Female Infertility and Obesity across the United States—A Geographic Cross-Sectional Analysis

This cross-sectional study investigates a connection between female infertility and obesity across various regions of the United States, utilizing data from the NIH’s “All of Us” Researcher Workbench. Analysis suggested that the Southern region exhibited the highest percentage of concurrently infertile and obese females at 32.3%, in contrast to the lowest in the Western region at 28.7%. The findings underscore the significant regional disparities in obesity-related infertility, particularly in medically underserved areas where healthcare access is limited. The study highlights the urgent need for targeted public health interventions, particularly in the Southern United States, to address the rising prevalence of obesity and its impact on infertility. Further, these results advocate for enhanced public health education and policies aimed at improving healthcare accessibility, with the goal of mitigating the adverse effects of obesity on reproductive health.

Ultrasound Causes of Female Infertility at the Fertilia Medical Clinic in Bamako

Aims: Infertility is a major problem in our current societies and the Fertilia medical clinic in Bamako is a center for medical assistance in procreation (MAP) where there is an increasingly growing demand for ultrasound. The objective of our study was to investigate the ultrasound causes likely to prevent the occurrence of pregnancy in a group of infertile and subfertile women. Subjects and Methods: This was a 5-year cross-sectional and prospective study, between January 2017 and January 2022, which involved 250 women wishing to become pregnant (infertile or subfertile), who came for pelvic ultrasound or follicular monitoring and who agreed to participate in our study. The parameters used were ultrasound reports including uterine, ovarian and tubal pathologies. It should be noted that in some cases no ultrasound cause of infertility was found. Data were entered and analyzed in SPSS. Results: 250 women were recruited into our. The average age was 32 years with extremes ranging from 17 to 51 years. 179 patients or 71.6% were between 17 and 35 years old. 139 patients or 55.6% had secondary infertility against 44.4% primary infertility. 202 patients or 80.8% had at least one ultrasound lesion and 48 patients or 19.2% had no significant ultrasound abnormality. The most represented ultrasound lesions were of uterine origin with 72.20%, 23.7% ovarian lesions and 04% tubal lesions. Uterine lesions were dominated by myomas, adenomyosis, endometrial polyps, uterine malformations and synechiae. As for ovarian lesions we noted cysts, polycystic ovary syndrome (PCOS), ovarian endometriosis, non-follicular ovaries and tubal ultrasound lesions showed unilateral or bilateral hydrosalpinx. Conclusion: In our study, ultrasound was an invaluable contribution to the diagnosis of the causes likely to explain subfertility and infertility in our respondents. She highlighted uterine, ovarian and tubal lesions, some of which could be corrected and pregnancies ensued.

Place of Selective Tubal Catheterization in the Management of Female Infertility in Togo

Objective: To determine the effectiveness of selective tubal catheterization in the management of female infertility due to proximal tubal obstruction. Method: This was a longitudinal descriptive study, conducted over a period of 24 months, which included 73 patients presenting with objectified bilateral proximal tubal obstruction after standard HSG. The intervention was performed on an outpatient basis, during the follicular phase with negative β-hCG assay the day before, in the interventional radiology room and under antibiotic coverage. Confirmatory hysterosalpingography was performed as the first step followed by selective tubal catheterization after the failure of spontaneous tubal opacification. The parameters studied related to socio-epidemiological, clinical and radiological data. Results: The age of our patients was between 24 and 42 years with an average of 33.97 years. The average duration of infertility was 3.95 years, with a predominance of primary infertility in 83.56% of cases. Voluntary termination of pregnancy (38.89%) and fibromyomas (33.33%) were the most represented gynecological-obstetrical antecedents. Selective tubal catheterization was successful in 92.14% of cases (129/140 tubes). It was possible bilaterally in 93.02% of cases and unilaterally in 6.98% of cases. The confirmatory HSG allowed a spontaneous opacification of 4.10% of the fallopian tubes. At the end of the procedure, all the recanalized tubes were opacified;62.01% of them were normal, against 37.99% pathological with a preponderance of inflammatory tubes 26.61% followed by hydrosalpinx in 5.03% of cases. No major complications were encountered. The fertility rate was 23.29%. Conclusion: Selective tubal catheterization is a simple technique, without major complications with an efficiency close to natural fertility. It should be proposed as the first intention before any other procedure in the treatment of infertility by proximal tubal obstruction.

Female infertility and laparoscopic surgery: A series of 415 operations at the Yaounde Gyneco-Obstetric and Pediatric Hospital, Cameroon

Objective: To describe the practice of laparoscopic surgery in the treatment of infertility at the Yaoundé Gyneco-Obstetrics and Pediatric Hospital. Materials and Methods: This was an observational study with retrolective data collection. All patients who underwent laparoscopy for infertility with a complete file were recruited. Data were collected on a pre-established form and analyzed with Microsoft Excel 2007 software. Results: Six hundred and thirty-three women, representing 6.9% of gynecologic operations, underwent laparoscopic surgery during the study period. Infertility accounted for 69.8% (442 cases) of the indications. Four hundred and fifteen files were analyzed. The commonest intraoperative findings were: tubo-peritoneal adhesions (71.6%), hydrosalpinx with distal tubal occlusion (41.5%), peri-hepatic adhesions (22.4%), uterine fibroids (20.2%) and tubal phimosis (14.0%). Adhesiolysis, neosalpingostomy and fimbrioplasty were the commonest surgical gestures. At the end of the procedure, the best tube was staged as favorable in 57.6% of our patients. A complication rate of 4.3% was observed. Conclusion: Infertility is the main indication for laparoscopic surgery in our setting. The main operative findings are tubo-peritoneal adhesions and hydrosalpinx. The most practiced tubal surgical gesture is neosalpingostomy. Half of the recruited women have a favorable stage for the best tube. The complication rate is low.

Role of Laparoscopic Surgery in the Management of Female Infertility at the Department of Gynecology of Hôpital du Mali

Infertility is a socio-cultural drama in Africa, especially in Mali and remains difficult for couples to overcome. Laparoscopy, also called minimally invasive surgery or keyhole surgery, is an operative technique that permits to explore the pelvis and perform an appropriate therapeutic procedure. The objective of our work was to assess the role of laparoscopic surgery in the treatment of female infertility at Hopital du Mali. It was a retrospective descriptive study that was conducted over a period of 5 years (January 2013 to December 2018). Any patients followed for infertility and who underwent laparoscopic surgery in the gynecology department over a period of two (2) years were included. The outcome of laparoscopic surgery was evaluated in terms of conception of pregnancy. We had collected 103 infertile patients out of 2984, with a frequency of 3.45%. The mean age of our patients was 30.2 years. Housewives and out-of-school women accounted for 68.93% and 54.37% respectively. Nulligravida represented 41.75%. Regarding infertility, it was primary in 41.75% and secondary in 58.25%, with an average duration of 6.2 years. Systematic chlamydial serology was positive in 62.14% of our patients. Hysterosalpingography (HSG) revealed bilateral tubal obstruction in 53.33% of cases. Laparoscopy found tubal adhesions in 97.80% of cases. Adhesiolysis was the main procedure performed with 84.47% bilateral tubal patency achieved in the methylene blue test. Among our patients who had contracted a pregnancy (22.99%), 85% had carried their pregnancies to term. Tubal damage was the main cause of infertility. Adhesiolysis remains the main laparoscopic procedure for treatment.

Traditional Chinese Medicine Compound Mianbu Mixfang Is Effective in Treating Immunological Infertility: a Female Mice

Objective To study the therapeutic effectivess of Traditional Chinese Medicine compound mixture Mianbu Fang (Immunological infertility therapy) on immunological infertility caused by antisperm antibody (AsAb) in female mice. Materials & Methods Forty-two female Kunming mice were evenly divided into 7 groups by weight. Group A was control group; Group B was model of infertility. Group C, D and E were fed with normal, half and double dosage of Mianbu I respectively. Group F and G were fed with Mianbu II and prednisone Acetates respectively. Animal model of immunological infertility were set up by injecting mice sperm to the other 36 Kunming female mice except Group A. The AsAb levels in serum, cervical mucus were measured, the histological and immunohistochemistry changes in ovary and endometrium were observed, and the pregnancy indexes were compared in different groups. Results Compared with the infertility model group, the AsAb level in serum and cervical mucus in treatment group was lower. Less immune compounds in ovary and endometrium and atretic follicle of ovary was found in treatment group than in model and control group. The immune compounds in ovary and endometrium were less in the treatment group than that in the model and control group. Conclusion By regulating immunological system, Traditional Chinese Medicine compound mixfang Mianbu Fang lowers AsAb in the circulation system and special organs, eliminates immunological compound, repairs tissue impairment and increases pregnancy of female mice.

Interference with the C-terminal structure of MARF1 causes defective oocyte meiotic division and female infertility in mice

Meiosis-arrest female 1（MARF1） is a recently identified key oogenic regulator essential for the maintenance of female fertility and genome integrity in mice. However, the detailed functions and the underlying mechanisms of MARF1 remain elusive. Here, in an attempt to create a mouse model expressing fluorescent protein-tagged MARF1 to facilitate further exploration of the roles of MARF1 in oocytes, we produced a Marf1-eGFP knockin（KI） mouse line in which the C-terminal structure and function of MARF1 were interfered by its fusing eGFP peptide. Using these Marfl-eGFP-KI mice, we revealed, unexpectedly, the functions of MARF1 in the control of oocyte meiotic division.We found that the Marfl-eGFP-KI females ovulated mature oocytes with severe meiotic and developmental defects,and thus were infertile. Moreover, meiotic reinitiation was delayed while meiotic completion was accelerated in the KI-oocytes, which was coincident with the increased incidence of oocyte aneuploidy. Therefore, MARF1 is indispensable for maintaining the fidelity of homolog segregation during oocyte maturation, and this function relies on its C-terminal domains.

An evaluation of methods for the test of tubal patency in female infertility

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A Retrospective Study of the Prevalence of Female Infertility in the Southwest Region, Cameroon

Background: Infertility is a major reproductive health care problem that affects the wellbeing of women. Although views vary between cultures, infertility is seen almost exclusively as a woman’s problem in Africa with secondary infertility being the most prevalent while sexually transmitted infections the most investigated cause of infertility. Objective: The aim of this study was to determine the prevalence of female infertility in the Limbe and Buea Regional hospitals of the Southwest region of Cameroon from 2015-2019. Materials and Methods: A retrospective descriptive design was used which involved studying clinical files of women within the reproductive age group (15 - 49) with infertility problems, at the gynaecological and maternity units of the selected hospitals in the Southwest region of Cameroon over a period of five years (2015-2019). Data were collected from all files included in the study. Results: A total of 4609 females visited the two hospitals for investigation and 1111 files were identified with infertility giving prevalence of 24 %. Three hundred and forty-three (343;31%) presented with primary infertility while seven hundred and sixty-eight (768;69%) had secondary infertility. The average age of affected female was 31.5 making age the predisposing factor of infertility because after the peak of 25 years, infertility started decreasing. Employment with salary and the association between diagnosis and age had a p-value < 0.005 which was considered significant in this study. Conclusion: This study found that the prevalence of infertility in Southwest Cameroon is high with secondary infertility being most predominant among infertile women with a prevalence of 69% caused principally by sexually transmitted infection (STIs). Age and occupation were significantly associated with infertility. Routine laboratory screening of women of reproductive age may reduce the high prevalence of infertility in the study area.

Aetiological Diagnosis of Infertility at Conakry University Hospital: Role of Hysterosalpingography and Pelvic Ultrasound

Objective: The objective of this study was to investigate the etiologies of infertility and to determine the contribution of hysterosalpingography coupled with ultrasound in the exploration of female infertility at Donka University Hospital. Methodology: This was a prospective descriptive cross-sectional study carried out in the Radiology Department of Donka National Hospital over a period of ten (10) months. It involved 78 women who came to the department for hysterosalpingography and/or pelvic ultrasound examinations, as part of the exploration of infertility. Data collection involved the use of pre-established survey forms to gather information on the parameters studied. Sociodemographic parameters, ultrasound and hysterosalpingography results were studied. A correlation was made between age at marriage and infertility to determine whether early marriage has an impact on primary infertility, with a statically significant result for p value greater than 0.05. Results: The mean age of our patients was 33.7 ± 5.6 years, with extremes of 18 and 35 years. The 18-35 age group was the most represented, with a frequency of 80.7%. The 34% of our patients were married before the age of 18, with a marriage duration ranging from 6 months to 15 years. The indication for investigations was dominated by secondary infertility, with a frequency of 65%, followed by primary infertility (35%). All our women underwent ultrasound-hysterosalpingography, i.e. 100%, in search of the cause of infertility. Ultrasound was pathological in 35.8%. The most common ultrasound lesions were myomas and ovarian dystrophies, with 12.8% each. However, hysterosalpingography was pathological in 35%. Tubal obstructions affected almost a third of our women (29.5%), followed by phimosis and tubo-peritoneal adhesions. Conclusion: Diagnostic evaluation of infertility requires a multidisciplinary approach, including collaboration between infertility gynecologists, radiologists and other infertility specialists. Medical imaging remains indispensable in the evaluation of female infertility.

Hysterosalpingographic Findings among Patients Undergoing Infertility Work-Up in Kisangani, Democratic Republic of the Congo

Introduction: Hysterosalpingography is an important tool in the investigation of the causes of female infertility. In developing countries such as the Democratic Republic of Congo, the HSG is the basic tool for performing first-line anatomical (pelvic) assessment. The aim of this study is to determine the prevalence of the different lesions observed in hysterosalpingography carried out during the assessment of infertile women monitored in Kisangani. The study set also out to look for differences in these lesions according to the type of infertility. Methods: This cross-sectional study was conducted in Kisangani from June 2016 to December 2018. The 130 cases of hysterosalpingography performed for female infertility assessment during the study period were included, of which 33.07% for primary infertility and 66.93% for secondary infertility. Results: The mean age of the patients was 33.52 ± 6.01 years;the history of pelvic inflammatory disease was noted with a predominance for secondary infertility (11% vs. 4.65%). Using hysterosalpingography, 7 (5.38%) patients had a normal result;94 (72.31%) had tubal obstruction;25 (19.23%) had hydrosalpinx;11 (8.46%) had uterine fibroids;pelvic adhesions were suspected in 12.64% of cases. There was no obvious association between all these lesions and the type of infertility. Conclusion: We found that tubal obstructions were the most prevalent lesions in this study, regardless of the type of infertility. These lesions would reflect the high prevalence of septic abortions and sexually transmitted infections in developing countries such as the Democratic Republic of the Congo.

116 CASES OF TUBAL OBSTRUCTIVE INFERTILITY TREATED BY ACUPUNCTURE AND POINT-APPLICATION OF DRUGS

Tubal obstructive in fertility is often due to insufficiency of kidney-Qi, dysfunction andvascular obstruction of the uterine collaterals, in view of these pahogenetic characteristics, we havetreated 116 cases of tubal obstructive in fertility based on .differentiation of symptoms and signs byacupuncture at Guanyuan(CV4 ), Shuidao (ST 26), Guilai (ST 29 ), Diji (SP 8 ), Sanyinjiao (SP 6 ),Taixi(KI 3), Taichong(LR 3) which have functions of removing obstruction in collaterals by warmingkidney, regulating functions of the Chongmai and removing obstruction of the Renmai, increasihg levelsof female sex hormones, activating ovarian function, and external application to Guanyuan(CV 4) pointwith fresh Radix Aconiti Praeparata, Herb of Garden Balsam, Radix Salviae Miltiorrhizae, Fructus Evodiae, Fructus Foeniculi, Mirabilitum, Ramulus Cinnamomi, Fructus Liguidambaris, etc., which have thefunction of softening and resolving hard masses, subduing swelling and disintegrating masses, improvingblood circulation of the pelvic cavity, promoting absorption of the obstructed focus. AInong them 83cases were cured (pregnancy) accounting for 71. 6 %. The effective rate reached 90. 5 %. Clinically, itis proved that the combination of acupuncture with drugs has satis factory effects.

Assessment of the Microbiome Collected from the Reproductive Tracts of Women from Saudi Arabia and Its Potential Influence on Infertility

Background and Objective: Female infertility may be attributed to several causes that are fundamentally related to the health status of women. The main objective of this project was to correlate the abundance of the microbiota in cervicovaginal fluid to infertility. Materials & Methods: A total of 36 married women who voluntarily came to the hospital in Riyadh for a routine visit participated in the study. To collect the cervicovaginal liquid, a SoftcupTM menstrual device was used by the participant;the cup was then transported in a liquid nitrogen box to the laboratory for analysis. Results: The mean vaginal pH in normal women and infertile women was 3.96 and 5.06, respectively, and the difference between the two cohorts was significant (p 5.5, is primarily composed of G. vaginalis, P. anaerobius, Mycoplasma hominis, Mobiluncus species and Atopobium vaginae. The protein content and viscosity of the cervicovaginal liquid were significantly lower in infertile women compared to normal women (p < 0.05).

Detection of <i>Chlamydia trachomatis</i>and <i>Neisseria gonorrhoeae</i>in Egyptian Women Suffering from Infertility

Chlamydial and gonococcal infections are recognized as two of the major causes of sexually transmissible human bacterial infection which may lead to infertility. In this cross sectional study, we aimed to determine the prevalence of Neisseria gonorrhoeae, Chlamydia trachomatis among Egyptian women using different microbiological methods. One hundred and fifty cervical swabs were collected, of which 100 were from infertile women. Culture and ELISA technique were used for screening of Neisseria gonorrhoeae and Chlamydia trachomatis individually. In addition, PCR was used for all examined samples. For C. trachomatis, 3 cases were positive for antigen detection by ELISA. Moreover, in obtained results of PCR, DNA was detected in 4 samples, and three of them from infertile group. So based on PCR results, the sensitivity and specificity of ELISA were 75% and 100% respectively. Furthermore, 3 samples were positive for gonococcal infections by PCR, and two of them were taken from infertile women. Positive results of two samples were verified by culture. The estimated sensitivity and specificity of culture method were 66.7% and 100% respectively. Results of this study indicate that PCR is a valuable method for detection of gonococcal and chlamydial infection and it is suitable for the confirmation of ELISA results for C. trachomatis diagnosis. Culture method is less sensitive than PCR for detection of N. gonorrhoeae. The prevalence of such infections is higher among infertile women.

The Endometrium Biopsy and Hystero-Laparoscopy in Evaluation of Women’s Infertility. A Prospective Study in Algeria

Female infertility is considered as a real obstacle to the development of a couple who cannot conceive in a natural way. The aim of this study is to evaluate female infertility using two complementary methods of exploration: hystero-laparoscopy and endometrial biopsy, to compare histopathological data with those of hystero-laparoscopy findings in the same patients, and finally assess the interest to couple both methods to detect a greater number of pathologies. Our prospective study included 64 patients aged 20 - 43 years with primary or secondary infertility for a period of 3 years ranging from 2012 to 2015 at obstetrics and gynecology department in which all patients were admitted to a hysteroscopy followed by laparoscopy. Endometrial biopsy curettage was performed and sent to the Pathological Anatomy Department for a histopathological study. On 64 infertile women explored, no pathologies were findings in 20 patients (31.3%) to the biopsy and 27 patients (42.2%) by hysteroscopy-laparoscopy. Histopathological study was in favor of dysfunctional endometrium (50%) followed by hyperplasia (10.9%). The lesions findings in the hystero-laparoscopy were in the first place uterine (18.8%) followed by equally between tubal and endometrial pathologies (10.9%). Associated diseases affecting the same organs or more were recorded with a percentage of 7.8%. The two methods have been shown effective and the most of common pathologies findings were uterine and endometrial. We concluded that the endometrial biopsy was more decisive in the exploration of endometrium pathologies while hystero-laparoscopy is more sensitive for the exploration of uterine, tubal and ovarian pathologies. Each method taken individually was revealed incomplete. It is more interesting to systematically couple the histology with endoscopic examination in order to detect a greater number of pathologies.

Chinese Medicine as Complementary Therapy for Female Infertility

Chinese medicine (CM) has been used in clinical treatment for thousands of years in China, Japan, Korea, and other countries. CM is at present attracting many attentions around the world for reproductive health care and disease prevention, including treatment of female infertility. This review focuses on the CM treatment for female infertility patients, and supplies a summary on the efficacy, safety, and mechanism of some Chinese herbal medicines, herbal medicine-derived active compounds, and acupuncture. A large number of researches have reported that CM could alleviate or even cure female infertility by regulating hormone, improving reproductive outcome of in vivo fertilization, affecting embryonic implantation, curing polycystic ovarian syndrome, endometriosis, pelvic inflammatory disease, relieving mental stress, and regulating immune system. Meanwhile, a few studies claimed that there was little adverse reaction of CM in randomized controlled trials. However, up to present there is a lack of adequate evidences with molecular mechanistic researches and randomized controlled trials to prove the CM as an effective and safe treatment for infertility. Thus, utility of CM as a complementary medicine will be a feasible method to improve the outcome of female infertility treatment.

Transcriptomic analysis of granulosa cells in patients with endometriosis-related infertility:identification of potential molecular mechanisms

Objective:To investigate the impact of endometriosis(EMS)on granulosa cell function and elucidate the molecular mechanisms involved.Methods:RNA sequencing,differential expression analysis,Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)enrichment analysis,gene set enrichment analysis,protein–protein interaction analysis,and RT-qPCR were employed to assess the effects of EMS on granulosa cell function.Results:The results revealed significant differences in gene expression between the EMS and control groups,including genes related to immune regulatory functions and ferroptosis.Hub gene modules and hub genes were identified,including those related to cell cycle and immune and inflammatory pathways.RT-qPCR revealed significant upregulation of the hub genesCCL3 andIL1B in granulosa cells of patients with EMS.Conclusion:The results of RNA sequencing demonstrated that EMS induces significant transcriptional alterations in granulosa cells of affected patients.These findings provide important insights into the diagnosis and treatment of EMS and highlight the importance of further investigation ofCCL3 andIL1B as potential biomarkers for EMS.

Female Sexual Dysfunction and Timed Intercourse: A Prospective Study of 105 Infertile Women

Introduction: Timed intercourse (TI) based on ovulation monitoring is an effective and common choice for treatment of infertility. However, TI related female sexual dysfunction remains to be elucidated. Method and Material: This was a prospective study and 105 infertile women were included using the Female Sexual Function Index (FSFI) to assess their sexual function in general sexual life (GSL) and TI cycle. Results: The mean age of the patients was 29.4 ± 3.4 years and the duration of infertility was 1.8 ± 0.5 years. The mean score of FSFI was 25.2 in GSL cycle and 24.5 in TI cycle (p = 0.008). Scores of 5 out of 6 domains of FSFI during GSL cycle were significantly higher than the counterparts during TI cycle. Female sexual function was related to stress, which mostly came from patients themselves and parents. The stronger the stress was, the more domains of FSFI were affected. Conclusion: Infertility is an important factor affecting female sexual function, especially TI condition reduced FSFI score in several domains, and this may be related to infertile stress.

Where is the optimal plane to mobilize the anterior rectal wall in female patients undergoing total mesorectal excision?

BACKGROUND Since Heald proposed the total mesorectal excision(TME)procedure,the prognosis of patients with rectal cancer has been significantly improved.But Heald did not specifically describe the anterior surgical plane in female patients.And the surgical plane for mobilizing the anterior rectal wall during TME surgery in female patients remains controversial.AIM To investigate the anatomy of the female pelvis and identify the optimal plane for mobilizing the anterior rectal wall.METHODS We retrospectively collected surgical procedure videos and clinical data of female patients diagnosed with middle or low rectal cancer who underwent the TME procedure between January 2020 and October 2022 across six hospitals.The patients were divided into two groups based on the surgical approach used to mobilize the anterior rectal wall:The experimental group was to open the peritoneum at the lowest point of the peritonea reflection and enter the plane for mobilizing,while the control group was cut at 0.5-1 cm above the peritoneal reflection and enter another plan.Then,we compared the preoperative and postoperative information between the two groups.We also dissected and observed ten adult female pelvises to analyze the anatomic structure and compare the entry plane between the two approaches.Finally,we researched the pathological structure between the rectum and the vagina.RESULTS Finally,77 cases that met the criteria were included in our study.Our observations revealed that the experimental group underwent a smooth procedure,entering the plane amidst the mesorectal fascia and adventitia of the vagina,whereas the control group entered the plane between the vaginal adventitia and muscle layers.Compared to the control group,the experimental group showed a significant decrease in intraoperative bleeding[22.5(19.5-50)mL vs 17(5-20)mL,P=0.01],as well as a shorter duration of hospitalization[9(7-11.25)d vs 7(6-10)d,P=0.03].Through the examination of surgical videos and cadaveric studies,we discovered that Denonvilliers'fascia is absent in females.Additionally,pathological sections further revealed the absence of Denonvilliers'fascia in females,with only loose connective tissue present between the mesorectal fascia and adventitia of the vagina.CONCLUSION The plane amidst the mesorectal fascia and vaginal adventitia is the optimal surgical plane to mobilize the anterior rectal wall for female patients undergoing the TME procedure.

2-Octyl Cyanoacrylate Skin Adhesive for Topical Skin Incision Closure in Female Pelvic Surgery

Background: 2-octyl cyanoacrylate (2OCA) high viscosity tissue adhesive (Medline Industries, Inc., Mundelein, IL) is a liquid topical skin adhesive. 2OCA offers the same design features and clinical utility in terms of flexibility, strength, and low complication rate as the commercially available 2OCA tissue adhesives. Additionally, 2OCA features high viscosity allowing for better control during the application process, polymerization without the use of an external activator, and a distinctive violet color for ease of application visualization. Objective: The aim of this prospective case series is to descriptively report clinical data with the application of 2OCA as a topical incision closure system in female pelvic surgery. The primary outcomes included: incisional pain, incisional dehiscence, and post-operative bleeding. The secondary outcome included drying times of the adhesive with regard to incision length. Methods: A prospective open-label observational case series study was conducted to evaluate the use of 2OCA in surgical wound closure of the topical skin in adult patients undergoing gynecologic surgical procedures. A total of 50 adult women undergoing gynecologic surgery were enrolled. 2OCA was applied only by surgeons who had undergone product training to the incisions in a standardized, protocol-defined fashion. Drying times for the adhesive and photography were recorded intraoperatively. Post treatment follow-up was conducted with queries of pain level, incisional dehiscence, and incisional bleeding immediately post-operatively, 48 hours, 5 - 10 days and 14 days post-treatment. Adverse events were documented. Results: 2OCA was applied to a total of 154 incisions from the 50 patients enrolled to the study. The procedures included: 16 laparoscopic total hysterectomies, 4 diagnostic laparoscopies, 2 laparoscopic myomectomies, 2 laparoscopic bilateral or unilateral salpingo-oophorectomies, 5 total robotic-assisted laparoscopic surgeries (2 total hysterectomies, 1 supracervical hysterectomy, 1 sacrocolpopexy, and one excision of endometriosis), 7 sacral neuromodulation procedures, and 18 midurethral slings. The overall rate of incisional dehiscence was 3% (4/154). The rate of reported incisional bleeding was 3% (4/154). There was 1 incisional infection. The pain reports based on a 10-point scale had a mean of 4.96 immediately post-operatively, which decreased to a mean score < 1 (0.2) by post-op day (POD) 14. The mean drying times for the various lengths of incisions included the following: 1.28 minutes for incisions ≤ 5 mm, 1.53 minutes for 6 - 8 mm, 1.66 minutes for 10 mm - 20 mm, and 1.57 minutes for the 40 - 50 mm incisions. In 23% (36/154) of incisions 2OCA was the sole method of skin closure. Conclusion: This study demonstrates that 2OCA is safe to use in gynecologic surgical incisions with low rates of post-operative incisional bleeding and incisional dehiscence. Post-operative reports of pain maintained expected levels for recovery. 2OCA is a practical alternative or augmentation to traditional suture closure of skin incisions at the time of gynecologic surgery.