Strengths and Limitations
Our study has several limitations. Firstly, the small sample size, limited us from performing subgroup analysis to various conditions that are known to affect microbial composition such as menopausal state, age, and former use of antibiotics. The latter is also a limitation in terms of the comparison of microbiota between cases and controls. While such studies are difficult to perform on a prospective cohort, larger studies are definitely needed.  Another limitation may be our decontamination protocols, which could be filtering out outputs that might have been of importance, and the choice to set a high rarefaction cutoff in the setting of a low biomass microbial environment causing many samples to fail the positivity criterion. While our preference was to optimize our analyzed data, it came with the cost of losing a substantial number of eligible samples. The study was performed at a single center, by the same surgical team, which is an advantage when considering the consistency (internal validity) of the sampling technique in all patients but its external validity and generalizability may be limited.