Ceana Nezhat

Background: Current endometriosis classification systems have important limitations in accurately describing total disease burden and predicting clinical outcomes. Existing staging frameworks often fail to integrate adenomyosis and do not adequately distinguish between genital and extragenital disease involvement. The aim of this article was to introduce the AGCES (American & Global College of Endometriosis Specialists) classification system, a novel framework designed to provide a more comprehensive and clinically meaningful approach to staging endometriosis. Methods: The AGCES classification system was developed through an expert consensus process involving scientific members of the American & Global College of Endometriosis Specialists (AGCES), informed by extensive surgical experience on thousands of endometriosis surgeries, synthesis of published evidence on disease pathophysiology and anatomical distribution, and systematic analysis of the limitations of existing classification systems (rASRM, ENZIAN, AAGL, EFI). Results: The framework integrates adenomyosis as a component of endometriosis staging and separates genital and extragenital disease into independent staging categories. Disease burden is reported using three parallel components representing adenomyosis (A), genital endometriosis (G), and extragenital endometriosis (E). A standardized operative reporting template and digital implementation through web-based applications were also developed to support clinical use. Conclusions: The AGCES classification system introduces a novel approach to endometriosis staging by integrating adenomyosis and separating genital and extragenital disease components. This framework provides a more complete assessment of disease burden and has the potential to improve clinical documentation, surgical planning, and research standardization in endometriosis care.

To quantify abdominal wall thickness and distances to the superior mesenteric artery (SMA) and major retroperitoneal vessels using standardized transabdominal ultrasound with color Doppler. Prospective observational study conducted at a single ...

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, a systemic ailment, profoundly affects various aspects of life, often eluding detection for over a decade. This leads to enduring issues such as chronic pain, infertility, emotional strain, and potential organ dysfunction. The prolonged absence of diagnosis can contribute to unexplained obstetric challenges and fertility issues, necessitating costly and emotionally taxing treatments. While biopsy remains the gold standard for diagnosis, emerging noninvasive screening methods are gaining prominence. These tests can indicate endometriosis in cases of unexplained infertility, offering valuable insights to patients and physicians managing both obstetric and non-obstetric conditions. In a retrospective cross-sectional study involving 215 patients aged 25 to 45 with unexplained infertility, diagnostic laparoscopy was performed after unsuccessful reproductive technology attempts. Pathology results revealed tissue abnormalities in 98.6% of patients, with 90.7% showing endometriosis, confirmed by the presence of endometrial-like glands and stroma. The study underscores the potential role of endometriosis in unexplained infertility cases. Although the study acknowledges selection bias, a higher than previously reported prevalence suggests evaluating endometriosis in patients who have not responded to previous reproductive interventions may be justified. Early detection holds significance due to associations with ovarian cancer, prolonged fertility drug use, pregnancy complications, and elevated post-delivery stroke risk.

Endometriosis is a prevalent condition that affects millions of individuals globally, leading to various symptoms and significant disruptions to their quality of life. However, the diagnosis of endometriosis often encounters delays, emphasizing the pressing need for non-invasive screening. This retrospective cross-sectional study aimed to evaluate the utility of the Endometriosis Risk Advisor (EndoRA) mobile application in screening for endometriosis in patients with chronic pelvic pain and/or unexplained infertility. The study consisted of 293 patients who met specific criteria: they were English-speaking individuals with chronic pelvic pain and/or unexplained infertility, owned smartphones, and had no prior diagnosis of endometriosis. The results demonstrated that the EndoRA score exhibited a high sensitivity of 93.1% but a low specificity of 5.9% in detecting endometriosis. The positive predictive value was 94.1%, while the negative predictive value was 5.0%. Although the study had limitations and potential selection bias, its findings suggest that EndoRA can serve as a valuable screening tool for high-risk individuals, enabling them to identify themselves as being at an increased risk for endometriosis. EndoRA’s non-invasive nature, free access, and easy accessibility have the potential to streamline evaluation and treatment processes, thereby empowering individuals to seek timely care and ultimately improving patient outcomes and overall well-being.