Objective To examine the short-term effects of salpingectomy during laparoscopic hysterectomy on ovarian reserve when ovarian preservation is planned in order to determine the feasibility of conducting this study on a large scale. Design Pilot Randomized controlled trial. Setting Tertiary care, academic medical center. Patients Thirty premenopausal women aged 18 to 45 years underwent laparoscopic hysterectomy with ovarian preservation for benign indications from April 2012 to September 2012. Intervention Bilateral salpingectomy (n=15) versus no salpingectomy (n=15) at the time of laparoscopic hysterectomy with ovarian preservation. Main Outcome Measures Antimüllerian hormone (AMH) was measured preoperatively, 4–6 weeks postoperatively, and 3 months postoperatively. Operative time and estimated blood loss were abstracted from the medical record. Results Mean AMH levels were not significantly different at baseline (2.26 vs. 2.25ng/ml), 4–6 weeks postoperatively (1.03 vs. 1.25ng/ml), or 3 months postoperatively (1.86 vs. 1.82ng/ml) among women with salpingectomy versus no salpingectomy, respectively. There was also no significant temporal change in mean AMH level from baseline to 3 months postoperatively (−.07 vs. −.08ng/ml) between groups. No difference in operative time (116 vs. 115min) or estimated blood loss (70 vs. 91ml) was observed. Conclusion Salpingectomy at the time of laparoscopic hysterectomy with ovarian preservation is a safe procedure that does not appear to have any short-term deleterious effects on ovarian reserve, as measured by AMH level. Conducting a trial of this nature that is adequately powered with long-term follow-up would be feasible and is required to definitively confirm these results.

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The human fallopian tube harbors the cell of origin for the majority of high-grade serous ''ovarian'' cancers (HGSCs), but its cellular composition, particularly the epithelial component, is poorly characterized. We perform single-cell transcriptomic profiling of around 53,000 individual cells from 12 primary fallopian specimens to map their major cell types. We identify 10 epithelial subpopulations with diverse transcriptional programs. Based on transcriptional signatures, we reconstruct a trajectory whereby secretory cells differentiate into ciliated cells via a RUNX3 high intermediate. Computational deconvolution of advanced HGSCs identifies the ''early secretory'' population as a likely precursor state for the majority of HGSCs. Its signature comprises both epithelial and mesenchymal features and is enriched in mesenchymal-type HGSCs (p = 6.7 3 10 À27 ), a group known to have particularly poor prognoses. This cellular and molecular compendium of the human fallopian tube in cancer-free women is expected to advance our understanding of the earliest stages of fallopian epithelial neoplasia.

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Objective To model outcomes in laparoscopic hysterectomy with morcellation compared to abdominal hysterectomy for the presumed fibroid uterus, examining short-and long-term complications, as well as mortality. Study Design A decision tree was constructed to compare outcomes for a hypothetical cohort of 100,000 premenopausal women undergoing hysterectomy for presumed fibroids over a 5-year time horizon. Parameter and quality of life utility estimates were determined from published literature for postoperative complications, leiomyosarcoma incidence, death related to leiomyomsarcoma, and procedure-related death. Results The decision analysis predicted fewer overall deaths with laparoscopic hysterectomy compared to abdominal hysterectomy (98 vs. 103 per 100,000). While there were more deaths from leiomyosarcoma following laparoscopic hysterectomy (86 vs. 71 per 100,000), there were more hysterectomy-related deaths with abdominal hysterectomy (32 vs. 12 per 100,000). The laparoscopic group had lower rates of transfusion (2,400 vs. 4,700 per 100,000), wound infection (1,500 vs 6,300 per 100,000), venous thromboembolism (690 vs. 840 per 100,000) and incisional hernia (710 vs. 8,800 per 100,000), but a higher rate of vaginal cuff dehiscence (640 vs. 290 per 100,000). Laparoscopic hysterectomy resulted in more quality-adjusted life years (499,171 vs. 490,711 over five years). Conclusion The risk of leiomyosarcoma morcellation is balanced by procedure-related complications associated with laparotomy, including death. This analysis provides patients and surgeons with estimates of risk and benefit, upon which patient-centered decisions can be made.

Women with DE have increased risk of AppE. Coincidental appendectomy should form part of complete endometriosis excision for these patients.

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As opposed to the satisfying solutions found in the management of acute pain, chronic pelvic pain can be a vexing problem for the patient and physician. Seldom is a single source or cause found, and nearly always the condition is influenced by the broader social and psychological context of the patient. In this article, we discuss the evaluation of chronic pelvic pain, often considering pain as the disease itself, and identify peripheral generators, which gynecologists can address to help reduce their contributions to symptoms.