Special Issue "Reproductive Surgery: Current Trends and Future Perspectives"

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

Deadline for manuscript submissions: 25 January 2024 | Viewed by 4274

Special Issue Editors

Unit of Gynecologic Oncology, ARNAS “Civico—Di Cristina—Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
Interests: women’s health; gynecological oncology; minimally invasive procedures; up-to-date management; gynecology; reproductive health; surgery
Special Issues, Collections and Topics in MDPI journals
1. School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
2. Department of Obstetrics and Gynecology, University Hospital Center, 10000 Zagreb, Croatia
Interests: gynecologic oncology; gynecologic surgical procedures; minimal invasive gynecological surgery; gynecology; hysteroscopy; urogynecology and female urology; pelvic reconstructive surgery; urogynecology; laparoscopic surgery; endometriosis
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

To date, reproductive surgery represents an important field of gynecology, aimed to preserve and restore the anatomy and functions of reproductive organs in both males and females. Indeed, several diseases such as endometriosis, adenomyosis, uterine fibroids, uterine malformations, pelvic inflammatory disease, and several other conditions may impair female fertility. These diseases are often found in women of reproductive age wishing to conceive; thus, fertility-sparing surgery is of paramount importance, and the surgeon dealing with them should be precisely trained for this purpose. In addition, the indications, timing, and techniques should be carefully evaluated and discussed with the patients, with or without subsequent assisted reproduction, especially using minimally invasive surgery (e.g., laparoscopy, robotic surgery, and hysteroscopy). In this regard, oocyte and ovarian tissue cryopreservation should be taken into account, especially when severe conditions, such as deep infiltrating endometriosis, are planned for surgical treatment. Finally, new perspectives are offered by novel approaches, from new instruments to innovative approaches such as uterine transplantation.

Considering these elements, the Special Issue “Reproductive surgery: current trends and future perspectives” aims to collect the most robust pieces of evidence about the topic and stimulate further discussion on future perspectives.

Dr. Antonio Simone Laganà
Dr. Mislav Mikuš
Guest Editors

Manuscript Submission Information

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Keywords

  • female infertility
  • male infertility
  • reproductive surgery
  • endometriosis
  • uterine fibroids
  • uterine malformations
  • pelvic inflammatory disease
  • fertility preservation
  • fertility-sparing surgery
  • minimally invasive surgery
  • laparoscopy
  • hysteroscopy
  • robotic surgery
  • assisted reproduction
  • oocyte cryopreservation
  • ovarian tissue cryopreservation
  • uterine transplantation

Published Papers (4 papers)

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Research

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Article
Does Hysteroscopic Dissection of Partial Uterine Septum Represent a Risk Factor for Placental Abnormalities in Subsequent Pregnancy Compared with Controls Undergoing Other Hysteroscopic Surgery? Results from a Large Case–Control Analysis
J. Clin. Med. 2023, 12(1), 177; https://doi.org/10.3390/jcm12010177 - 26 Dec 2022
Cited by 2 | Viewed by 1236
Abstract
Background: Hysteroscopic septum dissection (HSD) is thought to improve fertility and pregnancy outcomes. However, the available literature suggests that uterine surgery can cause placental abnormalities in subsequent pregnancies. Methods: A case–control study was performed at the University Medical Center of Ljubljana, Department of [...] Read more.
Background: Hysteroscopic septum dissection (HSD) is thought to improve fertility and pregnancy outcomes. However, the available literature suggests that uterine surgery can cause placental abnormalities in subsequent pregnancies. Methods: A case–control study was performed at the University Medical Center of Ljubljana, Department of Human Reproduction, from 1 January 2016 to 31 December 2018. The primary outcome was the association between HSD and the occurrence of placental abnormalities. We included women who underwent HSD due to infertility. Age-matched women who underwent hysteroscopic surgery for other issues were considered as controls. In addition, we divided the groups according to conception method. Only singleton pregnancies and first delivery were considered. Results: A total of 1286 women (746 who underwent HSD and 540 controls) were included in the analysis. HSD had no influence on placental abnormalities since the ratio was comparable regardless of the method of conception (113/746 vs. 69/540; p = 0.515). Infertile women who conceived naturally after HSD had a normal placentation rate comparable to women who did not undergo HSD (380/427 vs. 280/312; p = 0.2104). The rate of placental abnormalities in women who achieved pregnancy with IVF/ICSI procedures following HSD was comparable to that of women who did not undergo HSD (52/319 vs. 33/228; p = 0.5478). Placenta previa occurred significantly more often in infertile women without HSD after IVF/ICSI compared to natural conception (2/312 vs. 7/228; p = 0.0401). Conclusions: HSD was not associated with higher rate of placental abnormalities in the first singleton pregnancy compared with other hysteroscopic procedures. A higher rate of placenta previa in pregnancies following IVF/ICSI procedures, which was shown by our research, is corroborated by previous research findings. Full article
(This article belongs to the Special Issue Reproductive Surgery: Current Trends and Future Perspectives)
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Review

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Review
An Overview of Postoperative Intraabdominal Adhesions and Their Role on Female Infertility: A Narrative Review
J. Clin. Med. 2023, 12(6), 2263; https://doi.org/10.3390/jcm12062263 - 15 Mar 2023
Cited by 4 | Viewed by 1397
Abstract
Postoperative intraabdominal adhesions can occur after more than 90% of gynecologic surgeries. They not only cause chronic pelvic pain and small bowel obstruction, but are also one of the main reasons for infertility. Adhesions are not only a burden for the affected patients, [...] Read more.
Postoperative intraabdominal adhesions can occur after more than 90% of gynecologic surgeries. They not only cause chronic pelvic pain and small bowel obstruction, but are also one of the main reasons for infertility. Adhesions are not only a burden for the affected patients, but are also a burden for the healthcare system, since the treatment of adhesion-associated complications costs a considerable amount of money. The gold standard for the diagnosis of adhesions is by laparoscopy, although other methods, such as transvaginal hydro-laparoscopy, are being discussed as better alternatives. Ideally, adhesions are avoided inherently, by operating carefully and by using microsurgical principles. If this is not possible, gel barriers have been shown to be successful in reducing postoperative adhesions. Full article
(This article belongs to the Special Issue Reproductive Surgery: Current Trends and Future Perspectives)

Other

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Case Report
A Clinical and Ethical Dilemma: Expectant Management for Ectopic Pregnancy with a Vital Fetus in a Low-Resource Setting
J. Clin. Med. 2023, 12(17), 5642; https://doi.org/10.3390/jcm12175642 - 30 Aug 2023
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Abstract
Background: Guidelines recommend the prompt surgical removal of any ectopic pregnancy (EP) in the presence of a vital embryo. This treatment impacts future fertility, particularly in low-resource settings where access to assisted reproductive techniques is limited. In addition, growing evidence is reporting live [...] Read more.
Background: Guidelines recommend the prompt surgical removal of any ectopic pregnancy (EP) in the presence of a vital embryo. This treatment impacts future fertility, particularly in low-resource settings where access to assisted reproductive techniques is limited. In addition, growing evidence is reporting live births after conservative management of initially undiagnosed abdominal pregnancies. Therefore, the discussion on the acceptability of expectant management in selected cases has been recently raised. Case: We present and discuss the case of a woman with vital first trimester EP who refused surgical treatment at Princess Christian Maternity Hospital, Freetown, Sierra Leone. She was initially diagnosed with a 12 week pregnancy located in the left adnexal region without hemoperitoneum. She refused both surgical treatment and hospital admission and did not come back to the hospital for antenatal care until 26 weeks of gestational age. Therefore, she was admitted and finally delivered, at 34 weeks of gestation, a 1.9 kg healthy baby which was alive. To disentangle the potential conflict between the ethical principles of medical treatment’s beneficence and the patient’s autonomy, we provide an update on counselling for a patient with early vital EP in a resource-limited setting and discuss the knowledge gap in this area. Conclusions: Limited access to fertility treatment in low- and middle-income countries may justify the discussion of expectant management as an option in selected cases of uncomplicated vital EP. Full article
(This article belongs to the Special Issue Reproductive Surgery: Current Trends and Future Perspectives)
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Systematic Review
Feasibility and Surgical Outcomes of Hysteroscopic Myomectomy of FIGO Type 3 Myoma: A Systematic Review
J. Clin. Med. 2023, 12(15), 4953; https://doi.org/10.3390/jcm12154953 - 27 Jul 2023
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Abstract
The latest classification from the Fédération Internationale de Gynécologie et d’Obstétrique (FIGO) has reclassified type 3 myomas, changing their classification from intramural to submucosal. While hysteroscopic myomectomy is considered the gold standard treatment for patients experiencing symptoms from submucosal myomas, there are currently [...] Read more.
The latest classification from the Fédération Internationale de Gynécologie et d’Obstétrique (FIGO) has reclassified type 3 myomas, changing their classification from intramural to submucosal. While hysteroscopic myomectomy is considered the gold standard treatment for patients experiencing symptoms from submucosal myomas, there are currently no specific guidelines available for managing type 3 myomas, and the optimal surgical approach remains uncertain. Methods: The search for suitable articles published in English was carried out using the following databases (PROSPERO ID CRD42023418602): MEDLINE, EMBASE, Global Health, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register), Health Technology Assessment Database, Web of Science and search register. Only original studies reporting data on hysteroscopic myomectomy of type 3 myoma were considered eligible. The main outcomes investigated were the effectiveness and feasibility of hysteroscopic myomectomy and reproductive outcomes after surgical treatment. Results: Two hundred and sixty-one studies were screened and nineteen of these were read for eligibility. Three studies encompassing 56 patients in total were included. Among the overall population studied, three patients needed an additional procedure to completely remove the myoma and five cases of post-surgical synechiae were recorded. No complications were reported. Of 42 patients wishing for pregnancy, the cumulative live birth rates before and after the hysteroscopic myomectomy were 14.3% and 42.9%, respectively. Conclusions: Hysteroscopic myomectomy appears to be a safe and feasible approach. Nevertheless, data reported in the literature are extremely scarce and based on studies with few patients enrolled. New evidence is needed to assess the safety and effectiveness of hysteroscopic treatment for FIGO type 3 myomas. Full article
(This article belongs to the Special Issue Reproductive Surgery: Current Trends and Future Perspectives)
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