Sukhbir Sony Singh

• BSc, MD, FRCSC, FACOG
• Chair at University of Ottawa

Background Abnormal uterine bleeding is the direct cause of a significant health care burden for women, their families, and society as a whole. Up to 30% of women will seek medical assistance for this problem during their reproductive years. This guideline replaces previous clinical guidelines on the topic and is aimed to enable health care provide...

Objective: This review provides an overview of therapeutic options, with a specific focus on the emerging role of medical options for UF management. Research design and methods: PubMed, Google Scholar, and Cochrane Systematic Reviews were searched for articles published between 1980 and 2013. Relevant articles were identified using the following...

Objective The objective of this study is to evaluate the sensitivity of routine trans vaginal ultrasound (TVUS) compared to expert-guided transvaginal ultrasound (ETVUS) for the diagnosis of endometriosis. Methods A retrospective chart review performed at a Canadian tertiary center specializing in the diagnosis and management of endometriosis. A...

Residents and educators in obstetrics and gynecology have identified the need to improve endoscopic surgical education. The Canadian Endoscopy Education Project aims to create a national standardized endoscopy curriculum. The objective of the current project was to identify the core competencies for a gynecologic endoscopy (GE) curriculum in reside...

Despite national guidelines recommending that most hysterectomies should be performed vaginally or with laparoscopic assistance, the majority are still performed by laparotomy. Advocating for minimally invasive hysterectomy requires a strategy outlining the benefits and risks of the various approaches. We propose the use of "technicity," an index t...

Uterine fibroids are common benign gynecological tumors that are observed in up to 80% of premenopausal women. It is understood that as the fibroid size increases, the surrounding tissues will be subject to greater loads. However, the effect of fibroid region on the uterine structure is not as clear. To better understand the mechanical loading of t...

To perform a scoping review of the literature in which ultrasound elastography (UE) has been used in benign gynecology and identify avenues for its use in future research and clinical implementations. A structured search of EMBASE, Medline and Cochrane databases was conducted (last search date April 15th, 2022). Eligible studies included adult part...

Transgender and gender-diverse (TGD) reproductive health care is a field with an abundance of misinformation and a paucity of quality literature available for both health care professionals and their patients. Clinicians often receive limited education and training in this area, and TGD individuals face many barriers to reproductive health care, in...

Although many transgender and gender-diverse (TGD) people express a desire to become parents, providing quality counseling that encompasses patients' short-term and long-term fertility options often represents a challenge for health care professionals. Fertility care (from preservation to restoration or assisted reproduction or both) has a low upta...

Objective: To provide a contemporary approach to the understanding of the impact and methods for the diagnosis of endometriosis in Canada. Target Population: Individuals, families, communities, health care providers, and health care administrators who are affected by, care for patients with, or manage delivery of services for endometriosis. Optio...

Background Sexual and physical abuse are associated with endometriosis, but their relationship to pain in endometriosis patients has not been studied. The aim of this study was to characterize the prevalence of sexual and physical abuse history in an endometriosis population and its relationship to severity and type of pain symptoms. Methods This...

Objective: Describe the current practice of Canadian obstetricians-gynecologists in managing placenta accreta spectrum (PAS) disorders from suspicion of diagnosis to delivery planning and explore the impact of the latest national practice guidelines on this topic. Methods: We distributed a cross-sectional bilingual electronic survey to Canadian...

Objective Developments in 3-dimensional (3D) printing technology has made it possible to produce high quality, affordable 3D printed models for use in medicine. As a result, there is a growing assessment of this approach being published in the medical literature. The objective of this study was to outline the clinical applications of individualized...

While laparoscopy has classically been defined as the gold standard for diagnosis of endometriosis, there is now a strong recommendation for the use of advanced imaging in diagnosing the disease. In addition to playing a crucial role in the diagnosis of endometriosis, advanced imaging is also essential for assisting gynaecologic surgeons in plannin...

Objective: Developments in 3-dimensional (3D) printing technology has made it possible to produce high quality, affordable 3D printed models for use in medicine. As a result, there is a growing assessment of this approach being published in the medical literature. The objective of this study was to outline the clinical applications of individualize...

Study Objective To synthesize the literature in which ultrasound elastography (UE) has been used in benign gynecology and identify avenues for future research and clinical implementation. Design A structured search of EMBASE and Medline databases, last conducted on April 15th, 2022. Setting N/A. Patients or Participants Eligible studies included...

Study Objective Developments in 3-dimensional (3D) printing technology has increased production of high quality, affordable 3D printed models, and the investigation of 3D printing in the medical literature. The objective of this study was to outline the clinical applications of individualized 3D printing in gynecology through a scoping review. Des...

Endometriosis surgery requires thoughtful consideration and planning for those with infertility or those who wish to conceive in the future. Clinical history, examination, imaging, and fertility assessment can help plan, prepare and provide goal-directed surgical interventions when required. Further understanding of the benefits and limitations of...

Background: Failure to obtain an office-based endometrial biopsy for abnormal uterine bleeding is not uncommon. Although operating room-based procedures are traditionally considered the gold standard assessment tool in these circumstances, outpatient hysteroscopy is a less invasive, more cost-effective, and safer alternative. However, there is no...

Endometriosis, affecting 5-10% of reproductive-age women, is a common contributor to dysmenorrhea and chronic pelvic pain. Diagnosis requires laparoscopic tissue biopsy, but careful pelvic examination, and/or imaging with either ultrasound or MRI, may identify patients who should receive empiric first-line therapy. The presence of dyschezia, partic...

Study Objective This proof-of-concept study sought to evaluate the efficacy of using quantitative variables derived from 3D motion analysis to differentiate laparoscopic surgical skill level. Design Observational case-control. Setting Simulation-based setting; surgical task completion. Patients or Participants Expert laparoscopic surgeons (n=7)...

Study Objective To describe benefits of hysteroscopy over blind D&C in management of retained products of conception (RPOC), identify the role of hysteroscopy in managing RPOC in special populations, and differentiate various hysteroscopic techniques (resectoscopes, cold loop, mechanical tissue removal systems) for management of RPOC. Design Surgi...

Study Objective To describe a stepwise approach to the excision of bladder endometriosis by laparoscopy. Design Surgical video. Setting Academic tertiary care hospital. Patients or Participants Surgical footage was obtained from three patients who underwent surgery for bladder endometriosis. Interventions Laparoscopic excision of bladder endome...

Study Objective Poor ergonomics can contribute to musculoskeletal disorders and chronic pain for many surgeons which threatens career longevity. This proof-of-concept study sought to quantify upper body postural differences in expert laparoscopic surgeons and naïve surgeons using 3D motion capture during a standardized simulated surgical task. Des...

Objective To describe a stepwise approach to the laparoscopic excision of bladder endometriosis. Design Narrated surgical video. Setting Academic tertiary care hospital. Patient(s) Surgical footage was obtained from three patients who underwent surgery for bladder endometriosis. Institutional review board approval was not required in accordance...

Objective Evaluate the quality of information reported online about endometriosis and period pain. Methods An online search identified the top 20 websites for 4 search engines (Google, Ask, Bing, Yahoo). Videos, duplicates, and websites not containing information related to endometriosis and period pain were excluded. Three independent authors scr...

Background Patient specific three-dimensional (3D) models can be derived from two-dimensional medical images, such as magnetic resonance (MR) images. 3D models have been shown to improve anatomical comprehension by providing more accurate assessments of anatomical volumes and better perspectives of structural orientations relative to adjacent struc...

Objectives To evaluate the effect of using patient-specific 3D-printed anatomical models in pre-surgical planning for patients with uterine fibroids. Methods Gynecologic surgeons completed a questionnaire documenting their surgical plan, perceived surgical difficulty, and confidence in surgical approach before and after receiving a patient-specifi...

This video reviews the role of hysteroscopy in management of retained products of conception. We begin with reviewing standard methods for management of retained products and further discuss indications for hysteroscopic management. We visually present three cases that demonstrate different hysteroscopic techniques including intrauterine tissue ext...

Objectives To assess the current state of gynecology education in Canadian OBGYN residency programs with regards to: (1) transition to CBD, (2) teaching methods and infrastructure, (3) learner evaluation, (4) use of simulation, and (5) interest in a national educational database. Methods All OBGYN program directors in Canada were invited to partic...

Objective In this post hoc analysis, we evaluated the impact of elagolix on dysmenorrhea and nonmenstrual pelvic pain across menstrual period (bleeding days) and nonmenstrual (nonbleeding) days. Methods Data from two randomized, 6-month, placebo-controlled trials (Elaris Endometriosis (EM)-I and EM-II) of elagolix (150 mg once daily (QD) and 200 m...

Objective To characterize fellowship training experiences in the 11 Canadian minimally invasive gynaecologic surgery (MIGS) programs and compare the surgical exposure of fellows in these programs to that of the American Association of Gynecologic Laparoscopists (AAGL) accredited fellowship in MIGS (FMIGS). Methods In this cross-sectional study, 20...

Endometriosis may exert a profound negative influence on the lives of individuals with the disorder, adversely affecting quality of life, participation in daily and social activities, physical and sexual functioning, relationships, educational and work productivity, mental health, and well-being. Over the course of a lifetime, these daily challenge...

(Abstracted from Obstet Gynecol 2020;136:803–810) The vast majority of hysterectomies are performed for benign indications. Visceral injuries are major intraoperative complications of hysterectomy.

Objective To present a five-step approach to the laparoscopic excision of pericardial and diaphragmatic endometriosis. Design Surgical video. Setting Academic tertiary care hospital. Patient(s) 35-year-old nulliparous woman observed for chronic pelvic pain and infertility with a diagnosis of diaphragmatic endometriosis at a prior laparoscopy. Sy...

Study Objective To evaluate the effect of using patient specific 3D printed anatomical models in pre-surgical planning for patients with uterine fibroids. Design Repeated measures questionnaire study. Setting Tertiary academic hospital. Patients or Participants Minimally invasive gynecologic surgeons. Interventions Surgeons completed a question...

Study Objective Abnormal uterine bleeding (AUB) assessment involves uterine cavity evaluation, via ultrasound (US), saline-infusion sonography (SIS), endometrial biopsy, or hysteroscopy. Reducing diagnostic delay may improve patient experience and reduce healthcare costs. A portable handheld in-office hysteroscope introduced for assessment of AUB,...

Study Objective To demonstrate a minimally invasive surgical technique for management of interstitial ectopic pregnancy Design N/A Setting Operating room Patients or Participants Patients with interstitial ectopic pregnancy requiring surgical management Interventions Removal of interstitial ectopic pregnancy Measurements and Main Results N/A...

Study Objective To present a five-step approach to the excision of pericardial and diaphragmatic endometriosis by laparoscopy. Design Surgical video. Setting Academic tertiary care hospital. Patients or Participants 35-year-old nulliparous woman followed for chronic pelvic pain and infertility with a diagnosis of diaphragmatic endometriosis at a...

Study Objective (1) To compare quality of life (QoL) in women presenting for endometriosis care at a Canadian tertiary care centre to the general population and (2) to identify significant factors associated with reduced physical and mental QoL. Design Prospective observational questionnaire study. Setting Tertiary academic hospital. Patients or...

Study Objective To determine the extent of misinformation of endometriosis portrayed online by assessing accuracy and completeness of common websites. Design An online search identified the top 20 websites for 4 search engines. Videos and duplicates were excluded. An 82-item questionnaire with categories for characteristics, diagnosis and treatmen...

Background: Most often in Canada, the evaluation and management of abnormal uterine bleeding occurs under general anesthesia in the operating room. We aimed to assess the potential cost-effectiveness of an outpatient uterine assessment and treatment unit (UATU) compared with the current standard of care when diagnosing and treating abnormal uterin...

Objective: To estimate the incidence and risk factors for bowel injury in women undergoing hysterectomy for benign indications. Methods: A retrospective cohort study was conducted among women undergoing hysterectomy for benign indications from 2012 to 2016 at institutes participating in the American College of Surgeons National Surgical Quality...

Objective To quantify the effect of blood transfusion on the risk of venous thromboembolism (VTE) among women undergoing hysterectomy for non-malignant indications. Methods A retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) was conducted. Women who underwent hysterectomy fo...

Endometriosis involving the bowel requires a thorough evaluation prior to deciding upon surgical treatment. Patient symptoms, treatment goals, extent and location of disease, surgeon experience, and anticipated risks all play a part in the preoperative decision-making process. Short- and long-term complications after bowel surgery for endometriosis...

With the current global coronavirus disease 2019 (COVID-19) pandemic, new challenges arise as social distancing and isolation have become the standard for safety. Evidence supports the protective benefits of social connections and support during pregnancy and labor; there are increased maternal, fetal, and pregnancy risks when pregnant and laboring...

Selective progesterone receptor modulators may have a role in the treatment of endometriosis. The aim of this report is to review the effect of ulipristal acetate (UPA) on endometriosis lesions and symptoms in women treated prior to surgery. A pathology review of eutopic endometrium and endometriotic lesions was conducted by two gynecologic patholo...

Objective: This study sought to evaluate ethnic variations in the clinical presentation of women with uterine fibroids. Methods: A total of 996 premenopausal women with symptomatic uterine fibroids were enrolled in a prospective, non-interventional, observational registry at 19 clinical sites across Canada (CAPTURE Registry). Patient-reported ou...

Sir, We have read the commentary by Horne et al.,1 published in this journal, with great interest. The management of pelvic pain and endometriosis presents one of the greatest challenges for gynaecologists worldwide. The commentary challenges our community to postulate whether surgery for superficial peritoneal endometriosis (SPE) is effective, an...

Study Objective To assess the cost-effectiveness of a single-visit uterine assessment and treatment unit (UATU) compared with the current standard of care to diagnose and treat women with abnormal uterine bleeding (AUB). Design A cost-effectiveness analysis using a decision tree model from the perspective of the publicly funded health care system...

Video Objective The objectives of this video are to define bowel endometriosis and to explore various surgical parameters for the different types of surgical excision. Then, a specific surgical approach will be demonstrated. Setting Our case is of a 34 year old nulliparous woman who presented for surgical management of deep endometriosis, as she w...

Study Objective This preliminary investigation aimed to evaluate the feasibility of using ultrasound elastography (UE) to evaluate the myometrial and uterine leiomyoma stiffness. Our objectives were to (1) assess the reliability of UE stiffness measures of non-neoplastic myometrium, and (2) compare UE stiffness measures of non-neoplastic myometrium...

Study Objective To evaluate the impact of 3-dimensional (3D) digital and printed models on minimally invasive gynecologic surgeons’ operative plan, outcomes, and experience. Design Prospective, cross-sectional, repeated measures design. Setting Pre-, intra-, and post-operative minimally invasive gynecologic surgery. Patients or Participants Mini...

Video Objective Demonstrate a simple, temporary and reversible method for uterine artery occlusion at the time of laparoscopic myomectomy Setting Tertiary level Academic center. Interventions Temporary uterine artery occlusion has been shown to reduce blood loss at myomectomy. The technique demonstrated shows a simple approach for using laparosco...

Objective: Among women treated surgically for endometriosis-associated pain, comprehensive data are lacking on the proportions of patients who experience little or no symptom relief, develop recurrent symptoms, or require further surgical treatment for endometriosis. The aim of this study was to assess the efficacy of surgical procedures used to t...

Objective: This study sought to evaluate prevalence of regret with the decision to undergo a hysterectomy at a young age. Methods: A retrospective cohort study was performed at two centres and included patients who underwent an elective hysterectomy for benign indications under age 35, between January 1, 2008 and December 31, 2015. Eligible pati...

Uterine leiomyomas (myomas, fibroids) are very common in premenopausal women and frequently are associated with abnormal uterine bleeding, bulk effects, and reproductive issues. In women who wish to retain their uterus and/or to enhance or retain fertility, interventional therapies have been introduced, including radiofrequency, laser (chromo), cry...

Objectives: The aim of this guideline is to provide clinicians with an update to the 2015 Clinical Practice Guideline on the Management of Uterine Fibroids. As new information and evidence has become available since 2015, the Gynaecology Clinical Practice Committee of the Society for Obstetricians and Gynaecologists of Canada has determined that a...

Endometriosis associated pain (EAP) has a significant impact on the quality of life of those affected and their families. Recognizing that endometriosis is a chronic condition associated with an impairment in function and negative social impact, there is a shift towards reducing diagnostic delays and initiating timely management. This article provi...

Objective: This study sought to assess surgical outcomes of hysterectomy performed for transgender individuals compared with hysterectomy for individuals with menstrual disorders. Methods: This retrospective cohort study was conducted using the American College of Surgeons National Surgical Quality Improvement Program database. Data of transgend...

RÉSUMÉ Objectif Fournir aux chirurgiens-gynécologues une analyse contemporaine des problèmes pré-, per- et postopératoires chez les patientes obèses afin de guider l'optimisation des interventions et les stratégies à adopter pour améliorer la sécurité des soins chirurgicaux. Utilisateurs cibles Médecins, y compris gynécologues, médecins de famill...

Objective To provide gynaecologic surgeons with a contemporary review of pre-, intra-, and postoperative issues associated with obesity and to provide guidance for optimization and strategies for safer surgical care. Intended Users Physicians, including gynaecologists, family physicians, general surgeons; nurses, including registered nurses and nu...

Résumé Contexte Les troubles du spectre du placenta accreta (TSPA) constituent une complication de la grossesse potentiellement mortelle et exigent une coordination des soins interdisciplinaires afin d'améliorer la possibilité d'une issue favorable. La hausse de la fréquence des cas est due à l'augmentation du nombre d'interventions chirurgicales...

Background: Placenta accreta spectrum (PAS) disorders are a potentially life-threatening complication of pregnancy that demand coordinated interdisciplinary care to achieve safer outcomes. The rising incidence of this disease is due to a growing number of uterine surgical procedures, including the rising incidence of pregnancy following Caesarean...

Objectif: Améliorer la compréhension de l'endométriose et fournir une directive clinique factuelle pour ce qui est du diagnostic et de la prise en charge de l'endométriose. Issues: Parmi les issues évaluées, on trouve les effets de la prise en charge médicale et chirurgicale de l'endométriose sur la morbidité et l'infertilité que connaissent les...

Objectives To evaluate the prevalence of regret with the decision to undergo a hysterectomy at a young age (<35years of age) for the management of benign gynecologic conditions. Methods All hysterectomies performed at two tertiary level academic centers for benign indications between Jan. 1, 2008 and Dec.31, 2015 were included. A retrospective cha...

Objectives The non-invasive diagnosis of endometriosis by routine ultrasound is a challenge in the management of patients with this disease.This study sought to determine which clinical factors and markers on endometriosis specific US could differentiate the surgical presentations of deep endometriosis-(DeepEndo), superficial endometriosis-(SupEndo...

Background: Understanding the impact of race/ethnicity on the prevalence and presentation of endometriosis may help improve patient care. Objective: To review systematically the evidence for the influence of race/ethnicity on the prevalence of endometriosis. Search strategy: CENTRAL, MEDLINE, PubMed, Embase, LILACS, SCIELO, and CINAHL database...

Endometriosis can have a profound impact on women's lives, including associated pain, infertility, decreased quality of life, and interference with daily life, relationships, and livelihood. The first step in alleviating these adverse sequelae is to diagnose the underlying condition. For many women, the journey to endometriosis diagnosis is long an...

Objective: Pudendal neuralgia is a recognized cause of chronic pelvic pain. The diagnosis is complex, and there is no consensus on ideal management. Many current methods do not provide adequate relief. Pulsed radiofrequency is a minimally invasive option that has been reported for its use in other neuropathies. This study aimed to evaluate the fea...

Objective To assess the safety and efficacy of ilioinguinal/iliohypogastric nerve blocks for patients with lower abdominal wall pain in a gynaecology setting. Methods A retrospective chart review of 131 patients who received ilioinguinal/iliohypogastric nerve blocks at a tertiary referral centre for pelvic pain between 1 January 2012 and 13 July 2...

Endometriosis is a common gynecologic condition, affecting approximately 10% of reproductive-aged women. It commonly presents with pelvic pain, painful periods, and infertility and can significantly have an impact on one's quality of life. Early exploration into the pathophysiology of this condition identified race as a risk factor for endometriosi...

Objectif: La présente directive clinique conseille les gynécologues quant au recours au morcellement tissulaire pendant une chirurgie gynécologique. RéSULTATS: Le morcellement effectué au cours d'une chirurgie gynécologique peut permettre l'ablation de masses utérines volumineuses, offrant ainsi aux femmes une solution chirurgicale à effraction mi...

(Abstracted from J Minim Invasive Gynecol 2018;25:1088–1093) Definitive relief from several disease states that burden women can be provided by hysterectomy. This procedure can be performed via vaginal, laparoscopic, robotic, transabdominal, or combined approaches.

Objective: This guideline provides guidance to gynaecologists regarding the use of tissue morcellation in gynaecologic surgery. Outcomes: Morcellation may be used in gynaecologic surgery to allow removal of large uterine specimens, thus providing women with a minimally invasive surgical option. Adverse oncologic outcomes of tissue morcellation s...

Traditionally, hysteroscopy has been performed in the main operating room with the patient under general anaesthesia. Hysteroscopy performed in an office setting avoids the risks of general anaesthesia. The aim of this review was to evaluate the effectiveness of outpatient hysteroscopy compared with hysteroscopy performed in the operating room to d...

Objectives To assess the safety and efficacy of four vilaprisan doses (0.5–4.0 mg) in women with uterine fibroids. Design Randomized, double-blind, placebo-controlled, multicenter trial. Setting Ninety-eight centers in 12 countries. Patient(s) Women aged 18–50 years with uterine fibroids and heavy menstrual bleeding were randomized equally to or...

Background: Uterine fibroids are the most common benign tumor in women. Among those with fibroids, approximately 30% become symptomatic, with abnormal uterine bleeding, pelvic pain, and bulk symptoms. Despite the high prevalence of fibroids, little information is available regarding symptoms, treatment choices, and outcomes for patients. Objectiv...