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This video shows the case of a female patient presenting with bladder endometriosis managed safely and effectively using laparoscopic surgery. The patient presented with urinary discomfort, primarily during the initiation of micturition. A magnetic resonance imaging was performed, revealing a fibrotic focus measuring approximately 20 by 14.5mm in relation to the cesarean scar. This focus involved the posterior and upper wall of the bladder in close vicinity with the distal left ureter and the ureteral meatus. This surgery was performed by gynecology surgeons with the assistance of urological surgeons. The video is a stepwise demonstration of the technique with narrated video footage. This procedure is recommended to a gynecological surgical audience.
Endometriosis is estimated to affect around 10% of women in their reproductive age. Bladder endometriosis is considered a relatively rare form of endometriosis, accounting for a small subset of all endometriosis cases. It is estimated that bladder involvement occurs in about 1 to 7% of women with endometriosis. The common symptoms of bladder endometriosis include chronic pelvic pain, urinary symptoms, and painful intercourse. The approach involves a combination of continued hormone therapy and surgical intervention, including nodule resection.

Bibliography:
1. Tomasi MC, Ribeiro PAA, Farah D, Vidoto Cervantes G, Nicola AL, Abdalla-Ribeiro HS. Symptoms and Surgical Technique of Bladder Endometriosis: A Systematic Review. J Minim Invasive Gynecol. 2022 Dec;29(12):1294-1302. doi: 10.1016/j.jmig.2022.10.003. Epub 2022 Oct 15. PMID: 36252916. https://pubmed.ncbi.nlm.nih.gov/36252916/

2. Allaire C, Bedaiwy MA, Yong PJ. Diagnosis and management of endometriosis. CMAJ. 2023 Mar 14;195(10):E363-E371. doi: 10.1503/cmaj.220637. PMID: 36918177; PMCID: PMC10120420. https://pubmed.ncbi.nlm.nih.gov/36918177/

3. Piriyev E, Schiermeier S, Römer T. Laparoscopic Approach in Bladder Endometriosis, Intraoperative and Postoperative Outcomes. In Vivo. 2023 Jan-Feb;37(1):357-365. doi: 10.21873/invivo.13086. PMID: 36593051; PMCID: PMC9843782. https://pubmed.ncbi.nlm.nih.gov/36593051/

4. Diniz ALL, Resende JAD Jr, de Andrade CM Jr, Brandão AC, Gasparoni MP Jr, Favorito LA. Urological knowledge and tools applied to diagnosis and surgery in deep infiltrating endometriosis - a narrative review. Int Braz J Urol. 2023 Sep-Oct;49(5):564-579. doi: 10.1590/S1677-5538.IBJU.2023.9907. PMID: 37450770; PMCID: PMC10482465. https://pubmed.ncbi.nlm.nih.gov/37450770/

Courtesy of BJS: This video is part of a series of four given by BJS and BJS Open Editors as a short introductory course on how to referee a clinical paper, focusing on how to undertake a peer-review. Although these are stand-alone videos that can be viewed individually, they are also used as an integral part of a longer taught online course in surgical publishing from the BJS Institute. Details of the courses and other tutorials are available on the BJS Academy website.
Here, BJS Editor, Paul Sutton, explains what to look for in a scientific article that will help judge whether or not it has scientific credibility sufficient for publication, and in which journal.

In this key educational lecture, Dr. Barbora East, MD, PhD outlines midline incisional hernia guidelines as published by the European Hernia Society (EHS) in 2023.
Dr. B East, MD, PhD has the following potential conflicts of interest to disclose, receiving research grants from AZV and EHS, as well as speakers' fees from Medtronic. However, industrial companies were never committed to the elaboration and running organization of this webinar. There is neither commercial publicity nor commercial promotion in this webinar. Dr. B East is Secretary for (e)Quality at the EHS and Secretary of the AWS section at the UEMS; she will be the EHS 2024 Conference President, and she is co-producer of the Hernia Basecamp.
Dr. B East declares that she is fully committed to maintaining professional autonomy and independence in relation with the medical device Industry.
This webinar is aimed to promote education among its learners, and Dr. B East, MD, PhD declares that this webinar is fair, balanced, and free of commercial bias.
Dr. B. East has no financial affiliations that would affect the content of her talks.

This video presents the case of a 42-year-old female patient with a history of difficult birth, gravida 2, parity 2, and vaginal birth 2. She had no surgery or any significant medical history. She had a BMI of 29.8. The patient reported experiencing urinary leakage during coughing. A routine urinalysis was conducted; the result was normal. Valsalva and Boney tests were applied to the patient. A urodynamic test was performed. A diagnosis of type 2 stress urinary incontinence (SUI) was established, and it was decided to perform an extraperitoneal laparoscopic Burch colposuspension, which is a widely accepted technique for the treatment of stress urinary incontinence. Laparoscopic Burch colposuspension offers advantages over the open Burch colposuspension (i.e., reduced bleeding, shorter postoperative recovery time), and it is more minimally invasive. However, the surgery duration is longer. In our patient, we performed the extraperitoneal Burch colposuspension technique, and total surgical time was 37 minutes. Skipping the steps of opening and closing the peritoneum and directly entering the space of Retzius allow to save significant time. An appropriate dissection strategy allows to clearly visualize anatomical landmarks.

Bibliography:
1. Ye Y, Wang Y, Tian W, et al. Burch colposuspension for stress urinary
incontinence: a 14-year prospective follow-up. Sci China Life Sci. 2022;65(8):1667-
1672. doi:10.1007/s11427-021-2042-9

2. Bulent Tiras M, Sendag F, Dilek U, Guner H. Laparoscopic burch colposuspension:
comparison of effectiveness of extraperitoneal and transperitoneal techniques. Eur J
Obstet Gynecol Reprod Biol. 2004;116(1):79-84. doi:10.1016/j.ejogrb.2004.02.003

3. Obaid AA, Al-Hamzawi SA, Alwan AA. Laparoscopic and open burch
colposuspension for stress urinary incontinence: advantages and disadvantages. J
Popul Ther Clin Pharmacol. 2022;29(2):e20-e26. Published 2022 Jun 16.
doi:10.47750/jptcp.2022.926

Introduction:
Non-puerperal uterine inversion (NPUI) is a rare gynecologic condition with diagnostic and surgical challenges, characterized by the turning inside out of the uterus in women who are not pregnant or have recently given birth. It is unrelated to the postpartum period and can happen at any time.
The actual incidence is unknown and most of the published literature on NPUI is in the form of case reports. There have been 170 cases reports in the literature since 1940.
The mechanism of non-puerperal inversion is not so clear. However, it is often associated with the presence of benign or malignant tumors within or attached to the uterus, such as fibroids or polyps.
Clinical case presentation: This video presents the case of a 48-year-old woman with NPUI stage 4 associated with a large uterine myoma managed with a combined laparoscopic and vaginal approach.
The technical steps for its laparoscopic and vaginal management are demonstrated.
Conclusion:
The laparoscopic and vaginal management of NPUI is feasible with satisfying results.

Bibliography:
1. Rosa Silva, B., de Oliveira Meller, F., Uggioni, M. L., Grande, A. J., Chiaramonte Silva, N., Colonetti,T., ... & da Rosa, M. I. (2018). Non-puerperal uterine inversion: a systematic review. Gynecologic and Obstetric Investigation, 83(5), 428-436.
2. Kesrouani A, Cortbaoui E, Khaddage A, Ghossein M, Nemr E. Characteristics and Outcome in Non-Puerperal Uterine Inversion. Cureus. 2021 Feb 15;13(2):e13345. doi: 10.7759/cureus.13345. PMID: 33754086; PMCID: PMC7971731.
3. Thakur M, Thakur A. Uterine Inversion. 2022 Nov 28. In: StatPearls [Internet]. Treasure Island (FL): Stat Pearls Publishing; 2023 Jan–. PMID: 30247846.
4. Moshayedi F, Seidaei HS, Salehi AM. A Case Report of Non-puerperal Uterine Inversion due to Submucosa Leiomyoma in a Young Virgin Woman. Case Rep Surg. 2022 Aug 16;2022:5240830. doi:10.1155/2022/5240830. PMID: 36017477; PMCID: PMC9398870.

This is the case of a 39-year-old female patient with a history of suprapubic cystourethropexy and anterior colporrhaphy with a recurrent anterior and apical prolapse. She had a sensation of a vaginal mass and abnormal uterine bleeding with no presence of urinary incontinence. Due to the patient’s physical examination and symptoms, a laparoscopic sacral colpopexy with subtotal hysterectomy was considered to correct the recurrent prolapse and treat abnormal uterine bleeding. It was decided to perform a subtotal hysterectomy to reduce the risks of mesh extrusion.

Take-home messages:
Conventionally, anterior compartment recurrence has been higher when compared to apical and posterior compartment recurrence. Synthetic meshes aiming to decrease such recurrence rates have been the subject of much controversy. They led to an improvement in the staging of pelvic support in relation to the Pelvic Organ Prolapse Quantification System (POP-Q) and to provide a subjective sensation of relief from the vaginal mass, yet with an increase in complications and no improvement in quality-of-life surveys as compared to surgery with native tissue. Likewise, the rates of reoperation for prolapse are similar between the two groups. Similarly, apical suspension has been shown to be an essential factor for the successful treatment of the anterior compartment.
Sacral colpopexy via laparotomy or laparoscopy has become the gold standard for treatment of vaginal vault prolapse with a greater anatomical success and a lower probability of reoperation, when compared to surgery performed vaginally. This technique has been extrapolated to hystero-preservation surgeries or in patients with uterine prolapse, with similar results. Likewise, in this group of patients, there is controversy as to whether to perform a total hysterectomy or a subtotal hysterectomy.
Some authors report a decrease of up to 4 times regarding the probability of synthetic material exposure in the larger group of patients that were submitted to a sub-total hysterectomy with the same anatomical and subjective success rates.
In this patient with recurrent anterior prolapse and associated apical prolapse, this surgery was chosen, considering that it uses a multicompartmental surgical technique. It also addresses the three compartments and allows adequate correction of the anterior prolapse if the mesh is advanced to the bladder trigone. Likewise, the laparoscopic approach allows reduced intraoperative bleeding, diminished recovery time with similar results to an open approach. In this group of patients, it is essential to rule out any cervical pathology and to screen for cervical cancer.

Bibliography:
1. Rosati, M., Bramante, S. and Conti, F. (2014) ‘A review on the role of Laparoscopic Sacrocervicopexy’, Current Opinion in Obstetrics & Gynecology, 26(4), pp. 281–289. doi:10.1097/gco.0000000000000079.
2. Lang, P. and Whiteside, J.L. (2017) ‘Anterior compartment prolapse: What’s new?’, Current Opinion in Obstetrics & Gynecology, 29(5), pp. 337–342. doi:10.1097/gco.0000000000000392.
3. Geoffrion, R. and Larouche, M. (2021) ‘Guideline no. 413: Surgical management of apical pelvic organ prolapse in women’, Journal of Obstetrics and Gynaecology Canada, 43(4), pp. 511–523. doi: 10.1016/j.jogc.2021.02.001.
4. Campagna, G. et al. (2021) ‘Laparoscopic sacral hysteropexy versus laparoscopic sacral colpopexy plus supracervical hysterectomy in patients with pelvic organ prolapse’, International Urogynecology Journal, 33(2), pp. 359–368. doi:10.1007/s00192-021-04865-0.

Relive the highlights of the CLASSICA webinar focused on validating AI in classifying cancer in real-time surgery, held on March 26, 2024.
This event was a collaborative effort by IRCAD, EAES, and the CLASSICA team to bring together experts and practitioners in a comprehensive discussion about the future of cancer treatment.
This webinar gathers a panel of experts delving into the state-of-the-art of rectal polyp treatment, biophysics-inspired artificial intelligence (AI) for colorectal cancer characterization, liability, and legal concerns when using AI decision support in the operating room (OR), and guidance and training in intraoperative use. For any further information, please visit: https://classicaproject.eu/
Webinar program:
Introduction - A Arezzo, R Cahill, P Mascagni, R Rodríguez-Luna, S Perretta

State-of-the-art (SOA) for rectal cancer polyps - F Aigner

Biophysics-inspired AI for colorectal cancer (CRC) characterization - A Moynihan

Liability and legal concerns when using AI decision support in the OR - M Nunez Duffourc

Guidance and training in the intraoperative use of AI - P Mascagni

Panel discussion and concluding remarks

This video demonstrates a rare congenital Mullerian uterine anomaly, namely an accessory cavitated uterine mass (ACUM). It occurs due to the duplication of the ductal Mullerian tissue at the level of the round ligament and it is related to gubernaculum dysfunction. The video demonstrates the pre-surgical work-up, the surgical demonstration, and the histopathology report confirming the diagnosis.

Bibliography:
1. Mondal R, Bhave P. Accessory cavitated uterine malformation: Enhancing awareness about this unexplored perpetrator of dysmenorrhea. Int J Gynaecol Obstet. 2023 Aug;162(2):409-432. doi: 10.1002/ijgo.14681. Epub 2023 Feb 7. PMID: 36656754.
2. Peters A, Rindos NB, Guido RS, Donnellan NM. Uterine-sparing Laparoscopic Resection of Accessory Cavitated Uterine Masses. J Minim Invasive Gynecol. 2018 Jan;25(1):24-25. doi: 10.1016/j.jmig.2017.06.001. Epub 2017 Jul 21. PMID: 28599883.
3. Arya S, Burks HR. Juvenile cystic adenomyoma, a rare diagnostic challenge: Case Reports and literature review. F S Rep. 2021 Feb 10;2(2):166-171. doi: 10.1016/j.xfre.2021.02.002. PMID: 34278349; PMCID: PMC8267394.