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Clinical Advances in Minimally Invasive Gynecologic Surgery
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Clinical Advances in Minimally Invasive Gynecologic Surgery

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

Deadline for manuscript submissions: closed (10 March 2026) | Viewed by 1541

Special Issue Editor

Dr. Giulia Bonavina

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Guest Editor
Department of Obstetrics and Gynecology, IRCCS MultiMedica, 20138 Milan, Italy
Interests: endometriosis; minimally invasive surgery; laparoscopy; urogynecology

Special Issue Information

Dear Colleagues,

Surgical innovation is a cornerstone of advancing and enhancing surgical practice. Continuous improvements in surgical techniques, technologies, and approaches have consistently led to better patient outcomes, reduced complications, and shorter recovery times. The integration of novel tools, such as minimally invasive techniques and robotics, has transformed the way surgeons approach complex procedures, making surgeries safer and more effective. Despite these advancements, the wide variability in surgeon experience and the complexity of individual patient cases highlight the need for additional evidence to guide clinical decision making. Recently, some new surgical techniques have been developed for benign and malignant gynecological conditions. Specifically, robotics and natural orifice transluminal endoscopic surgery (vNOTES) are providing surgeons with alternative options, which may potentially improve outcomes. In this Special Issue, we welcome authors to submit papers on the clinical advances in minimally invasive gynecological surgery to help clarify their advantages and limitations, and ensure their safe and effective integration into everyday clinical practice.

Dr. Giulia Bonavina
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 gynecological surgery
  • MIGS
  • laparoscopy
  • robotics
  • natural orifice transluminal endoscopic surgery
  • endometriosis
  • endometrial cancer
  • vaginal hysterectomy
  • leiomyomas
  • fibroids
  • vNOTES

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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

12 pages, 853 KB  
Article
Robot-Assisted Hysterectomy for Endometrial Cancer—Own Observations
by Anna Bogaczyk, Tomasz Zuzak, Patryk Jasielski, Michał Maźniak, Andrzej Wróbel, Jan Wróbel, Marcin Misiek, Krzysztof Przyśliwski, Aleksander Rycerz and Tomasz Kluz
J. Clin. Med. 2026, 15(8), 3008; https://doi.org/10.3390/jcm15083008 - 15 Apr 2026
Viewed by 323
Abstract
Background: Endometrial cancer is one of the most common cancers in women. In recent years, minimally invasive methods such as laparoscopy and robotic surgery have become very popular. Robotic surgery is a rapidly evolving and continuously improving modality. Methods: The main goal of [...] Read more.
Background: Endometrial cancer is one of the most common cancers in women. In recent years, minimally invasive methods such as laparoscopy and robotic surgery have become very popular. Robotic surgery is a rapidly evolving and continuously improving modality. Methods: The main goal of our study was to compare patients operated on with the da Vinci robot with laparoscopy. The study included 300 patients with endometrial cancer who underwent surgery using the da Vinci robotic system and 80 patients with endometrial cancer who underwent laparoscopic surgery. Results: We have demonstrated that robot-assisted surgery is associated with significantly lower blood loss and a reduced risk of complications, whereas operative time remains shorter with laparoscopy. At the same time, we have observed that prolonged robotic operative time occurs particularly in older patients and those with a higher BMI, which should be taken into account when planning surgical procedures. Conclusions: Further research is needed to better define the groups of patients who benefit most and to optimize surgical strategies. Full article
(This article belongs to the Special Issue Clinical Advances in Minimally Invasive Gynecologic Surgery)
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24 pages, 5167 KB  
Article
Correlation Between Pain Intensity in Different Locations and Intraoperative Stage of Endometriosis According to rASRM and #ENZIAN Classification
by Krzysztof Przyśliwski, Maciej Pliszkiewicz, Joanna Jacko, Anna Bogaczyk, Bogumił Paweł Siekierski and Tomasz Kluz
J. Clin. Med. 2026, 15(7), 2725; https://doi.org/10.3390/jcm15072725 - 3 Apr 2026
Viewed by 337
Abstract
Background/Objectives: Endometriosis is a chronic inflammatory disease with a heterogeneous clinical presentation, in which pain represents the predominant symptom. The association between pain severity and intraoperative disease stage remains unclear, particularly with regard to the rASRM and #ENZIAN classifications. This study aimed to [...] Read more.
Background/Objectives: Endometriosis is a chronic inflammatory disease with a heterogeneous clinical presentation, in which pain represents the predominant symptom. The association between pain severity and intraoperative disease stage remains unclear, particularly with regard to the rASRM and #ENZIAN classifications. This study aimed to evaluate the relationship between pain intensity at different anatomical sites and the stage of endometriosis according to the rASRM and #ENZIAN systems. Methods: A total of 138 patients with advanced endometriosis undergoing surgical treatment between May 2024 and August 2025 were included. Pain intensity was assessed using a 10-point Numerical Rating Scale (NRS) for pelvic pain, pain during defecation, pain during micturition, and pain during or after sexual intercourse. The stage of endometriosis was evaluated intraoperatively according to the rASRM and #ENZIAN classifications. Non-parametric statistical tests and Spearman’s rank correlation coefficient were applied. A p-value < 0.05 was considered statistically significant. Results: No significant correlation was found between overall pelvic pain intensity and disease stage according to the rASRM classification. However, significant differences in pain during micturition were observed depending on rASRM stage (p = 0.004). In the #ENZIAN-based analysis, significant associations were identified between selected anatomical areas and specific pain symptoms, particularly pain during micturition, defecation, and sexual intercourse. Conclusions: Pain severity in advanced endometriosis does not consistently correlate with overall disease stage according to rASRM. The anatomical localization of lesions defined by the #ENZIAN classification may better reflect the type and distribution of pain symptoms. These findings should be interpreted in the context of a selected cohort of surgically treated patients with advanced disease and may not be generalizable to patients with milder or non-surgically managed endometriosis. Full article
(This article belongs to the Special Issue Clinical Advances in Minimally Invasive Gynecologic Surgery)
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13 pages, 877 KB  
Article
Two-Year Clinical Outcomes of Transvaginal Radiofrequency Ablation for Symptomatic Uterine Fibroids: A Retrospective Observational Study
by Mª Eugenia Marín Martínez, Gema Vaquero Argüello, Tirso Pérez Medina, Victoria E. Rey, Mª Luisa de la Cruz Conty and Sara Cruz Melguizo
J. Clin. Med. 2026, 15(4), 1518; https://doi.org/10.3390/jcm15041518 - 14 Feb 2026
Viewed by 556
Abstract
Background: Transvaginal radiofrequency ablation (TRFA) is a minimally invasive, uterus-preserving technique for symptomatic uterine fibroids. This study evaluates its two-year clinical and volumetric outcomes, safety profile, patient satisfaction, and reintervention rates. Methods: In this single-center, retrospective, single-arm observational cohort study, 121 premenopausal women [...] Read more.
Background: Transvaginal radiofrequency ablation (TRFA) is a minimally invasive, uterus-preserving technique for symptomatic uterine fibroids. This study evaluates its two-year clinical and volumetric outcomes, safety profile, patient satisfaction, and reintervention rates. Methods: In this single-center, retrospective, single-arm observational cohort study, 121 premenopausal women underwent outpatient TRFA under general anesthesia between 2018 and 2023. Follow-up visits at 1, 6, 12, and 24 months assessed fibroid volume reduction, symptom improvement using the Uterine Fibroid Symptom and Quality of Life Questionnaire (UFS-QoL), vascularity, satisfaction, complications, and the need for reintervention. A total of 169 fibroids were treated. Results: TRFA resulted in progressive fibroid shrinkage, with a mean volume reduction of 57.97% at 6 months and 60.75% at 24 months, accompanied by sustained improvement in UFS-QoL scores (from 30.19 at baseline to 14.97 at 24 months). Patient satisfaction was high (96.61%). Complications were infrequent and predominantly mild, and recovery was rapid, with short postoperative analgesia (mean 2.87 days) and limited sick leave (mean 3.34 days). The two-year reintervention rate was 24.79%, with a substantial proportion corresponding hysteroscopic procedures planned a priori as part of a sequential therapeutic strategy. Among 22 pregnancies recorded after TRFA, 81.82% resulted in term deliveries with favorable neonatal outcomes although fertility was not a predefined study endpoint. Conclusions: TRFA appears to be a safe, effective, and well-tolerated minimally invasive treatment for symptomatic uterine fibroids, offering durable symptom relief and significant volume reduction and rapid recovery, and encouraging reproductive outcomes. Within the limitations of its single-arm observational design, these results support TRFA as a valuable uterus-preserving therapeutic option. Full article
(This article belongs to the Special Issue Clinical Advances in Minimally Invasive Gynecologic Surgery)
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