OBJECTIVE: To describe current and future strategies to reduce the burden of ovarian cancer through prevention.
RESULTS: Current strategies in genetic testing are missing a substantial number of individuals at risk, representing a missed opportunity for ovarian cancer prevention. Past efforts at screening and early detection have thus far failed to improve ovarian cancer mortality, and novel techniques are needed. Surgical prevention is highly effective, but surgical menopause from oophorectomy has significant side effects. Novel surgical strategies aimed at reducing risk while minimizing these harms are currently being studied. To maximize ovarian cancer prevention, a multi-pronged approach is needed. We propose that more inclusive and accurate genetic testing to identify more individuals at risk, novel molecular screening and early detection, surgical prevention that maximizes quality of life while reducing risk, and broader adoption of targeted and opportunistic salpingectomy will together reduce the burden of ovarian cancer.

OBJECTIVE: To evaluate the effect of video-based coaching on the gynecology resident performance of laparoscopic salpingectomy.
METHODS: PGY-1 and PGY-2 residents were randomized before their gynecology rotations to standard gynecology curriculum (control group) or standard curriculum plus two video-coaching sessions by a fellowship-trained minimally invasive gynecologic surgeon (VBC group). Residents were video recorded intraoperatively performing three unilateral laparoscopic salpingectomies. Participants in the VBC group were coached between the procedures. The primary outcome was the improvement in modified GOALS (Global Operative Assessment of Laparoscopic Skills) and OSA-LS (Objective Structured Assessment of Laparoscopic Salpingectomy) scores, compared with baseline, in the VBC and control groups, with videos independently graded by three blinded minimally invasive gynecologic surgeons. A minimum sample size of 18 participants (nine per group) was needed to achieve 90% power to detect a difference of 5.0 points.
RESULTS: From October 2021 to December 2022, 28 PGY-1 and PGY-2 residents completed the study with 14 participants per group. Baseline characteristics were similar between groups. In the VBC group, modified GOALS scores significantly improved by 3.0 points from video 1 to video 2 ( P =.04) and by 3.2 points from video 1 to video 3 ( P =.02). Modified OSA-LS scores also increased significantly in the VBC group, by 6.1 points from video 1 to video 3 ( P =.02). In the control group, modified GOALS and OSA-LS scores improved from baseline but were not significant ( P =.2, P =.5). Video-based coaching also enhanced resident comfort and confidence in performing laparoscopic surgery.
CONCLUSIONS: Video-based coaching improves resident performance of laparoscopic salpingectomy and can be used as an adjunct to resident surgical training.
BACKGROUND: ClinicalTrials.gov , NCT05103449.

OBJECTIVE: To provide available evidence comparing surgical outcomes of different vaginal hysterectomy (VH) techniques and devices.
METHODS: Pubmed, Embase and ClinicalTrials.gov databases were searched from inception to Dec 1, 2023, using relevant key words.
METHODS: Studies comparing at least two surgical techniques and devices for VH were included. An arm-based random effect frequentist network meta-analysis was performed. All available surgical outcomes were evaluated.
RESULTS: Ten randomized controlled trials and seven observational studies were eligible reporting on 1,577 women undergoing VH with different techniques and devices (50% conventional, 22.5% Ligasure®, 17.3% BiClamp®, and 9.2% natural orifice transluminal endoscopic surgery-vNOTES). All surgical techniques/devices had a comparable risk ratio in terms of intraoperative complications, but Clavien-Dindo Grade III post-operative complications were significantly reduced in the vNOTES group (risk ratio 0.15; 95% CI, 0.03 to 0.82; I2= 0%) compared to conventional VH. The pooled network analysis showed a lower standard mean deviation for blood loss when comparing energy-based vessel sealing technologies (Ligasure®: standard mean deviation -0.92; 95% CI, -1.47 to -0.37 and BiClamp®: standard mean deviation -1.66; 95% CI, -2.77 to -0.55) compared to conventional VH. Total operative time, post-operative haemoglobin variation and pain were significantly reduced only in the Ligasure® group compared to conventional VH. Bilateral salpingectomy or bilateral salpingo-oophorectomy was most commonly performed in the vNOTES group (risk ratio 1.9; 95% CI, 1.17 to 3.10) compared to the conventional VH group.
CONCLUSIONS: Modern surgical techniques/devices have the potential to improve anatomical exposure and to reduce morbidity of VH. This may drive resurgence of vaginal approach to hysterectomy.

OBJECTIVE: Chronic ectopic pregnancy is a variant of ectopic pregnancy featured with a low or normal serum beta-human chorionic gonadotropin (β-hCG) test. Obscure clinical presentations and non-specific images make chronic ectopic pregnancy a diagnostic dilemma until now.
METHODS: A 40-year-old female was misdiagnosed as tubo-ovarian abscess initially due to chronic lower abdominal pain, negative pregnancy test, and a complicated pelvic mass on abdominal CT scan and serial follow-up ultrasonography. Diagnostic laparoscopy was performed because of persistent pelvic mass with abdominal pain and irregular vaginal bleeding. Left tubal salpingectomy was performed and pathology reported a hematocele with inactive trophoblast tissue. Chronic ectopic pregnancy was proved. The symptoms resolved completely after our surgery.
CONCLUSIONS: An abnormal adnexal mass with a history of recent pregnancy could still be possible for chronic ectopic pregnancy even with a negative pregnancy test. Diagnostic laparoscopy and pathology confirmation could be helpful when the clinical manifestation is confusing.

Tubal abortion is characterized by the extrusion of the foetus into the abdominal (peritoneal) cavity. It can either be a complete extrusion or incomplete with residual tissue remaining in the fallopian tube. It is a type of ectopic pregnancy that is difficult to determine the exact incidence of tubal pregnancies. Identifying cases of tubal abortions is crucial for individualized care since it can lead to a more conservative treatment approach. The diagnosis should be based on ultrasound imaging, b-hCG levels and visual conformation during exploratory surgery, either open or laparoscopic. The article describes the case of a 30-year old patient who presented with lower abdominal pain and was admitted for a suspected ectopic pregnancy. Ultrasound imaging showed a mass resembling a tubal pregnancy next to the uterus with b-hCG levels of 111.8 U/L. During laparoscopic surgery, a tubal abortion was detected in the pouch of Douglas (Rectouterine pouch). This finding led us to preserve both fallopian tubes. Histopathology confirmed our clinical findings. A conservative approach can be sufficient in case of tubal abortions, which can lead to preserved fertility and tubal functions.

A woman from sub-Saharan Africa living in the Middle East, presented with acute abdominal pain and COVID-19 infection. She underwent a laparotomy and left salpingectomy for a left tubal ruptured ectopic pregnancy. The histopathology report revealed the presence of tubal schistosomiasis in addition to the ectopic sac. The report emphasises the importance of considering female genital schistosomiasis as a potential cause of ectopic pregnancy and the need for collaboration between obstetricians and infectious disease physicians in the definitive treatment of the disease to reduce reproductive morbidity. This case report highlights the possibility of female genital schistosomiasis as a cause of ectopic pregnancy in women from endemic regions.

A focal serous tubal intraepithelial lesion (STIL) is a rare lesion found on fallopian tubes that are characterized by atypical epithelial cells exhibiting morphological abnormalities with the accumulation of mutant p53 proteins. The p53 gene is a tumor suppressor gene, and when mutated gives rise to mutant p53 proteins that promote cancer cell growth and survival. We present a case of a 47-year-old gravida 2, para 2002 (G2P2) female who presented to the outpatient clinic with bilateral lower quadrant abdominal pain and back pain of four years\' duration. The patient\'s history included endometriosis with lysis of adhesions and gynecological laparoscopy, leiomyomata, infertility, ovarian cyst, dysmenorrhea, two full term births, and Essure implants used for contraception; her family history included maternal grandfather with breast cancer. Multiple fibroids and endometriosis were confirmed on pelvic ultrasound (US) and magnetic resonance imaging (MRI). Due to worsening pain, the patient chose to have an elective hysterectomy and Essure implant removal with bilateral salpingectomy. The postoperative pathology report revealed a right fallopian tube with a STIL. Multiple genetic mutations are known to contribute to the development of STILs including p53 and the breast cancer gene (BRCA). There are two BRCA genes, BRCA1 and BRCA2, that have many functions including producing proteins that repair damaged DNA. When mutated, this allows cells to divide and change rapidly, leading to certain types of cancer. Given the patient\'s family history of breast cancer, the patient was tested for BRCA1 and BRCA2 for which the results were negative. However, even without having a BRCA mutation that is known to increase the risk of ovarian, fallopian tube, and peritoneal cancers, STILs continue to pose an increased risk of high-grade serous ovarian carcinoma (HGSOC). This case demonstrates the reasoning behind prophylactic salpingectomies alongside hysterectomies and the significance of the postoperative pathology report from gynecological procedures.

OBJECTIVE: To explore the risk factors for tubal patency after partial salpingectomy and end-to-end anastomosis, and their impact on pregnancy outcomes.
METHODS: A total of 300 patients with tubal pregnancy who underwent partial salpingectomy and end-to-end anastomosis in Zhengzhou Maternal and Child Health Hospital from January 2020 to April 2023. Hysterosalpingography was performed after surgical treatment to examine the tubal patency. Lasso-Logistic regression was used to analyze the risk factors for postoperative tubal patency, and Spearman\'s correlation was used to analyze the impact of each risk factor on the pregnancy rate.
RESULTS: Hysterosalpingography showed that the fallopian tube was not obstructed in 225 cases (unobstructed group), the tube was not completely patent (n=54) or blocked (n=21) (obstructed group). Univariate analysis showed that age, diameter of the tubal pregnancy sac, location of tubal pregnancy, timing of surgery, pelvic adhesion, anastomotic method, length of remaining tubal, history of pelvic surgery, number of intraoperative electrocoagulation, intraoperative blood loss, and experience of surgeons were factors affecting postoperative tubal patency (all P<0.01). Lasso regression analysis identified location of tubal pregnancy, pelvic adhesion, anastomotic surgical method, length of remaining tubal, history of pelvic surgery, number of intraoperative electrocoagulation, and experience of surgeons as influencing factors. Multivariate Logistic regression analysis showed that tubal isthmus pregnancy, pelvic adhesion, open anastomosis surgery, history of pelvic surgery, and number of intraoperative electrocoagulation were independent risk factors for postoperative tubal patency, while length of remaining tubal and surgeon\'s work experience were independent protective factors for postoperative tubal patency (all P<0.01). A total of 295 patients were followed up of 1 year, 192 cases (65.08%) were pregnant, including 172 cases of intrauterine pregnancy (89.58%) and 20 cases of ectopic pregnancy (10.42%). Spearman correlation analysis showed that tubal isthmus pregnancy, pelvic adhesion, open abdominal anastomosis surgery, pelvic surgery history, and times of intraoperative electrocoagulation were negatively correlated with postoperative pregnancy, while the remaining tubal length and years of surgeon\'s working experience were positively correlated with postoperative pregnancy rate (all P<0.01).
CONCLUSIONS: For the tubal patency of patients after partial salpingectomy combined with end-to-end anastomosis, the history of tubal isthmus pregnancy, pelvic adhesion, open abdominal anastomosis, pelvic surgery, and the number of intraoperative electrocoagulation are independent risk factors, which are negatively correlated with postoperative pregnancy. The remaining tubal length and the surgeon\'s work experience are independent protective factors, which are positively correlated with postoperative pregnancy.
目的: 探讨输卵管部分切除术联合端端吻合术后影响患者输卵管通畅性和妊娠的风险因素。方法: 选取2020年1月至2023年4月郑州市妇幼保健院300例输卵管妊娠患者，所有患者均行输卵管部分切除术联合端端吻合术，并于术后行子宫输卵管造影检查。对患者术后输卵管的通畅性进行统计分析，并采用Lasso-Logistic回归分析术后输卵管通畅性的风险因素，Spearman相关性分析法分析各风险因素与术后妊娠的关系。结果: 300例患者中输卵管通畅225例（通畅组），输卵管通而不畅54例及输卵管堵塞21例（不通畅组）。单因素分析结果显示，年龄、输卵管孕囊直径、输卵管妊娠部位、手术时机、盆腔黏连、吻合术方式、剩余输卵管长度、盆腔手术史、术中电凝输卵管部位的次数（以下简称术中电凝次数）、术中出血量、手术医生工作年限是术后输卵管通畅性的影响因素（均P<0.01）；Lasso回归分析进一步筛选出7个影响因素：输卵管妊娠部位、盆腔黏连、吻合术方式、剩余输卵管长度、盆腔手术史、术中电凝次数、手术医生工作年限；Logistic回归分析结果显示，输卵管峡部妊娠、盆腔黏连、开腹吻合术、盆腔手术史、术中电凝次数是术后输卵管通畅性的独立危险因素，剩余输卵管长度、手术医生工作年限是术后输卵管通畅性的独立保护因素（均P<0.01）。研究随访1年，失访5例。295例患者中，术后1年妊娠192例（65.08%），其中宫内妊娠172例（89.58%），异位妊娠20例（10.42%）。Spearman相关性分析结果显示，输卵管峡部妊娠、盆腔黏连、开腹吻合术、盆腔手术史、术中电凝次数与术后妊娠呈负相关，剩余输卵管长度、手术医生工作年限与术后妊娠呈正相关（均P<0.01）。结论: 输卵管峡部妊娠、盆腔黏连、开腹吻合术、盆腔手术史、术中电凝次数是影响输卵管部分切除术联合端端吻合术后患者输卵管通畅性的独立危险因素，且与术后妊娠呈负相关；剩余输卵管长度、手术医生工作年限是影响输卵管部分切除术联合端端吻合术后患者输卵管通畅性的独立保护因素，且与术后妊娠呈正相关。.

Disseminated peritoneal leiomyomatosis (DPL) is a rare and benign clinical entity. It is also known as leiomyomatosis peritonealis disseminata (LPD). Here, we report and discuss a case of a primiparous woman in her early 40s who presented with heavy, prolonged, painful menses and heaviness in her lower abdomen. She underwent a laparoscopic myomectomy for a fibroid uterus, 12 months ago for similar complaints. On workup, she was diagnosed with DPL. We performed a total abdominal hysterectomy with bilateral salpingectomy, low anterior resection with stapled colorectal anastomosis and excision of peritoneal tumour deposits in consortium with the gastrosurgery team. Her postoperative period was uneventful, and the patient was discharged on postop day 6. Her histopathology report was consistent with leiomyoma; the follow-up period was uneventful.

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