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Gynecological Surgery: New Clinical Insights and Challenges

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

Deadline for manuscript submissions: 25 July 2025 | Viewed by 8103

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Prof. Dr. Francesco Plotti

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Department of Obstetrics and Gynecology, University Campus Biomedico of Rome, Rome, Italy
Interests: surgical oncology; screening; laparoscopic surgery laparoscopic; urinary incontinence; oncology; laparoscopy; gynecologic oncology
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Special Issue Information

Dear Colleagues,

Minimally invasive surgery continues to transform the field of gynecological surgery and is now the standard of care for the surgical treatment of many diseases in gynecology. Recent advances in minimally invasive surgery offer several benefits to patients with gynecological diseases. Owing to minimally invasive surgery’s clear advantages, new advances in technology are being employed rapidly, enabling even the most complicated procedures to be performed less invasively. The advantages of a minimally invasive approach include reduced intraoperative blood loss, less postoperative pain, shorter rehabilitation time, and a significant reduction in overall and surgical postoperative morbidity. However, all surgical procedures have certain risks associated with them. The patient’s age, comorbidities, weight, level of compliance, hygiene, nutrition, and functional performance may prove to be directly or indirectly causative. A timely diagnosis and prompt treatment are key to dealing with these problems. In this Special Issue, we welcome authors to submit papers on the clinical advancement of minimally invasive benign and malignant gynecologic surgery, with particular attention to the patient's perioperative morbidity.

Prof. Dr. Francesco Plotti
Guest Editor

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Keywords

minimally invasive surgery
urogynecologic surgery
complications
gynecologic oncology
robotic surgery
benign gynecologic surgery
vaginal surgery

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Published Papers (7 papers)

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Research

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11 pages, 388 KiB

Open AccessArticle

Effectiveness of Obliterative Surgery in Managing Advanced Apical Prolapse in Elderly Women: A 20-Years of Single Surgeon’s Experience

by Dayong Lee, Tae Hun Kim and Taek Sang Lee

J. Clin. Med. 2025, 14(9), 3101; https://doi.org/10.3390/jcm14093101 - 30 Apr 2025

Viewed by 66

Abstract

Objectives: The aim of this study was to evaluate the surgical outcomes, therapeutic efficacy, and psychological satisfaction of the Le Fort partial colpocleisis (LFC) procedure, an obliterative surgical treatment option, in elderly women with advanced apical prolapse, based on the 20-year surgical experience of a single surgeon. Methods: A retrospective cohort study was conducted on 81 women aged 60 and older who underwent LFC for advanced apical prolapse at a single institution from 2006 to 2025. Baseline characteristics, comorbidities, perioperative outcomes, complications, and patients’ satisfaction were analyzed. Results: Among the patients, 86.4% were aged 70 or older, and also 85.2% of the women had comorbidities that could influence surgical outcomes. The surgical success rate was 96.3%, with recurrences observed in three cases. The median operative time was 89 min, but it decreased to median 77 min as the accumulated surgeon’s experience. Similarly, hospitalization duration and patient-reported postoperative pain score also showed significant reductions. Transient postoperative complications were minimal, predominantly transient urinary symptoms (voiding difficulty in 4.9%, urinary frequency in 6.2%, and urinary incontinence in 3.7% of the patients). Satisfaction with the surgical treatment was high, with 98.4% reporting overall satisfaction. Conclusion: LFC is a safe and effective option for elderly women with advanced apical prolapse, offering high satisfaction rates and low morbidity. Surgeon’s experience significantly enhances outcomes after about 20 cases. Careful patient selection and throughout counseling are essential to optimize outcomes and address patients’ satisfaction by enhancing physical and psychological quality of life. Full article

(This article belongs to the Special Issue Gynecological Surgery: New Clinical Insights and Challenges)

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13 pages, 440 KiB

Open AccessArticle

Morbidity and Mortality Outcomes After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for Treatment of Ovarian Cancer

by Migang Kim, Yong Jae Lee, Ki Eun Seon, Sunghoon Kim, Chan Lee, Hyun Park, Min Chul Choi and Jung-Yun Lee

J. Clin. Med. 2025, 14(5), 1782; https://doi.org/10.3390/jcm14051782 - 6 Mar 2025

Viewed by 598

Abstract

Background/Objectives: Hyperthermic intraperitoneal chemotherapy (HIPEC) with cytoreductive surgery (CRS) has been reported to improve survival in patients with peritoneal carcinomatosis. This study aimed to investigate the morbidity and mortality rates of CRS with HIPEC in patients with ovarian cancers. Methods: We retrospectively reviewed the medical records of patients who underwent CRS with HIPEC for ovarian cancer from January 2013 to July 2021 at two tertiary institutions. The morbidities and mortalities that occurred within 30 days after HIPEC and the clinical and operative factors related to morbidities were investigated. Results: A total of 155 procedures in 151 patients were included in this study. The median age was 55 years and the median score of the peritoneal carcinomatosis index was eight points. Morbidities of grade ≥3 within 30 days of HIPEC occurred in 18 patients (11.6%). The most common severe morbidity was wound infection (3.2%), followed by pleural effusion (1.9%) and postoperative hemorrhage (1.9%). Within the 30-day postoperative period, there were no reported mortality cases. There were statistical differences in age, length of stay, peritoneal carcinomatosis index, bowel resection, operation time, and completeness of cytoreduction between the patients and severe morbidity. However, in the multivariate logistic analysis, none of the factors showed a statistically significant relationship with the occurrence of severe morbidity. Conclusions: The morbidity and mortality rates of CRS with HIPEC in gynecologic cancer patients were relatively low compared to those in previous reports. Further studies about the possible risk factors are needed. Full article

(This article belongs to the Special Issue Gynecological Surgery: New Clinical Insights and Challenges)

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10 pages, 878 KiB

Open AccessArticle

Robotic Rectus Abdominis Myoperitoneal Flap for Posterior Vaginal Wall Reconstruction: Experience at a Single Institution

by Noama Iftekhar, Kathryn Cataldo, Seungwon Jong Seo, Brett Allen, Casey Giles, Matthew William Kelecy, Joshua MacDavid and Richard C. Baynosa

J. Clin. Med. 2025, 14(1), 292; https://doi.org/10.3390/jcm14010292 - 6 Jan 2025

Viewed by 1204

Abstract

Background: The adoption of robotic surgery has been widespread and increasing amongst gynecologic surgeons given the ability to decrease morbidity. It is important that plastic surgeons adjust their reconstructive algorithm to ascertain the benefits of robotic-assisted surgery. Herein we report our outcomes of robotic-assisted rectus abdominis muscle reconstruction of the posterior vaginal wall along with a current literature review on robotic-assisted reconstructive pelvic surgery. Methods: An IRB-approved retrospective review was completed of all patients who underwent robotic pelvic reconstruction between 2016 and 2024 at a single institution. Patients who underwent posterior vaginal wall reconstruction utilizing a robotic-assisted rectus abdominis muscle (RRAM) were selected for final analysis. Results: Thirty-two patients were identified who underwent pelvic reconstruction using robotic surgical techniques. Five (mean age = 56.2, 32–72; mean BMI = 30.0, 24–39.9) underwent posterior vaginal wall reconstruction with an RRAM flap. Two patients (40%) had minor wound complications, and one patient (20%) had vaginal stenosis eight years after operation. None had major complications requiring a return to the OR or hospital admission. All patients went on to achieve successful healing. Conclusions: In the literature, robotic-assisted surgery has shown significant advantages, including reduced morbidity with decreased intra-operative blood loss, reduced pain, faster recovery, and shorter hospital stays. The RRAM flap for pelvic reconstruction is well tolerated in patients despite comorbidities and preserves the minimally invasive benefits of extirpative surgery. As the technology becomes more widely incorporated, it is important for plastic surgeons to integrate robotic surgical techniques into their practice. Full article

(This article belongs to the Special Issue Gynecological Surgery: New Clinical Insights and Challenges)

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10 pages, 1401 KiB

Open AccessArticle

Access to Hysterectomy—What Is the Realistic Rate for Pure Vaginal Hysterectomy? A Single-Center Prospective Observational Study

by Felix Neis, Aylin Ayguen, Romina-Marina Sima, Erich-Franz Solomayer, Ingolf Juhasz-Boess, Gudrun Wagenpfeil, Percy Brandner and Klaus Joachim Neis

J. Clin. Med. 2024, 13(20), 6130; https://doi.org/10.3390/jcm13206130 - 15 Oct 2024

Viewed by 1294

Abstract

Background/Objectives: Hysterectomy (HE) is the most common surgical procedure in gynecology worldwide. The guidelines of most countries unanimously recommend vaginal hysterectomy (VH) as the access of first choice. However, there are significant international differences in the implementation of this recommendation. Methods: In the consistent implementation of the national guidelines, the aim of this prospective observational cohort study was to evaluate how many hysterectomies can be performed vaginally under real-world conditions for benign indications excluding genital prolapse and extensive endometriosis. For this purpose, the requirements of the guidelines were implemented for all HE cases. All HEs were performed by a single, experienced surgeon. The aim was not to go to the limits of the method, but to develop a reproducible benchmark with the lowest possible complication rate. Results: From 2011 to 2020, 230 hysterectomies were performed for benign indications. A VH was performed in 146 cases (63.5%), and a laparoscopic hysterectomy (LH) in 75 cases (32.6%). An abdominal hysterectomy (AH) was only required in nine cases (3.9%). The decision for LH was made in half of the cases due to the assumed presence of endometriosis or a significantly enlarged uterus. The median duration of VH was 32 min (range 16–118 min), and the uterine weights were 15–540 g. The rate of postoperative complications of VH was 3.4%. Conclusions: In line with international guidelines, VH is possible in over 60% of cases with a short surgical time and a low complication rate. LH procedures are useful in the presence of assumed additional pathology in 35%. AH is reserved for huge uteri. A reduction in AH below 10% is possible. The global target could be a rate of 60–30–10% for VH, LH, and AH. Full article

(This article belongs to the Special Issue Gynecological Surgery: New Clinical Insights and Challenges)

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12 pages, 924 KiB

Open AccessArticle

The Rendezvous Technique: A Minimally Invasive Non-Surgical Approach for the Management of Iatrogenic Ureteral Injuries

by Eliodoro Faiella, Giuseppina Pacella, Elva Vergantino, Domiziana Santucci, Carlo De Cicco Nardone, Corrado Terranova, Francesco Plotti, Roberto Angioli, Bruno Beomonte Zobel and Rosario Francesco Grasso

J. Clin. Med. 2024, 13(13), 3820; https://doi.org/10.3390/jcm13133820 - 28 Jun 2024

Viewed by 1495

Abstract

Background/Objectives: The aim of our study is to evaluate the feasibility and efficacy of the rendezvous technique for the treatment of iatrogenic ureteral injuries. Methods: From 2014 to 2019, 29 patients treated with the rendezvous technique for mono- or bilateral iatrogenic ureteral injuries were enrolled in this retrospective study. All the leaks were previously assessed by CT-urography and antegrade pyelography. Ureteral continuity was restored by performing the rendezvous technique, combining antegrade trans-nephrostomic access and a retrograde trans-cystostomic approach. A double J stent was antegradely inserted, and a nephrostomy tube was kept in place at the end of the procedure. A post-procedure CT-urography and a 30-day nephrostogram follow-up were performed. In the absence of a contrast leak, the nephrostomy tube was removed. Patient follow-up was set with CT-urography at 3, 6, and 12 months and stent substitution every 4 months. The CT-urography was performed to confirm the restored integrity of the ureter before stent removal. Results: The rendezvous technique was successful in all cases with the resolution of the ureteral leak. No major complications were observed. In all the patients, the nephrostomy tube was removed after 30 days. After performing CT-urography, the stent was removed permanently after 12 months. Only three cases showed local post-treatment stenosis treated with surgical ureteral reimplantation. Conclusions: The rendezvous technique is a safe and effective minimally invasive procedure that can be used to restore the continuity of the ureter, avoiding open surgery and providing valuable support for the management of complications after gynecological surgery. Full article

(This article belongs to the Special Issue Gynecological Surgery: New Clinical Insights and Challenges)

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Review

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12 pages, 486 KiB

Open AccessReview

Vasa Previa: Prenatal Diagnosis and the Rationale Behind Using a 5 cm Distance from Internal Os

by Claudio V. Schenone, Faezeh Aghajani, Ali Javinani, Eyal Krispin, Yinka Oyelese, Ramesha Papanna, Ramen H. Chmait and Alireza A. Shamshirsaz

J. Clin. Med. 2025, 14(3), 1009; https://doi.org/10.3390/jcm14031009 - 5 Feb 2025

Viewed by 1330

Abstract

In pregnancies with vasa previa, prenatal diagnosis and pre-labor cesarean delivery are associated with significantly improved perinatal outcomes compared to undetected cases. However, a universally accepted ultrasonographic definition of vasa previa is lacking. Specifically, the distance from the cervical internal os beyond which vaginal delivery can be safely recommended remains to be determined. Field experts and recently published societal guidelines agree that a 2 cm cut-off is suboptimal, given that complete cervical dilation during labor risks unprotected fetal vessels within a 5 cm radius from the internal os. Thus, in the setting of a scarcity of evidence and case reports of perinatal death with unprotected fetal vessels beyond 2 cm from the internal os, a more conservative definition that includes unprotected fetal vessels located within 5 cm of the internal os is imperative to improve outcomes. Full article

(This article belongs to the Special Issue Gynecological Surgery: New Clinical Insights and Challenges)

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Other

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9 pages, 526 KiB

Open AccessSystematic Review

The True Impact of Voiding Dysfunctions after Transobturator Sub-Urethral Tape Procedures: A Systematic Review of Literature

by Francesco Plotti, Stefania Rampello, Corrado Terranova, Carlo De Cicco Nardone, Daniela Luvero, Roberto Montera, Violante Di Donato, Anna Franca Cavaliere, Giuseppe Campagna, Fernando Ficarola, Arianna Martinelli and Roberto Angioli

J. Clin. Med. 2024, 13(16), 4762; https://doi.org/10.3390/jcm13164762 - 13 Aug 2024

Viewed by 1388

Abstract

Introduction: Transobturator techniques are frequently used for the surgical treatment of female stress urinary incontinence (SUI), due to their high success rates and few intraoperative complications. However, controversial results have been reported in the literature regarding their incidence. The aim of this study is to analyze the real incidence and trend over time of such complications, especially voiding dysfunctions and overactive bladder (OAB) symptoms. Methods: A comprehensive search using PubMed/MEDLINE, Scopus, and Cochrane databases was performed. The search string used was the following: (female stress urinary incontinence) AND (complication) AND ((midurethral sling) OR (transobturator tape) OR (TVT-O) OR (voiding dysfunctions) OR (de novo OAB) OR (recurrent UTI) OR (vaginal erosion)). We included randomized controlled trials, prospective controlled studies, prospective and retrospective observational studies. All selected articles were screened based on titles and abstracts. Relevant data were extracted and tabulated. Results: A total of 39 studies were included in our analysis. Transobturator tape procedures show a high objective cure rate for SUI, from 76.9% to 100%. Postoperative voiding dysfunctions are shown to be quite common, ranging from 0–22% of cases. Despite that, this percentage decreases to 0–1% after 12 months. De novo OAB incidence ranges from 3% to 14% at 12 months, with variability over time due to multiple factors. Tape-related complications usually occur after 12 months, with a variable incidence up to 7%. Urinary tract infections (UTIs) are quite common in the immediate postoperative period but sometimes can be recurrent, requiring long-term prophylactic antibiotic treatment. Conclusions: Voiding dysfunctions are generally transient complications, while de novo OAB may persist over time. An adequate preoperative counseling, along with accurate written informed consent, could enhance patient tolerance of these issues and contribute to long-term patient satisfaction. Full article

(This article belongs to the Special Issue Gynecological Surgery: New Clinical Insights and Challenges)

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