control group, especially when administering postoperative around-the-clock analgesia.

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A similar abstract of the interim analysis was previously published in Fertility and Sterility. EPIGALLOCATECHIN GALLATE (EGCG) FOR TREATMENT OF UNEXPLAINED INFERTILITY ASSOCIATED WITH UTERINE FIBROIDS (PRE-FRIEND TRIAL): EARLY SAFETY ASSESSMENT. Uterine fibroids are the most common cause of unexplained infertility in reproductive-aged women. Epigallocatechin gallate (EGCG), a green tea catechin, has demonstrated its ability to shrink uterine fibroids in prior preclinical and clinical studies. Hence, we developed an NICHD Confirm-funded trial to evaluate the use of EGCG for treating women with fibroids and unexplained infertility (FRIEND trial). Prior to embarking on that trial, we here conducted the pre-FRIEND study (NCT04177693) to evaluate the safety of EGCG in premenopausal women. Specifically, our aim was to assess any adverse effects of EGCG alone or in combination with an ovarian stimulator on serum liver function tests (LFTs) and folate level. In this randomized, open-label prospective cohort, participants were recruited from the FRIEND-collaborative clinical sites: Johns Hopkins University, University of Chicago, University of Illinois at Chicago, and Yale University. Thirty-nine women, ages ≥18 to ≤40 years, with/without uterine fibroids, were enrolled and randomized to one of three treatment arms: 800 mg of EGCG daily alone, 800 mg of EGCG daily with clomiphene citrate 100 mg for 5 days, or 800 mg of EGCG daily with Letrozole 5 mg for 5 days. No subject demonstrated signs of drug induced liver injury and no subject showed serum folate level outside the normal range. Hence, our data suggests that a daily dose of 800 mg of EGCG alone or in combination with clomiphene citrate or letrozole (for 5 days) is well-tolerated and is not associated with liver toxicity or folate deficiency in reproductive-aged women.

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Background and Objectives: The aim of this study was to analyze indirect costs of vaginal and laparoscopic routes for hysterectomy to determine whether this makes a difference in total costs when considering route for surgery. Methods: A five-year observational retrospective cohort study was conducted in an academic tertiary care center. A total of 517 patients scheduled for total laparoscopic hysterectomy (n = 137) and vaginal hysterectomy (n = 380) for benign conditions between January 1, 2008 and December 31, 2012 meeting inclusion criteria were reviewed. Results: Indirect costs were higher in the vaginal hysterectomy group compared to the laparoscopic hysterectomy group (mean cost €3,239.86 vs. €1,371.58; cost increase of €1,868.28; p < .001). Indirect costs due to lost-work-productivity were the most important, represented by 97.7% in the vaginal group and 93.6% in the laparoscopic group. Conclusion: Among women undergoing hysterectomy for benign disease, laparoscopic hysterectomy appears to be superior to vaginal hysterectomy when indirect costs are analyzed in a five-year temporal horizon. Laparoscopic hysterectomy is a good alternative to vaginal hysterectomy when technically feasible as both present comparable advantages. The surgical approach to hysterectomy should be decided in light of the relative benefits and hazards, which will depend on clinical circumstances and surgical expertise.

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Causal inference is one of the challenges in epidemiologic studies. Gynecologic diseases have been reported to have association with obesity, however the causality remained controversial except for uterine endometrial cancer. We conducted two-sample Mendelian randomization (MR) analysis using the large-scale genome-wide association study (GWAS) results of gynecologic diseases and body mass index (BMI) in the Japanese population to assess causal effect of BMI on gynecologic diseases. We first conducted GWAS of ovarian cancer, uterine endometrial cancer, uterine cervical cancer, endometriosis, and uterine fibroid (n = 647, 909, 538, 5236, and 645 cases, respectively, and 39 556 shared female controls), and BMI (81 610 males and non-overlapping 23 924 females). We then applied two-sample MR using 74 BMI-associated variants as instrumental variables. We observed significant causal effect of increased BMI on uterine endometrial cancer (ß = 0.735, P = .0010 in inverse variance-weighted analysis), which is concordant with results of European studies. Causal effect of obesity was not apparent in the other gynecologic diseases tested. Our MR analyses provided strong evidence of the causal role of obesity in gynecologic diseases etiology, and suggested a possible preventive effect of intervention for obesity.

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Fecundity, the biologic capacity to reproduce, is essential for the health of individuals and is, therefore, fundamental for understanding human health at the population level. Given the absence of a population (bio)marker, fecundity is assessed indirectly by various individual-based (e.g. semen quality, ovulation) or couple-based (e.g. time-to-pregnancy) endpoints. Population monitoring of fecundity is challenging, and often defaults to relying on rates of births (fertility) or adverse outcomes such as genitourinary malformations and reproductive site cancers. In light of reported declines in semen quality and fertility rates in some global regions among other changes, the question as to whether human fecundity is changing needs investigation. We review existing data and novel methodological approaches aimed at answering this question from a transdisciplinary perspective. The existing literature is insufficient for answering this question; we provide an overview of currently available resources and novel methods suitable for delineating temporal patterns in human fecundity in future research.

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Since 2008, various single-port access laparoscopic surgeries in gynecologic diseases have been performed in Korea. Single-port laparoscopic surgery has some advantages. It has less visible scars, less pain, and a faster recovery. Single-port laparoscopic surgery also has a drawback that is hard to handle instruments compared to conventional multi-port laparoscopic surgery. However, single-port laparoscopic surgery can be performed safely by practitioners who have experiences in single-port laparoscopic techniques. Based on experiences of gynecologic single-port laparoscopic surgery for 1000 cases in Incheon St. Mary's Hospital until August 2011, we describe techniques for single-port access laparoscopic surgery.

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OBJECTIVE: The purpose of this study is to evaluate the application rate and effectiveness of endoscopic operations based on 6,017 cases in the field of gynecology. METHODS: Six-thousand-seventeen cases of endoscopic operations were performed from March 1993 to June 2004 in the department of Obstetrics and Gynecology, Center for Endoscopy, Good Moonhwa Hospital. Endoscopic operations were done on the majority of patients who had benign gynecologic diseases. We applied "two-surgeons system" and simplified methods of operation consisted of endoloop-ligation, endosuture and endotying. RESULTS: Our endoscopic operations were successful in 5,994 cases (99.62%) out of 6,017 attempts. Twenty-three cases (0.38%) were converted to laparotomy due to severe pelvic adhesion, excessive bleeding or difficulty in accessibility. In the first year endoscopic operations were done in 29.0% of the total gynecologic operations, but was increased to 52.9% during the next 4 years. In 2003, 93.0% and in 2004, 99.0% of the total gynecologic operations were done by endoscope. While the simple technique surgeries showed a high application rate, the more complicated technique surgeries, which began at a lower rate, showed a steady increase up to 89.3%. Blood loss and operation time were markedly declined during 3 year period and maintained at a low level thereafter. A 3 years' period of endoscopic operations (about 500 cases) is necessary for a hospital learning curve while, 26.4 cases is necessary an individual surgeon's learning curve. The major complications during the study period was 28 cases (0.47%). CONCLUSION: Endoscopic operations can be applied in almost all benign gynecologic diseases. In particular, "two-surgeons system" is a safe method with few complications and minimal learning period. These results suggest that if appropriate techniques could be learned, endoscopic operation might be preferred to laparotomy for both surgeons and patients.

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OBJECTIVE: To assess the advantages, disadvantages, applicability, and complications of laparoscopy in gynecologic diseases. MATERIALS AND METHODS: A retrospective case series which includes 1711 patients who underwent laparoscopic surgery at Department of Obstetrics and Gynecology, Ajou University Hospital from June, 1994 to August, 2001 for gynecologic diseases. RESULTS: The patient's ages ranged from 11 to 77 years, and their mean age was 31.5 years. The indications of laparoscopy were ectopic pregnancy in 626 cases (36.6%), endometriosis, ovarian tumor, secondary infertility, tubal obstruction, primary infertility, myoma of the uterus, pelvic adhesion, and pelvic inflammatory disease in order. The operations performed were salpingectomy in 589 cases (34.4%), diagnostic laparoscopy, ovarian cystectomy, fulguration, salpingo-oophorectomy, laparoscopic-assisted vaginal hysterectomy, fimbrioplaty, oophorectomy, and myomectomy in order. Operation times were from 5 to 260 minutes (mean: 60.6 minutes). Postoperative hospital stays were from 0 day to 29 days (mean: 2.3 days). There were 18 surgical complications including 1 trocar site hematoma, 3 incision site infections, 9 postoperative fever, 2 postopertive ileus and 3 patinets underwnet expolatory laparotomy because of severe adhesion. CONCLUSION: We conclude that operative laparoscopy is useful in gynecologic diseases but need development of laparoscopic equipments, research of operative method, extension of operative indications, and skilled laparoscopic surgeons.

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OBJECTIVE: To assess the advantages, disadvantages, applicability, and complications of laparoscopy in gynecologic diseases. MATERIALS AND METHODS: A retrospective case series which includes 1711 patients who underwent laparoscopic surgery at Department of Obstetrics and Gynecology, Ajou University Hospital from June, 1994 to August, 2001 for gynecologic diseases. RESULTS: The patient's ages ranged from 11 to 77 years, and their mean age was 31.5 years. The indications of laparoscopy were ectopic pregnancy in 626 cases (36.6%), endometriosis, ovarian tumor, secondary infertility, tubal obstruction, primary infertility, myoma of the uterus, pelvic adhesion, and pelvic inflammatory disease in order. The operations performed were salpingectomy in 589 cases (34.4%), diagnostic laparoscopy, ovarian cystectomy, fulguration, salpingo-oophorectomy, laparoscopic-assisted vaginal hysterectomy, fimbrioplaty, oophorectomy, and myomectomy in order. Operation times were from 5 to 260 minutes (mean: 60.6 minutes). Postoperative hospital stays were from 0 day to 29 days (mean: 2.3 days). There were 18 surgical complications including 1 trocar site hematoma, 3 incision site infections, 9 postoperative fever, 2 postopertive ileus and 3 patinets underwnet expolatory laparotomy because of severe adhesion. CONCLUSION: We conclude that operative laparoscopy is useful in gynecologic diseases but need development of laparoscopic equipments, research of operative method, extension of operative indications, and skilled laparoscopic surgeons.

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