Abstract:Laparoendoscopic single-site surgery(LESS),which achieves minimally invasive effect through a single access port,demonstrates significant advantages in gynecology,including better cosmesis,rapid recovery,and potential fertility preservation.Studies confirm that LESS exhibits comparable safety to conventional laparoscopy in ovarian cystectomy,myomectomy,and cervical cancer surgery,with shorter hospital stay.Its indications include adnexal surgery,hysterectomy,early-stage malignancies,and pelvic floor reconstruction.Pre-bent instruments and robot-assisted techniques(R-LESS)further address the"chopstick effect"and the limited maneuverability.Future advancements in instrument innovation,guideline standardization,and remote surgical technology will expand LESS applications in complex gynecological diseases.

Abstract:Transvaginal natural orifice transluminal endoscopic surgery(vNOTES)has been developing well in the field of gynecology for years.With proper selection of patients,this procedure can cover most surgical treatments for benign diseases,and especially in the preservation of fertility,it has its unique advantages.With the continuous development of robot-assisted technology,robotic vNOTES has led this procedure to a more accurate and less invasive direction.This article will discuss the application progress of this procedure in preserving fertility,so as to provide theoretical basis for the formulation of clinical surgical strategy.

Abstract:Laparoendoscopic single-site surgery,an innovative technique in the field of minimally invasive gynecology,has demonstrated significant clinical value in the diagnosis and treatment of ovary-related tumors.This technique,with its advantages of reduced postoperative pain,rapid recovery,and better cosmetic outcomes for the abdominal wall,has been widely applied in the surgical treatment of benign ovarian tumors,borderline ovarian tumors,and the comprehensive staging surgery of early-stage malignant tumors.However,due to its technical complexity,especially in the management of complex cases and advanced-stage ovarian cancer,the safety and adaptability of single-port laparoscopic surgery still have certain limitations.Therefore,further optimization and research of its clinical application remain crucial for its future development.This article provides an overview of the current status,advantages,and limitations of single-port laparoscopic surgery in ovary-related tumors,analyzes the surgical techniques involved,and looks into the prospects of its future development.

Abstract:Objective To compare the clinical outcomes and beneficiary populations of prophylactic risk-reducing salpingo-oophorectomy(RRSO)for patients at high risk of ovarian cancer with those of opportunistic salpingo-oophorectomy(OS)due to other gynecological diseases.Methods This retrospective study involved 105 patients who underwent prophylactic resection(bilateral appendixes)at the Department of Obstetrics and Gynecology,The First Affiliated Hospital of University of Science and Technology of China,from March 2020 to September 2023.Baseline clinical information,including preoperative CA125 levels and imaging findings,postoperative pathology,and immunohistochemical results were collected and analyzed.Results Among the 25 patients who completed homologous recombination deficiency(HRD)-related genetic testing,20 carried pathogenic mutations in homologous recombination repair(HRR)pathway genes.Twenty-four patients underwent SEE-FIM(Sectioning and Extensively Examining the FIMbriated end)protocol sampling,and 4 were diagnosed with high-grade serous ovarian carcinoma(HGSC).In contrast,none of the 80 patients who underwent OS due to other gynecologic conditions were diagnosed with malignancy.Conclusions Genetic counseling and timely RRSO are recommended for individuals carrying pathogenic BRCA1/2 mutations,as RRSO can effectively reduce the incidence of ovarian cancer.The timing of surgery will affect the final beneficiary populations.

Abstract:Objective To analyze factors affecting the prognosis of patients with stage ⅢC1 cervical cancer and to develop a nomogram for exploring its value in prognosis evaluation.Methods A total of 91 patients with pathological diagnosis of stage ⅢC1 cervical cancer were included as research subjects,who underwent radical hysterectomy at the First Affiliated Hospital of Bengbu Medical University between January 2016 and December 2020.Prognostic factors were identified using Cox proportional hazards regression analysis,and a nomogram was constructed.The nomogram was evaluated using calibration curves,receiver operating characteristic(ROC)curves,and decision curve analysis(DCA).Results Tumor diameter ≥4cm,paracervical involvement,and lymph node ratio(LNR)≥0.22 were the risk factors for 3-year OS of the patients with stage ⅢC1 cervical cancer.Tumor diameter ≥4cm,lymphovascular space invasion(LVSI),and LNR ≥0.22 were the risk factors for 3-year DFS of the patients with stage ⅢC1 cervical cancer.The calibration curves of nomogram demonstrated high prediction accuracy of this model,the ROC curves showed high predictive accuracy of the model,and DCA curve confirmed the clinical utility of the model.Conclusions Tumor size,LNR,paracervical involvement,and LVSI are risk factors affecting the prognosis of the patients with stage ⅢC1 cervical cancer.The constructed nomogram may help to guide doctors in stratification management and to take comprehensive treatment in order to improve patient outcomes.

Abstract:Objective To analyze the differences in hematological indicators among patients with different stages of endometriosis(EM)and non-EM controls,and to explore their diagnostic value in the occurrence and progression of severe EM.Methods This retrospective study included 112 patients with stage Ⅰ or Ⅱ EM(mild group),136 patients with stage Ⅲ or Ⅳ EM(severe group),and 136 patients without EM(control group),all treated at Ningbo Women and Children's Hospital of Ningbo University between December 2022 and May 2024.General and hematological data were collected.Differences among groups were analyzed using pair comparisons,and logistic regression analysis was used to identify factors associated with development of severe EM.The diagnostic performance of relevant markers was assessed using receiver operating characteristic(ROC)curves.Results No significant differences were found between the mild and control groups in general or hematological parameters.Compared with controls and mild cases,the severe group showed significantly elevated levels of fibrinogen(FIB),CA125,CA19-9,and plasma D-dimer(P＜0.05).Logistic regression identified CA125 and FIB as independent predictors of severe EM.The combination of CA125 and FIB yielded an area under the ROC curve(AUC)of 0.834 with sensitivity and specificity of 80.10％and 80.60％,respectively,surpassing single-indicator models.In distinguishing severe from mild EM,the combined model also improved diagnostic sensitivity.Conclution The combination of CA125 and FIB provides a more effective diagnostic approach for identifying and evaluating severe endometriosis,offering a promising noninvasive tool for clinical application.

Abstract:Objective To evaluate the clinical efficacy and safety of simultaneously integrated boost-intensity modulated radiotherapy(SIB-IMRT)to the tumor center in the initial stage in patients with bulky cervical cancer with acute bleeding.Methods Retrospective analysis was performed on the clinical data of the patients with bulky cervical cancer with bleeding who received SIB-IMRT to the tumor center in the initial stage in the Radiotherapy Department of Affiliated Hospital of Nanjing University of Chinese Medicine from January 2019 to January 2023.The propensity score matching method was used to match patients receiving SIB-IMRT to the tumor center in the initial stage with those receiving conventional IMRT.A total of 20 pairs of 40 patients were included in the study.In the SIB group 15 Gy in 3 fractions was delivered to the tumor center(the region that was the subtractive margin from the tumor boundary by 1.5 to 2 cm),and simultaneously 46 Gy in 23 fractions was delivered to the periphery of tumor and lymphatic drainage area of pelvic cavity at the initial three times of external irradiation.In the second course,the tumor and pelvic lymphatic drainage area were given a conventional fractionated dose of 40 Gy in 20 fractions.The patients treated with conventional IMRT(46 Gy/23 fractions)in cervical mass and pelvic lymphatic drainage area were regarded as control group.After the external irradiation,intracavitary radiotherapy was given.The primary endpoint was hemostasis effect.The secondary endpoints included adverse events(AEs),local contral(LC)rate and overall survival(OS)rate.Results Median follow-up was 48 months.The effective hemostasis rates in the SIB group and the control group in one week were 100％and 40％,respectively.There were no statistically significant differences in LC rate,OS rate,or acute and late AEs between two groups.Conclusion SIB-IMRT is effective and safe for bulky cervical cancer patients with bleeding,which can be selectively used in suitable patients.

Abstract:Transvaginal natural orifice transluminal endoscopic surgery(vNOTES)has emerged as a rapidly advancing technique in gynecology,demonstrating unique advantages in the surgical management of pelvic organ prolapse(POP).By integrating with conventional vaginal surgical approaches,vNOTES significantly expands the depth and scope of pelvic floor reconstruction while simultaneously reducing postoperative pain and accelerating recovery.However,its implementation demands proficiency in both single-port laparoscopic techniques and vaginal surgery,necessitating a substantial learning curve.With the increasing adoption of single-port laparoscopy and robotic-assisted platforms,the utilization of vNOTES for POP is expected to gain wider clinical acceptance.

Abstract:Objective To compare the perioperative outcomes of laparoendoscopic single-site myomectomy using the"chopstick"technique(cLESS-M)with those of conventional laparoscopic myomectomy(CLS-M).Methods A retrospective analysis was conducted on 255 patients who underwent laparoscopic myomectomy at the First Affiliated Hospital of Army Medical University between August 2018 and April 2020.Patients were divided into the cLESS group(n=117)and the CLS group(n=138)based on the surgical approach.Intraoperative parameters,postoperative recovery indicators,and incidence of perioperative complications were compared between the two groups.Results Baseline data were similar between the two groups(P＞0.05).There were no significant differences in operation time,estimated blood loss,or incidence of perioperative complications.Compared to the CLS group,the cLESS group had a significantly shorter postoperative hospital stay[4.0(4.0,5.0)vs.5.0(4.0,6.0)days,P=0.006],lower pain scores at 1 hour postoperatively[2.0(2.0,3.0)vs.3.0(2.0,3.0),P＜0.001],and lower pain scores at 24 hours after operation[1.0(1.0,1.0)vs.1.0(1.0,2.0),P=0.008].Conclusion The cLESS-M technique offers comparable surgical outcomes to CLS-M,with advantages of shorter hospital stay and less pain after operation.

Abstract:Objective To develop and internally validate a risk prediction model for postpartum stress urinary incontinence(SUI)in women using machine learning,aiming to provide evidence for early prevention.Methods This retrospective study included 516 postpartum women who underwent pelvic floor screening at 42 days after delivery at Ningbo University Women and Children's Hospital from October 2022 to June 2023(a case group of 82 cases and a control group of 434 cases).The influencing factors were collected,including age,delivery mode,parity,electromyographic(EMG)data of pelvic floor and pelvic floor ultrasound data.Five machine learning algorithms such as random forest(RF)and support vector machine(SVM)were used to build predictive models.Model performance was evaluated using 10-fold cross-validation.Results The overall incidence of postpartum SUI was 15.89％.Among all models,the random forest model demonstrated the best performance,with an F1 score of 1.000 and AUC of 1.000 in the training set,and an F1 score of 0.776 and AUC of 0.837 in the validation set.The key influencing factors included pelvic floor EMG parameters(e.g.,intense contraction and endurance contraction phases),age,parity,perineal injury,and BMI.Pelvic floor EMG parameters contributed the most to classification performance.Conclusions The random forest model shows the best predictive ability.Pelvic floor EMG parameters are strongly associated with postpartum SUI.This model offers a valuable tool for clinicians to accurately assess individual risk and guide early rehabilitation intervention,such as Kegel exercises and biofeedback therapy,which provides new tools for the prevention and treatment of postpartum SUI.

Abstract:Transvaginal natural orifice transluminal endoscopic surgery(vNOTES),as an innovative minimally invasive technique in gynecology,enables scarless operations through endogenous pathways.However,its clinical application is limited by the mechanical coupling effect and the lack of a triangle of support in traditional single-port instruments.The robotic surgical system,with its multi-degree-of-freedom wristed instruments,three-dimensional high-definition imaging,and motion scaling technology,effectively addresses the vision-operation axis collinearity challenge of vNOTES and overcomes the spatial constraints within narrow cavities.Based on evidence-based medical evidence,this article systematically analyzes the key technical advantages of different robotic surgical platforms in various gynecological procedures.With the iterative improvement in miniaturized intracavitary robots and cross-modal surgical navigation systems,robotic vNOTES is driving gynecological surgery towards ultra-minimally invasive and intelligent directions,providing innovative solutions to high-risk procedures such as radical resection of malignant tumors.

Abstract:Objective To analyse the influencing factors related to the success of external cephalic version,and to construct a line chart model and verify the predictive efficacy.Methods A retrospective cohort study was conducted which included 230 pregnant women who underwent external cephalic version at Women and Children's Hospital Affiliated to Xiamen University from April 2018 to October 2022,of which 165 cases were successful and 65 failed.The cases were divided into training set and validation set according to the ratio of 7∶3.The clinical data and preoperative ultrasound indexes of the study subjects were collected,and the influencing factors of the success of external cephalic version were analysed by logistic regression.The line chart model was then established by R 4.2.3 software.The C-index and standard calibration curve were used to assess the efficacy of the model,and the decision curve was used to assess the clinical practicality of the model.Results Logistic regression analysis showed that frank breech,anterior placenta,amniotic fluid index＜14.10 cm,and primiparity were the risk factors for the success of external cephalic version[odds ratio(OR)values being 0.173,0.170,1.335,and 1.975,P＜0.05].A line chart model was constructed based on the above influencing factors.The C-index of the training set was 0.838(95％CI 0.775-0.900),and the area under the ROC curve was 0.815;the C-index of the validation set was 0.822(95％CI 0.759-0.884)and the area under the ROC curve was 0.780.The model curves were closer to the ideal curves,and separated from the extreme curves.Conclusion The line chart prediction model based on placental position,breech presentation type,amniotic fluid index,and the number of deliveries has high efficacy and good clinical practicality,and it can be used as a tool for screening and assessing the population fit for external cephalic version.

Abstract:Endometriosis(EM)is a common chronic disease among women of childbearing age.It is characterized by the invasion of active endometrial tissue into tissues and organs outside the uterine cavity,often leading to dysmenorrhea,abnormal menstruation,infertility,dyspareunia,and a decrease in the quality of life.Although traditional laparoscopic surgery is the gold standard for treatment,its multi-port operation may be accompanied by an increase in incision complications and cosmetic problems.With the continuous development of minimally invasive technology,laparoendoscopic single-site surgery(LESS)can be completed through a single access route,showing the advantages of both minimal invasiveness and cosmesis.In recent years,LESS has received much attention in the treatment of EM.This article reviews the current application status,technical advantages,and existing challenges of LESS in the diagnosis and treatment of endometriosis,aiming to provide a reference for clinical practice.