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Advances in Minimally Invasive Gynecologic Surgery: Optimizing Outcomes and Perioperative Strategies

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Obstetrics & Gynecology".

Deadline for manuscript submissions: 20 September 2026 | Viewed by 3802

Special Issue Editor

Dr. Raanan Meyer

E-Mail Website
Guest Editor
Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA, USA
Interests: minimally invasive gynecologic surgery; myomectomy; hysterectomy; endometriosis excision; hysteroscopy; laparoscopic surgery

Special Issue Information

Dear Colleagues,

Minimally Invasive Gynecologic Surgery (MIGS) has become the standard of care for many gynecologic conditions, including fibroids, endometriosis, benign adnexal masses, and early-stage endometrial cancer. Studies increasingly demonstrate that MIGS is associated with shorter hospital stays, lower complication rates, and quicker recovery, particularly among well-selected patient populations.

This Special Issue aims to highlight the evolving landscape of MIGS, with a focus on improving patient outcomes, refining surgical techniques, and identifying predictors of perioperative risk. From preoperative assessments to perioperative strategies. this issue seeks to provide a comprehensive overview of both the clinical efficacy and systemic integration of MIGS.

We welcome submissions of original research articles, reviews, and clinical insights from researchers, clinicians, and industry experts. Topics of interest include, but are not limited to:

  • Risk prediction and patient stratification
  • Surgical innovations and robotic approaches
  • Preoperative and postoperative management strategies

We look forward to your contributions to this Special Issue, which aims to inform, inspire, and advance the future of minimally invasive gynecologic surgery.

Dr. Raanan Meyer
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • minimally invasive gynecologic surgery
  • MIGS
  • laparoscopy
  • robotic surgery
  • endometrial cancer
  • endometriosis

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (3 papers)

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Research

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11 pages, 215 KB  
Article
Routine Ketorolac Use for Postoperative Pain Does Not Increase Bleeding Risk After Hysterectomy
by Grace M. Pipes, Rebecca J. Schneyer, Kacey M. Hamilton, Ogechukwu Ezike, Katharine Ciesielski, Kelly N. Wright, Raanan Meyer and Matthew T. Siedhoff
J. Clin. Med. 2026, 15(2), 869; https://doi.org/10.3390/jcm15020869 - 21 Jan 2026
Viewed by 816
Abstract
Background/Objective: Ketorolac is an effective alternative and addition to opioids for postoperative pain control; however, there is concern of perioperative bleeding risk with its use. Within gynecology, this risk has not yet been explored in the context of hysterectomy. This study aimed to [...] Read more.
Background/Objective: Ketorolac is an effective alternative and addition to opioids for postoperative pain control; however, there is concern of perioperative bleeding risk with its use. Within gynecology, this risk has not yet been explored in the context of hysterectomy. This study aimed to evaluate the risk of postoperative bleeding complications with ketorolac administration in the context of hysterectomy. Methods: This was a retrospective cohort study that included all patients who underwent hysterectomy for benign indications between 2015 and 2024 at a quaternary care academic hospital. Inclusion criteria were any type of hysterectomy during the study period, while exclusion criteria were malignancy and peripartum status. Complication data for up to thirty days post operation were collected. Multivariable regression analysis, including age, American Society of Anesthesiology category, use of celecoxib before surgery, anticoagulant treatment, uterus size, surgical approach, increased surgical complexity, and lysis of adhesions, was performed to identify the adjusted odds of postoperative bleeding complications. The primary outcome was a composite of any postoperative bleeding complications by use of postoperative ketorolac, including postoperative transfusion, readmission, or reoperation for bleeding. Results: In total, 4236 patients underwent hysterectomy for benign indications during our study period, of which 76% (n = 3236) received ketorolac postoperatively. The composite postoperative bleeding rate was lower in the ketorolac group (2.1% vs. 4.1%, p = 0.001). There was no association between ketorolac use and risk of postoperative bleeding in multivariable regression analysis (aOR 1.02, 95% CI 0.36–2.88). There was no difference in overall intraoperative or perioperative complications (p = 0.070 for both). Major perioperative complications were less likely in the ketorolac group (p = 0.046). Additionally, there were no differences in postoperative complications except for ileus, which was less likely in the ketorolac group (p = 0.034). Conclusions: Ketorolac administration was not associated with a higher risk of bleeding complications after hysterectomy, including when celecoxib was used preoperatively as part of an enhanced recovery protocol. It may safely be administered as an opioid-sparing pain medication in this setting. Full article
(This article belongs to the Special Issue Advances in Minimally Invasive Gynecologic Surgery: Optimizing Outcomes and Perioperative Strategies)
9 pages, 204 KB  
Article
Predictors for Using Electricity During Hysteroscopic Removal of Retained Products of Conception
by Liat Mor, Tzvi Leibowitz, Emilie Ben-Ezry, Ram Kerner, Ran Keidar, Eran Weiner, Ron Sagiv and Ohad Gluck
J. Clin. Med. 2025, 14(21), 7587; https://doi.org/10.3390/jcm14217587 - 26 Oct 2025
Viewed by 736
Abstract
Background: Retained products of conception (RPOC) can be managed via hysteroscopic removal using mechanical or electrosurgical techniques. Electrosurgery introduces greater technical complexity and may reflect more adherent or vascular tissue, yet preoperative predictors for its necessity remain poorly defined. Objective: The objective of [...] Read more.
Background: Retained products of conception (RPOC) can be managed via hysteroscopic removal using mechanical or electrosurgical techniques. Electrosurgery introduces greater technical complexity and may reflect more adherent or vascular tissue, yet preoperative predictors for its necessity remain poorly defined. Objective: The objective of this study was to evaluate clinical outcomes and identify preoperative predictors associated with the use of electrosurgery during hysteroscopic removal of RPOC. Methods: In this retrospective cohort study conducted at a single tertiary center, we reviewed 551 cases of hysteroscopic RPOC removal performed between January 2008 and December 2022. Patients were categorized based on intraoperative use of electrosurgical instruments. Clinical, sonographic, and operative data were compared between groups. Multivariate logistic regression was used to identify independent predictors of electrosurgical use. Results: Electrosurgical intervention was required in 84 patients (15.2%). Compared with those treated without electricity, these patients were older (33.2 ± 6.4 vs. 31.2 ± 5.8 years, p = 0.004), more likely to be smokers (15.4% vs. 8.1%, p = 0.033), and had higher rates of prior hysteroscopy (5.9% vs. 1.0%, p = 0.002). Electrosurgical use was more common following vaginal delivery than abortion (57.1% vs. 24.8%, p < 0.001), particularly when manual placental removal was performed (23.8% vs. 5.7%, p < 0.001). Larger RPOC size and positive Doppler flow were also associated with the use of electrosurgery. On multivariate analysis, maternal age, postpartum RPOC, manual placental removal, and Doppler vascularity remained independent predictors. No significant differences were observed in short-term postoperative complications. Conclusions: Older age, postpartum RPOC, manualysis, and vascularity on ultrasound are preoperative predictors for the need of electrosurgical intervention during hysteroscopic removal of RPOC. Identifying these factors may improve surgical planning and patient counseling. Future prospective studies incorporating advanced hysteroscopic technologies are warranted. Full article
(This article belongs to the Special Issue Advances in Minimally Invasive Gynecologic Surgery: Optimizing Outcomes and Perioperative Strategies)

Review

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16 pages, 1575 KB  
Review
Minimizing Hemorrhage Risk Strategies in Cervical Pregnancy—Stepwise Pharmacologic Priming and Delayed Surgical Evacuation: A Narrative Review
by Victor Bogdan Buciu, Gabriel Florin Răzvan Mogoș, Nicolae Albulescu, Sebastian Ciurescu, Dorin Novacescu, Mihai Ionac, Abhinav Sharma, Nilima Rajpal Kundnani and Denis Serban
J. Clin. Med. 2025, 14(21), 7489; https://doi.org/10.3390/jcm14217489 - 22 Oct 2025
Viewed by 1551
Abstract
Background: CP (CP) and HCP (HCP) are rare and high-risk conditions, often historically managed with radical intervention and associated with hemorrhage and fertility loss. Objective: To summarize current evidence on the conservative, fertility-preserving management of cervical and heterotopic cervical pregnancies and [...] Read more.
Background: CP (CP) and HCP (HCP) are rare and high-risk conditions, often historically managed with radical intervention and associated with hemorrhage and fertility loss. Objective: To summarize current evidence on the conservative, fertility-preserving management of cervical and heterotopic cervical pregnancies and to illustrate a stepwise pharmacologic protocol applied in our tertiary center. Methods: A narrative literature review (PubMed, Scopus, Web of Science; inception—July 2025) was conducted using the following key terms: “CP,” “HCP,” “methotrexate,” “mifepristone,” “misoprostol,” “uterine artery embolization,” “hysteroscopy,” and “Doppler ultrasound.” We integrated a personal institutional case that applied stepwise pharmacologic priming, Doppler-guided surveillance, and delayed evacuation. Results: Evidence—primarily from case reports and small series—supports conservative, multi-modal strategies combining systemic or local methotrexate ± mifepristone, timed to Doppler-confirmed vascular regression, before surgical intervention. Adjuncts such as misoprostol, hysteroscopic resection, balloon tamponade, and uterine artery embolization further reduce hemorrhage risk while maintaining fertility. Our case utilized a novel, incremental dosing strategy of mifepristone followed by methotrexate, a week-long interval to confirm vascular involution via Doppler, and delayed suction curettage with minimal blood loss. Conclusions: Conservative, imaging-guided management is promising for reducing hemorrhagic complications and preserving fertility in CP/HCP. Future multicenter registries and standardized Doppler-based protocols are urgently needed to refine decision-making and optimize outcomes. Full article
(This article belongs to the Special Issue Advances in Minimally Invasive Gynecologic Surgery: Optimizing Outcomes and Perioperative Strategies)
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