New Insights and Perspectives in Minimally Invasive Gynecology: Part II

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Obstetrics and Gynecology".

Deadline for manuscript submissions: 20 July 2024 | Viewed by 6762

Special Issue Editors


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Guest Editor
Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
Interests: urogynecology and female urology; gynecology; urodynamics; obstetric delivery
Special Issues, Collections and Topics in MDPI journals

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Guest Editor
Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
Interests: endometrial cancer
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Over the last twenty years, minimally invasive gynecology has experienced several clinical and technical upgrades. The advent of robotic surgery, ultra-minimally invasive laparoscopy and vNOTES has improved the surgical, clinical and reproductive performances of the procedures. Moreover, tailored fertility preservation therapies have been developed to meet the childbearing demand from more than half of the women aged between 18 and 40 years with a diagnosis of gynecological cancer. As a matter of fact, the potential loss of fertility could be more distressing than the malignancy itself.

Similarly, in-office hysteroscopy has been proposed as a novel gold-standard approach for the diagnosis and treatment of intrauterine pathologies, including the conservative approach for atypical endometrial hyperplasia and early endometrial carcinoma.

On the other hand, varied progress has been achieved in the field of urogynecology, revolutionizing the treatment and follow-up of women with genital prolapse and urinary incontinence.

This focused Special Issue aims to provide an update about the most recent advances in diagnosis management, treatment and outcomes of gynecological malignancies and benign pathologies, from basic science to translation, clinical and surgical approaches, with a special focus on novel minimally invasive surgical techniques and postsurgical quality of life.

Several experts in the field will participate in this upcoming Special Issue, providing up-to-date knowledge regarding the most popular topics in gynecology and urogynecology. Potential topics include but are not limited to the following:

  • Technological innovations in the field of gynecological laparoscopy;
  • Robotic approach for uterine fibroids: why, when and how?;
  • Conservative management of atypical endometrial hyperplasia and early endometrial cancer in childbearing age;
  • Reproductive outcomes after fertility-sparing surgery for ovarian neoplasms: an up-to-date review;
  • Hysteroscopic and molecular diagnosis of endometrial cancer;
  • Diagnostic cornerstones and up-to-date approaches for uterine prolapse;
  • Genitourinary syndrome of menopause: current strategies and future perspectives;
  • The new era of in-office hysteroscopy: feasibility and current limits;
  • Training and simulation for gynecological laparoscopy: strengths and limitations;
  • Quality of life, psychological wellbeing and sexuality in women with urinary incontinence—where are we now.

Comprehensive, updated and concise reviews, as well as recently developed original articles, are welcomed for submission.

Prof. Dr. Marco Torella
Dr. Gaetano Riemma
Guest Editors

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Keywords

  • minimally invasive gynecology
  • urogynecology
  • reproductive surgery
  • hysteroscopy
  • endometrial cancer
  • ovarian neoplasms

Published Papers (5 papers)

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Research

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13 pages, 1784 KiB  
Article
The Role of β1 Integrin/CD29 as a Potential Prognostic Factor for the Risk of Progression to Cervical Carcinoma in HPV-Associated Lesions
by Maria Teresa Schettino, Eleonora Petra Preti, Valeria Vietri, Nadia Agrillo, Nicola Iavazzo, Diego Domenico Fasulo, Pasquale De Franciscis, Maria Rosaria Campitiello, Maria Giovanna Vastarella, Gaetano Riemma, Barbara Gardella and Filippo Murina
Medicina 2024, 60(3), 364; https://doi.org/10.3390/medicina60030364 - 21 Feb 2024
Viewed by 900
Abstract
Background and Objectives: Available evidence reports the overexpression of β1 integrin in dysplastic rather than normal cervical tissue. We aimed to evaluate the involvement of β1 (CD29) integrin in the progressive pathogenesis of cervical intraepithelial neoplasia (CIN). Materials and Methods: From [...] Read more.
Background and Objectives: Available evidence reports the overexpression of β1 integrin in dysplastic rather than normal cervical tissue. We aimed to evaluate the involvement of β1 (CD29) integrin in the progressive pathogenesis of cervical intraepithelial neoplasia (CIN). Materials and Methods: From January 2019 to December 2021, we prospectively enrolled women undergoing a colposcopy with a cervical biopsy for abnormal cervical cytology and/or undefined cytology with a positive HPV DNA test and women with relapsing cervical inflammatory disorders. Based on the histopathological results, women were divided into four groups: group A (CIN1), group B (CIN2), group C (CIN3), and group D (no CIN diagnosis) as a control group. Subsequently, cytofluorimetry and immunohistochemical analysis (based on the identified positive cell ratios as follows: ≤10%, negative; 10–25%, 1+ (weak); 25–50%, 2+ (medium); ≥50%, and 3+ (high)) for β1 integrin were carried out. Results: In total, 154 women were included. The average fluorescence intensity in the four groups was 2.35 ± 1.37, 2.73 ± 1.56, 3.09 ± 1.56, and 2.13 ± 1.25 UA from groups A to D, respectively; this figure was significantly different for CIN3 (group C) women relative to the other groups (p = 0.0132). Higher β1 integrin/CD29 concentrations in the CIN groups with HR-HPV 16 and 18 were also detected (p = 0.0292, 0.0367, and 0.0357 respectively for CIN3, CIN2, and CIN1). Immunohistochemistry analysis showed higher results for the CIN3 group compared to controls and all the other groups (p < 0.001). Conclusions: β1/CD29 integrin expression increased with CIN grade, and it was significantly higher in CIN3 lesions. This could be used as a promising screening tool to identify women prone to developing high-grade cervical lesions. However, additional evidence is needed to strengthen these findings. Full article
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11 pages, 869 KiB  
Article
High Uterosacral Ligaments Suspension for Post-Hysterectomy Vaginal Vault Prolapse Repair
by Marta Barba, Alice Cola, Tomaso Melocchi, Desirèe De Vicari, Clarissa Costa, Silvia Volontè, Lucia Sandullo and Matteo Frigerio
Medicina 2024, 60(2), 320; https://doi.org/10.3390/medicina60020320 - 13 Feb 2024
Viewed by 913
Abstract
Background and Objectives: Uterosacral ligaments (USLs) suspension is a well-studied, safe, and long-lasting technique for central compartment correction. Preliminary clinical experiences showed encouraging data for this technique, also for post-hysterectomy vaginal vault prolapse surgical treatment. However, up-to-date evidence for post-hysterectomy vaginal vault [...] Read more.
Background and Objectives: Uterosacral ligaments (USLs) suspension is a well-studied, safe, and long-lasting technique for central compartment correction. Preliminary clinical experiences showed encouraging data for this technique, also for post-hysterectomy vaginal vault prolapse surgical treatment. However, up-to-date evidence for post-hysterectomy vaginal vault prolapse repair through high uterosacral ligaments suspension is limited. Consequently, with this study, we aimed to assess the efficiency, complications frequency, and functional results of native-tissue repair through USLs in vaginal vault prolapse. Materials and Methods: This was a retrospective study. Women with symptomatic vaginal vault prolapse (≥stage 2) who underwent surgery with transvaginal native-tissue repair by high uterosacral ligaments were included. Patient characteristics, preoperative assessment, operative data, postoperative follow-up visits, and re-interventions were collected from the hospital’s record files. High uterosacral ligament suspension was performed according to the technique previously described by Shull. A transverse apical colpotomy at the level of the post-hysterectomy scar was performed in order to enter the peritoneal cavity. USLs were identified and transfixed from ventral to dorsal with three absorbable sutures. Sutures were then passed through the vaginal apex and tightened to close the transverse colpotomy and suspend the vaginal cuff. At the end of the surgical time, a diagnostic cystoscopy was performed in order to evaluate ureteral bilateral patency. Using the POP-Q classification system, we considered an objective recurrence as the descensus of at least one compartment ≥ II stage, or the need for a subsequent surgery for POP. The complaint of bulging symptoms was considered the item to define a subjective recurrence. We employed PGI-I scores to assess patients’ satisfaction. Results: Forty-seven consecutive patients corresponding to the given period were analyzed. No intraoperative complications were observed. We observed one postoperative hematoma that required surgical evacuation. Thirty-three patients completed a minimum of one-year follow-up (mean follow-up 21.7 ± 14.6 months). Objective cure rate was observed in 25 patients (75.8%). No patients required reintervention. The most frequent site of recurrence was the anterior compartment (21.2%), while apical compartment prolapse relapsed only in 6% of patients. An improvement in all POP-Q parameters was recorded except TVL which resulted in a mean 0.5 cm shorter. Subjective recurrence was referred by 4 (12.1%) patients. The mean satisfaction assessed by PGI-I score was 1.6 ± 0.8. Conclusion: This analysis demonstrated that native-tissue repair through high USL suspension is an effective and safe procedure for the treatment of post-hysterectomy vaginal vault prolapse. Objective, subjective, functional, and quality of life outcomes were satisfactory, with minimal complications. Full article
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10 pages, 845 KiB  
Article
Efficacy of a Novel Rigenase® and Polyhexanide (Fitostimoline® Septagel) Hydrogel Device for the Treatment of Vulvovaginitis Symptoms: Cross-Sectional Analysis of a National Survey and Prospective Observational Study
by Gaetano Riemma, Giampaolo Mainini, David Lukanović, Gaetano Scalzone, Lucia Sandullo, Maria Teresa Schettino, Maria Giovanna Vastarella, Mattia Dominoni, Gorizio Pieretti, Pasquale De Franciscis, Mario Passaro and Marco Torella
Medicina 2023, 59(11), 2004; https://doi.org/10.3390/medicina59112004 - 15 Nov 2023
Cited by 2 | Viewed by 1049
Abstract
Background and Objectives: Signs and symptoms of vulvovaginitis, especially when recurrent, have a significant impact on a woman’s quality of life. The aim of this study was to survey gynecologists about their habits regarding the treatments of the pathology and to evaluate [...] Read more.
Background and Objectives: Signs and symptoms of vulvovaginitis, especially when recurrent, have a significant impact on a woman’s quality of life. The aim of this study was to survey gynecologists about their habits regarding the treatments of the pathology and to evaluate the efficacy of a novel vaginal hydrogel composed of wheat extracts and polyhexanide aimed at reducing vulvovaginitis symptomatology. Materials and Methods: A cross-sectional analysis of a national survey using 155 Italian gynecologists and a prospective, open-label, observational study were carried out in 75 outpatient clinics across Italy. Pre- and postmenopausal women with suspicion of vulvovaginitis due to at least four of the following symptoms (leucoxanthorrhea, bad odor from genitalia, vulvovaginal dryness, petechiae, burning, and pruritus) while waiting for microbiological swab analysis were included and treated with one hydrogel application every 3 days for 1 week. Primary endpoint was the complete resolution of symptomatology. Results: The pre-study survey reported that, for most clinicians, local or oral treatment (65.7% and 82.8%, respectively) with antibiotics or antifungals is used very often. Therefore, we proceeded to carry out an observational study. Overall, 615 (362 of fertile age and 253 in postmenopause) women were included in this study. At the 28th follow-up examination, complete resolution of symptomatology was achieved in 578/615 (94.1%; p < 0.001) within 12.72 ± 6.55 and 13.22 ± 6.33 days for those of fertile age and in postmenopause, respectively (p = 0.342). All of the evaluated symptoms were significantly reduced after treatment (p = 0.001) without differences according to the patient’s menopausal status. A slightly significant reduction in Gardnerella Vaginalis (p = 0.040) and Candida Albicans (p = 0.049) was found after treatment. No patient reported side effects, adverse reactions, or discontinued therapy. Conclusions: This pilot study showed that a hydrogel based on Rigenase® (wheat extract) and polyhexanide could be a promising treatment for the relief of vulvovaginitis symptoms. However, these results are limited by the absence of a control group. Additional comparative and randomized controlled trials between the hydrogel and other non-antibiotic devices as well as local antibiotic therapy should be performed to increase the validity of the findings. Full article
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Review

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14 pages, 1963 KiB  
Review
Expanding Robotic-Assisted Surgery in Gynecology Using the Potential of an Advanced Robotic System
by Ibrahim Alkatout, Odile O’Sullivan, Göntje Peters and Nicolai Maass
Medicina 2024, 60(1), 53; https://doi.org/10.3390/medicina60010053 - 27 Dec 2023
Cited by 1 | Viewed by 1721
Abstract
Minimally invasive surgery (MIS) in gynecology was introduced to achieve the same surgical objectives as traditional open surgery while minimizing trauma to surrounding tissues, reducing pain, accelerating recovery, and improving overall patient outcomes. Minimally invasive approaches, such as laparoscopic and robotic-assisted surgeries, have [...] Read more.
Minimally invasive surgery (MIS) in gynecology was introduced to achieve the same surgical objectives as traditional open surgery while minimizing trauma to surrounding tissues, reducing pain, accelerating recovery, and improving overall patient outcomes. Minimally invasive approaches, such as laparoscopic and robotic-assisted surgeries, have become the standard for many gynecological procedures. In this review, we aim to summarize the advantages and main limitations to a broader adoption of robotic-assisted surgery compared to laparoscopic surgeries in gynecology. We present a new surgical system, the Dexter Robotic System™ (Distalmotion, Switzerland), that facilitates the transition from laparoscopy expertise to robotic-assisted surgery. Full article
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Other

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20 pages, 649 KiB  
Systematic Review
Exploring Surgical Strategies for Uterine Fibroid Treatment: A Comprehensive Review of Literature on Open and Minimally Invasive Approaches
by Stefano Cianci, Ferdinando Antonio Gulino, Vittorio Palmara, Marco La Verde, Carlo Ronsini, Paola Romeo, Sara Occhipinti, Giosuè Giordano Incognito, Vito Andrea Capozzi, Stefano Restaino, Giuseppe Vizzielli and Marco Palumbo
Medicina 2024, 60(1), 64; https://doi.org/10.3390/medicina60010064 - 28 Dec 2023
Cited by 4 | Viewed by 1656
Abstract
Background and Objectives: Uterine myomas represent one of the most prevalent pathologies affecting the female population. These benign neoplasms originate from the smooth muscular cells of the uterus, and they can be either single or multiple. Often associated with debilitating symptoms such as [...] Read more.
Background and Objectives: Uterine myomas represent one of the most prevalent pathologies affecting the female population. These benign neoplasms originate from the smooth muscular cells of the uterus, and they can be either single or multiple. Often associated with debilitating symptoms such as pelvic heaviness, pain, constipation, and urinary dysfunctions, the surgical management of myomectomy exhibits considerable variability. This diversity in approaches is influenced by factors such as the number and size of myomas, the patient’s age, and overall clinical conditions. This study aims to elucidate and compare the advantages and disadvantages of different surgical approaches, specifically endoscopic procedures versus open surgery, providing valuable insights for clinical decision making. Materials and Methods: A comprehensive bibliographic search spanning from 2013 to 2023 was systematically conducted across databases including Medline, Embase, the Cochrane Database of Systematic Reviews, and ClinicalTrials.gov. The search utilized keywords such as “myomectomy laparoscopic and open”, “myomectomy open and minimally invasive”, “myomectomy open and laparoscopic”, and “myomectomy open vs. laparoscopic.” The research methodology, along with predetermined inclusion and exclusion criteria, was established prior to the search, ensuring a systematic and rigorous approach. Subsequently, data analysis was carried out. Results: Following the study selection process, 25 articles met the eligibility criteria for inclusion in this analysis. The average numbers of myomas were 3.7 (ranging from 1 to 13.7) and 5.4 (ranging from 1 to 13.5) for the minimally invasive surgery and open surgery groups, respectively. In terms of myoma size, the total averages across studies were 7 cm (ranging from 4.8 to 14) for the minimally invasive group and 8 cm (ranging from 3.9 to 11.2) for the open surgery group. The average pregnancy and delivery rates were 29.7% (ranging from 1.8 to 100) for the minimally invasive group and 28.5% (ranging from 1.8 to 100) for the open surgery group. Regarding complications, the average rate was 14.2% (ranging from 0 to 50) for the endoscopic group and 22.3% (ranging from 0 to 60.3) for the laparotomic group. Conclusions: In conclusion, a critical factor influencing the choice of surgical approach is primarily the size and quantity of fibroids. The mini-laparotomic approach emerges as a viable alternative to endoscopy, demonstrating favorable surgical outcomes and aesthetic results. Interestingly, the type of surgical procedure appears to have no significant impact on the pregnancy rate. Full article
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