M. Rossi, S. Solfrini, F. Tarsitano, F. Rosati, C. Facchini, P. Antonazzo
: The aim of this paper is to review latest evidences concerning the risk of minimal access or minimally invasive surgery, with detail on incidence and impact of occult leiomyosarcoma (LMS) morcellation at treatment time for presumed benign conditions. Mini-invasive surgery includes techniques in which abdominal wall integrity is preserved (laparoscopy, robotic) and its advantages compared to laparotomy are well known (lower hospital stay, wound infection incidence, recovery time). Morcellation refers to the division of tissue into smaller pieces or fragments and is often used to facilitate the removal of specimens through small incisions. LMS is a rare tumour with aggressive behaviour, but morcellation seems to decrease patients’ prognosis further. Iatrogenic damages to other organs from power morcellation are also reported. In 2014 a Food and Drug Association (FDA)-warning banned the use of morcellation in peri- and post-menopause and “candidates for en bloc tissue removal”. After this ban, gynaecologists partially revised their surgical procedures. The real occult LMS incidence varies deeply in literature, with 0.08–1.2% range, mixing premalignant and malignant diseases, different histotypes and surgical techniques. Preoperative differential diagnosis between leiomyoma and LMS is challenging despite progresses in gynaecological imaging. Nevertheless, more efforts should be done to define an “high risk patient” based on anamnesis, symptoms, clinical and radiological information [both with magnetic resonance imaging (MRI) or an accurate ultrasound investigation by an expert sonographer], in order to avoid abdominal cells spread at the time of surgery. In bag morcellation could be a feasible and safe alternative to open surgery in selected cases. Every institution should review its surgical protocols in the diagnosis and treatment of myometrial masses, valuating pros and cons of laparoscopic/robotic approach for presumed fibroids. Risks and benefits should be widely discussed with the patient.
{"title":"Risk of minimal access surgery in uterine leiomyosarcomas: a narrative review","authors":"M. Rossi, S. Solfrini, F. Tarsitano, F. Rosati, C. Facchini, P. Antonazzo","doi":"10.21037/gpm-21-11","DOIUrl":"https://doi.org/10.21037/gpm-21-11","url":null,"abstract":": The aim of this paper is to review latest evidences concerning the risk of minimal access or minimally invasive surgery, with detail on incidence and impact of occult leiomyosarcoma (LMS) morcellation at treatment time for presumed benign conditions. Mini-invasive surgery includes techniques in which abdominal wall integrity is preserved (laparoscopy, robotic) and its advantages compared to laparotomy are well known (lower hospital stay, wound infection incidence, recovery time). Morcellation refers to the division of tissue into smaller pieces or fragments and is often used to facilitate the removal of specimens through small incisions. LMS is a rare tumour with aggressive behaviour, but morcellation seems to decrease patients’ prognosis further. Iatrogenic damages to other organs from power morcellation are also reported. In 2014 a Food and Drug Association (FDA)-warning banned the use of morcellation in peri- and post-menopause and “candidates for en bloc tissue removal”. After this ban, gynaecologists partially revised their surgical procedures. The real occult LMS incidence varies deeply in literature, with 0.08–1.2% range, mixing premalignant and malignant diseases, different histotypes and surgical techniques. Preoperative differential diagnosis between leiomyoma and LMS is challenging despite progresses in gynaecological imaging. Nevertheless, more efforts should be done to define an “high risk patient” based on anamnesis, symptoms, clinical and radiological information [both with magnetic resonance imaging (MRI) or an accurate ultrasound investigation by an expert sonographer], in order to avoid abdominal cells spread at the time of surgery. In bag morcellation could be a feasible and safe alternative to open surgery in selected cases. Every institution should review its surgical protocols in the diagnosis and treatment of myometrial masses, valuating pros and cons of laparoscopic/robotic approach for presumed fibroids. Risks and benefits should be widely discussed with the patient.","PeriodicalId":92781,"journal":{"name":"Gynecology and pelvic medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41528523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The invention of the sling interventions in urology made a big step forward in the cure of stress urinary incontinence. Nevertheless, with high success outcomes came high rates of complications, that requested evolvement of urologists’ surgical skills. Therefore, a decrease of interaction with a tissue can provide a less damaging effect and sustainable effect of the mid-urethral sling surgery. This study evaluates the effectiveness of the most commonly used mini-sling Ophira in our practice. Methods: The study included patients who underwent this surgical intervention in the period from February 2010 to July 2012. A total of 68 patients took part in the study. The mean age of the patients was 58,7 years (range, 31–85 years). All patients were invited for follow-up visits: 1 month, 1 year after surgery. Results: After 1 month after surgery, a negative cough test was recorded in 58 patients (85.3%). Fifty-nine patients (86.8%) had no residual volume. 3 patients (4.4%) reported pelvic pain after surgery. In 5 patients (7.4%), signs of overactive bladder appeared. 49 patients (72.1%) were pleased with the result of the surgery, 13 patients (19.1%) were satisfied with the results of the surgery, 6 patients (8.8%) were dissatisfied with the results of treatment. After 12 months after the surgery, a negative cough test was observed in 55 patients (87.3%). We did not observe any recurrence of urinary incontinence. Two patients (3.2%) had a residual volume of fewer than 100 mL. Two patients (3.2%) had overactive bladder syndrome. 1 patient (1.6%) still had pelvic pain. 50 patients (79.4%) were pleased with the result of the surgery, 9 patients were satisfied with the treatment results (14.3%), 4 patients (6.3%) were dissatisfied with the treatment results. Conclusions: This tape can be implanted in patients with recurrent urinary incontinence after previous surgeries, where obturator or retropubic route was used. With the right choice of patients for this operation, adequate preoperative assessment, and planning, as well as direct performance of the intervention according to its steps, mini-sling Ophira provides high success efficiency and a low rate of complications in the surgical treatment of stress urinary incontinence.
{"title":"Mini-sling Ophira in treatment of stress urinary incontinence: experience of the Urology Clinic of A.I. Yevdokimov Moscow State University of Medicine and Dentistry","authors":"M. Gvozdev, M. Dzhuraeva, O. Arefyeva, D. Pushkar","doi":"10.21037/gpm-21-22","DOIUrl":"https://doi.org/10.21037/gpm-21-22","url":null,"abstract":"Background: The invention of the sling interventions in urology made a big step forward in the cure of stress urinary incontinence. Nevertheless, with high success outcomes came high rates of complications, that requested evolvement of urologists’ surgical skills. Therefore, a decrease of interaction with a tissue can provide a less damaging effect and sustainable effect of the mid-urethral sling surgery. This study evaluates the effectiveness of the most commonly used mini-sling Ophira in our practice. Methods: The study included patients who underwent this surgical intervention in the period from February 2010 to July 2012. A total of 68 patients took part in the study. The mean age of the patients was 58,7 years (range, 31–85 years). All patients were invited for follow-up visits: 1 month, 1 year after surgery. Results: After 1 month after surgery, a negative cough test was recorded in 58 patients (85.3%). Fifty-nine patients (86.8%) had no residual volume. 3 patients (4.4%) reported pelvic pain after surgery. In 5 patients (7.4%), signs of overactive bladder appeared. 49 patients (72.1%) were pleased with the result of the surgery, 13 patients (19.1%) were satisfied with the results of the surgery, 6 patients (8.8%) were dissatisfied with the results of treatment. After 12 months after the surgery, a negative cough test was observed in 55 patients (87.3%). We did not observe any recurrence of urinary incontinence. Two patients (3.2%) had a residual volume of fewer than 100 mL. Two patients (3.2%) had overactive bladder syndrome. 1 patient (1.6%) still had pelvic pain. 50 patients (79.4%) were pleased with the result of the surgery, 9 patients were satisfied with the treatment results (14.3%), 4 patients (6.3%) were dissatisfied with the treatment results. Conclusions: This tape can be implanted in patients with recurrent urinary incontinence after previous surgeries, where obturator or retropubic route was used. With the right choice of patients for this operation, adequate preoperative assessment, and planning, as well as direct performance of the intervention according to its steps, mini-sling Ophira provides high success efficiency and a low rate of complications in the surgical treatment of stress urinary incontinence.","PeriodicalId":92781,"journal":{"name":"Gynecology and pelvic medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44320855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
: It is estimated that the incidence of pelvic floor dysfunction disease in women over 50 years old is 50%. The aim of treatment for pelvic floor dysfunction is to alleviate symptoms and reconstruct the normal pelvic anatomy in order to improve the quality of life. The surgical methods are various and can be divided into traditional surgery and reconstruction surgery. Reconstruction surgery includes sacral fixation, sacrospinal ligament fixation, high uterosacral ligament suspension, and pelvic floor reconstruction with synthetic mesh. In addition to these, sacrocolpopexy has been widely used in clinical treatment for apical compartment prolapse as one of the classic methods. At present, it is usually completed using an abdominal or laparoscopic method with mesh, but the mesh is a foreign body, which may lead to many complications arising from mesh exposure and erosion. We have been performing transvaginal vaginal sacral fixation with 2 absorbable sliding lines instead of the patch to suspend the vaginal stump on the anterior longitudinal ligament in front of the sacrum. However, due to the need to establish a special surgical position, the use of special lengthening instruments, and the high requirements of teamwork, a limited number of these operations have been completed over the past few years. Recently, different surgical approaches have emerged, especially single-port laparoscopy. With the popularity of the minimally invasive concept and the continuous development of single-port laparoscopic technology, minimal invasiveness, good aesthetic appearance, rapid recovery, and maintaining treatment effectiveness, are the new requirements for our operations. Therefore, we aimed to complete the operation with the aid of transvaginal single-port laparoscopy. The combination of vaginal surgery and laparoscopic surgery avoids the drawbacks in vaginal surgery of a small visual field and exposure difficulties and allows for laparoscopy to be performed under direct vision, which improves the safety of the operation. Furthermore, no scar is left on the body surface, operation-related pain is reduced, the appearance of the body is improved, and rapid recovery is promoted. Here, we describe transvaginal single-port laparoscopic-assisted vaginal sacral fixation.
{"title":"Transvaginal single-port laparoscopic-assisted vaginal sacral fixation","authors":"Lu Qu, Chunyan Liu, Nan-nan Mu, Yangyang Li","doi":"10.21037/GPM-20-69","DOIUrl":"https://doi.org/10.21037/GPM-20-69","url":null,"abstract":": It is estimated that the incidence of pelvic floor dysfunction disease in women over 50 years old is 50%. The aim of treatment for pelvic floor dysfunction is to alleviate symptoms and reconstruct the normal pelvic anatomy in order to improve the quality of life. The surgical methods are various and can be divided into traditional surgery and reconstruction surgery. Reconstruction surgery includes sacral fixation, sacrospinal ligament fixation, high uterosacral ligament suspension, and pelvic floor reconstruction with synthetic mesh. In addition to these, sacrocolpopexy has been widely used in clinical treatment for apical compartment prolapse as one of the classic methods. At present, it is usually completed using an abdominal or laparoscopic method with mesh, but the mesh is a foreign body, which may lead to many complications arising from mesh exposure and erosion. We have been performing transvaginal vaginal sacral fixation with 2 absorbable sliding lines instead of the patch to suspend the vaginal stump on the anterior longitudinal ligament in front of the sacrum. However, due to the need to establish a special surgical position, the use of special lengthening instruments, and the high requirements of teamwork, a limited number of these operations have been completed over the past few years. Recently, different surgical approaches have emerged, especially single-port laparoscopy. With the popularity of the minimally invasive concept and the continuous development of single-port laparoscopic technology, minimal invasiveness, good aesthetic appearance, rapid recovery, and maintaining treatment effectiveness, are the new requirements for our operations. Therefore, we aimed to complete the operation with the aid of transvaginal single-port laparoscopy. The combination of vaginal surgery and laparoscopic surgery avoids the drawbacks in vaginal surgery of a small visual field and exposure difficulties and allows for laparoscopy to be performed under direct vision, which improves the safety of the operation. Furthermore, no scar is left on the body surface, operation-related pain is reduced, the appearance of the body is improved, and rapid recovery is promoted. Here, we describe transvaginal single-port laparoscopic-assisted vaginal sacral fixation.","PeriodicalId":92781,"journal":{"name":"Gynecology and pelvic medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47763307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Uterine necrosis following uterine artery embolization: case report and literature review","authors":"Ling Han, Gang Shi, J. Ruan","doi":"10.21037/gpm-21-46","DOIUrl":"https://doi.org/10.21037/gpm-21-46","url":null,"abstract":"","PeriodicalId":92781,"journal":{"name":"Gynecology and pelvic medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46252751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Metastatic cervical cancer of gastric cancer is rare, especially in young patients with cervical lesions as the primary manifestation and diagnosed at the same time with gastric cancer. We reported a 22-year-old woman diagnosed as gastric cancer with no gastrointestinal symptoms. But her primary complaint was menstrual dysregulation and genital bleeding after intercourse. In the beginning, due to no abnormalities were found upon cervical liquid-based cytology or human papilloma virus (HPV) typing, the patient was diagnosed with functional uterine bleeding and was given Diane-35 oral treatment. After treatment, the patient’s symptoms did not improve, and when she went to the doctor again, colposcopy was performed, and cervical biopsy indicated a poorly differentiated mucinous adenocarcinoma, with signet ring cell carcinoma differentiation in some areas. The results of immunohistochemistry analysis suggested metastatic cancer from a digestive system tumor. Then the pathological results of a gastric mucosa multipoint biopsy showed poorly-differentiated mucinous adenocarcinoma and signet ring cell carcinoma were found. After diagnosis, the patient began chemotherapy. During the sixth cycle of chemotherapy, the patient developed Intracystic hemorrhage from metastatic ovarian lesions, and emergency bilateral salpingo-oophorectomy was performed. The patient is in a stable condition and is currently undergoing chemotherapy. To the best of our knowledge, this is the youngest case identified so far. Although metastatic cervical cancer is rare, especially diagnosed at the same time with gastric cancer, clinicians should be aware that it can occur in very young patients.
{"title":"Gastric cancer in a 22-year-old woman with metastasis to the cervix: a case report and literature review","authors":"Mengpei Zhang, Kemin Li, R. Yin","doi":"10.21037/gpm-21-32","DOIUrl":"https://doi.org/10.21037/gpm-21-32","url":null,"abstract":"Metastatic cervical cancer of gastric cancer is rare, especially in young patients with cervical lesions as the primary manifestation and diagnosed at the same time with gastric cancer. We reported a 22-year-old woman diagnosed as gastric cancer with no gastrointestinal symptoms. But her primary complaint was menstrual dysregulation and genital bleeding after intercourse. In the beginning, due to no abnormalities were found upon cervical liquid-based cytology or human papilloma virus (HPV) typing, the patient was diagnosed with functional uterine bleeding and was given Diane-35 oral treatment. After treatment, the patient’s symptoms did not improve, and when she went to the doctor again, colposcopy was performed, and cervical biopsy indicated a poorly differentiated mucinous adenocarcinoma, with signet ring cell carcinoma differentiation in some areas. The results of immunohistochemistry analysis suggested metastatic cancer from a digestive system tumor. Then the pathological results of a gastric mucosa multipoint biopsy showed poorly-differentiated mucinous adenocarcinoma and signet ring cell carcinoma were found. After diagnosis, the patient began chemotherapy. During the sixth cycle of chemotherapy, the patient developed Intracystic hemorrhage from metastatic ovarian lesions, and emergency bilateral salpingo-oophorectomy was performed. The patient is in a stable condition and is currently undergoing chemotherapy. To the best of our knowledge, this is the youngest case identified so far. Although metastatic cervical cancer is rare, especially diagnosed at the same time with gastric cancer, clinicians should be aware that it can occur in very young patients.","PeriodicalId":92781,"journal":{"name":"Gynecology and pelvic medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42706089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Tang, G. Liao, H. Cao, Le-ni Kang, B. Wei, M. Xi, Xi Zeng, Min-Yan Chen
Background: We aimed to determine the potential role of complementarity-determining region 3s (CDR3s) in prognosis of high-risk HPV (hr-HPV) infections and cervical intraepithelial neoplasia (CIN) in a prospective study for 12 months. Methods: Twenty-six women aged 30–64 years were recruited using cytology and HPV DNA test in China. After obtaining written informed consent, our team utilized ARM-PCR and second-generation high throughput sequencing to detect the diversity 50 (D50) value of CDR3s diversity among the groups of cancer (n=5), CIN 2/3 (n=4), CIN 1 (n=6), hr-HPV positive (n=8) and normal control (n=3) at the baseline year. Additionally, cytology and HPV DNA test adopted to the groups of CIN 1 and hr-HPV found the status of cervical lesions and hr-HPV infected persistence between CIN 1 (n=6) and hr-HPV (n=7) groups. Results: The prevalence of CDR3s diversity staining was 9.2±7.9, 5.7±5.6, 4.0±6.0, 13.6±7.7, 8.0±7.6 among women with normal, hr-HPV positive, CIN 1, CIN 2/3 and cancer biopsies. Decreased CDR3s diversity were not significantly associated with disease progression (P=0.093). There is no significant difference between CDR3s diversity and HPV clearance (P=0.173). All CIN1 cases regressed. Conclusions: CDR3s might be a biomarker to predict HPV-positive outcomes. The detection of CDR3s may assist in the clinical management of CIN 1. Women with CIN 1 and decrease of CDR3s diversity may benefit from closer follow-up at frequently intervals. (The trial registration number in Chinese Clinical Trial Registry: ChiCTR2000038164 and date of registration: September 11, 2020). 9
{"title":"Detection of CDR3s diversity and its prediction of persistent high-risk HPV infection and cervical intraepithelial neoplasia risk: a prospective study","authors":"D. Tang, G. Liao, H. Cao, Le-ni Kang, B. Wei, M. Xi, Xi Zeng, Min-Yan Chen","doi":"10.21037/gpm-21-48","DOIUrl":"https://doi.org/10.21037/gpm-21-48","url":null,"abstract":"Background: We aimed to determine the potential role of complementarity-determining region 3s (CDR3s) in prognosis of high-risk HPV (hr-HPV) infections and cervical intraepithelial neoplasia (CIN) in a prospective study for 12 months. Methods: Twenty-six women aged 30–64 years were recruited using cytology and HPV DNA test in China. After obtaining written informed consent, our team utilized ARM-PCR and second-generation high throughput sequencing to detect the diversity 50 (D50) value of CDR3s diversity among the groups of cancer (n=5), CIN 2/3 (n=4), CIN 1 (n=6), hr-HPV positive (n=8) and normal control (n=3) at the baseline year. Additionally, cytology and HPV DNA test adopted to the groups of CIN 1 and hr-HPV found the status of cervical lesions and hr-HPV infected persistence between CIN 1 (n=6) and hr-HPV (n=7) groups. Results: The prevalence of CDR3s diversity staining was 9.2±7.9, 5.7±5.6, 4.0±6.0, 13.6±7.7, 8.0±7.6 among women with normal, hr-HPV positive, CIN 1, CIN 2/3 and cancer biopsies. Decreased CDR3s diversity were not significantly associated with disease progression (P=0.093). There is no significant difference between CDR3s diversity and HPV clearance (P=0.173). All CIN1 cases regressed. Conclusions: CDR3s might be a biomarker to predict HPV-positive outcomes. The detection of CDR3s may assist in the clinical management of CIN 1. Women with CIN 1 and decrease of CDR3s diversity may benefit from closer follow-up at frequently intervals. (The trial registration number in Chinese Clinical Trial Registry: ChiCTR2000038164 and date of registration: September 11, 2020). 9","PeriodicalId":92781,"journal":{"name":"Gynecology and pelvic medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44404770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Endometriosis affects women throughout their reproductive years starting from adolescence. Its prevalence reaches a peak in early 40’s but many women trace the beginning of their symptoms back to their teenage years, suggesting that the disease process starts in young ages (1,2). Endometriosis is considered a chronic condition with a high risk of recurrence after treatment (3). This is of particular significance in young women in their teens or 20s who have many more years ahead of them before they become menopausal. It is quite common to treat young women with cyclical pain symptoms such as dysmenorrhoea with hormonal contraceptives alone or in combination with analgesics. This may improve the pain in a significant proportion whether they have endometriosis associated pain or primary dysmenorrhoea so that further intervention may not be needed at that point. However, some will have Review Article
{"title":"Endometriosis surgery in young women: a narrative review","authors":"E. Sarıdoğan, E. Sarıdoğan","doi":"10.21037/gpm-20-57","DOIUrl":"https://doi.org/10.21037/gpm-20-57","url":null,"abstract":"Endometriosis affects women throughout their reproductive years starting from adolescence. Its prevalence reaches a peak in early 40’s but many women trace the beginning of their symptoms back to their teenage years, suggesting that the disease process starts in young ages (1,2). Endometriosis is considered a chronic condition with a high risk of recurrence after treatment (3). This is of particular significance in young women in their teens or 20s who have many more years ahead of them before they become menopausal. It is quite common to treat young women with cyclical pain symptoms such as dysmenorrhoea with hormonal contraceptives alone or in combination with analgesics. This may improve the pain in a significant proportion whether they have endometriosis associated pain or primary dysmenorrhoea so that further intervention may not be needed at that point. However, some will have Review Article","PeriodicalId":92781,"journal":{"name":"Gynecology and pelvic medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47819268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Appropriate surgical approach for the treatment of gynecologic cancers is crucial to optimize the prognosis, increase the rate of curability and to overcome discrepancies in the management. In this special series, we put the best emphasis on the surgical approach for ovarian cancer with a series of three articles that encompass all the critical phases related to surgery for this malignancy. In detail, we investigated the role of interval debulking surgery by detailing all that should be known for an optimal choice and the role of laparoscopy in this type of surgery. Again, we focused on secondary cytoreduction for recurrent ovarian cancer giving an expert point of view. Finally, we investigated the role of robotic surgery in endometrial cancer, in particular in comparison with classic keyhole surgery.
{"title":"The quest of surgical appropriateness for gynecological cancers","authors":"F. Ferrari","doi":"10.21037/gpm-21-55","DOIUrl":"https://doi.org/10.21037/gpm-21-55","url":null,"abstract":"Appropriate surgical approach for the treatment of gynecologic cancers is crucial to optimize the prognosis, increase the rate of curability and to overcome discrepancies in the management. In this special series, we put the best emphasis on the surgical approach for ovarian cancer with a series of three articles that encompass all the critical phases related to surgery for this malignancy. In detail, we investigated the role of interval debulking surgery by detailing all that should be known for an optimal choice and the role of laparoscopy in this type of surgery. Again, we focused on secondary cytoreduction for recurrent ovarian cancer giving an expert point of view. Finally, we investigated the role of robotic surgery in endometrial cancer, in particular in comparison with classic keyhole surgery.","PeriodicalId":92781,"journal":{"name":"Gynecology and pelvic medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46167126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hengxi Chen, Eranga Abeysundera, T. Tian, Xiaorong Qi
The incidence of müllerian duct anomalies has been estimated in 0.16–10% of all women and unicornuate uterus accounts for 4–5% of these cases (1-3), although the true incidence is unknown. Although tubal pregnancy is the most common ectopic pregnancy, tubal pregnancy in a unicornuate uterus with rudimentary horn has rarely been documented. Here we present the clinical manifestations and management of two cases of tubal pregnancy in a unicornuate uterus with rudimentary horn and reviewed the literature on this topic. We present the following cases in accordance with the CARE reporting checklist (available at https://dx.doi.org/10.21037/gpm-21-43).
{"title":"Tubal pregnancy complicated with rudimentary horn: two case reports and literature review","authors":"Hengxi Chen, Eranga Abeysundera, T. Tian, Xiaorong Qi","doi":"10.21037/gpm-21-43","DOIUrl":"https://doi.org/10.21037/gpm-21-43","url":null,"abstract":"The incidence of müllerian duct anomalies has been estimated in 0.16–10% of all women and unicornuate uterus accounts for 4–5% of these cases (1-3), although the true incidence is unknown. Although tubal pregnancy is the most common ectopic pregnancy, tubal pregnancy in a unicornuate uterus with rudimentary horn has rarely been documented. Here we present the clinical manifestations and management of two cases of tubal pregnancy in a unicornuate uterus with rudimentary horn and reviewed the literature on this topic. We present the following cases in accordance with the CARE reporting checklist (available at https://dx.doi.org/10.21037/gpm-21-43).","PeriodicalId":92781,"journal":{"name":"Gynecology and pelvic medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42864206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Koninckx, A. Ussia, J. Keckstein, M. Malzoni, L. Adamyan, A. Wattiez
The indication and technique of endometriosis surgery changed rapidly over the last 50 years since better understanding the disease and an improved diagnosis. This review will therefore include a short discussion of the importance and limits of evidence-based medicine (EBM), the clinical importance and diagnostic value of imaging and the alternative medical treatments. Surgery is the cornerstone of infiltrating and fibrotic endometriosis and useful for minor endometriosis. We suggest redefining the aim of surgery, as the elimination of all endometrium like cells with genetic or epigenetic (G-E) endometriotic changes. Microscopic endometriosis in the peritoneum, in the bowel wall and in lymph nodes at distance from a deep endometriosis nodule does not need surgery since there is no evidence that it causes pain, infertility or progression into more severe forms of endometriosis. Subtle and typical lesions need excision or destruction since some of them might progress because of G-E changes. Excision of cystic ovarian endometriosis is associated with fewer recurrences, probably since more complete, but with more ovarian damage than superficial destruction of the lining of the cyst. However, since endometriotic infiltration in the cyst wall is less than 2 mm deep, the rest of the capsule being fibrosis, chemical superficial destruction might combine completeness with superficial treatment. For the surgery of deep endometriosis, the authors have reached consensus on many aspects. This comprises the prevention of nerve damage, the complete excision from the vaginal fornix, the complete excision from the bladder preserving the intramural ureter, ureter excision and anastomosis for fibrotic stenosis, short instead of large bowel resections when necessary and the liberal use of sigmoid resections. Other aspects remain debated, such as the excision of fibrotic endometriosis surrounding and extending below the ureter risking to damage the inferior hypogastric plexus, the exact indication of rectum resections versus complete excision with eventual suture of muscularis or mucosa versus limited excision completed by discoid excision with a circular stapler. The concept of completeness of excision will be discussed since the outer layers might be metaplastic cells without G-E changes. Also, the treatment of macroscopically fibrotic lesions without endometriosis is not clear.
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