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Gynecologic Mini-Invasive Operations: Current Updates and Perspectives
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Gynecologic Mini-Invasive Operations: Current Updates and 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: 10 July 2024 | Viewed by 2395

Special Issue Editors

Dr. Matteo Frigerio

E-Mail Website
Guest Editor
Department of Obstetrics and Gynecology, Fondazione IRCCS San Gerardo dei Tintori, University Milano-Bicocca, Monza, Italy
Interests: urogynecology; pelvic floor; prolapse; incontinence; pelvic organ prolapse; pelvic floor surgery; stress incontinence; recurrent urinary tract infection; pelvic pain
Special Issues, Collections and Topics in MDPI journals
Dr. Marta Barba

E-Mail Website
Guest Editor Assistant
Department of Obstetrics and Gynecology, University of Milano-Bicocca, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
Interests: urogynecology; pelvic floor; prolapse; incontinence; pelvic organ prolapse; pelvic floor surgery; stress incontinence; recurrent urinary tract infection; pelvic pain

Special Issue Information

Dear Colleagues,

Minimally invasive surgery represents, when feasible, the approach of choice to reduce morbidity, complications and length of hospitalization. Additionally, offering the most effective and mini-invasive treatment options is of the utmost importance in gynecological surgery to protect women’s health . These involve endoscopy, laparoscopy, robotics, transvaginal procedures and natural orifice endoscopy.

Surgical advancements regard patients with oncologic and benign conditions, such as pelvic floor disorders, and they have an impact on the patients’ quality of life at different ages. The successful management of these conditions usually requires the work of a team of specialists, the contribution of new technologies, and mini-invasive surgical solutions to minimize complications and reduce postoperative recovery.

Nowadays, these new surgical approaches are offering unprecedented opportunities in the history of gynecological surgery, and it is our responsibility to share our experience and scientific data in order to offer our patients the best possible available management for their conditions. This Special Issue of the Journal of Clinical Medicine is dedicated to offering an overview of new minimally invasive gynecological surgical procedures for women's health. Groups from all specialties are encouraged to submit original research articles and reviews.

Dr. Matteo Frigerio
Guest Editor
Dr. Marta Barba
Guest Editor Assistant

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 100 words) can be sent to the Editorial Office for announcement on this website.

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

  • urogynecology
  • gynecology
  • pelvic floor medicine
  • surgical devices
  • surgery
  • laparoscopy
  • vaginal surgery
  • endoscopic surgery
  • oncology
  • isteroscopy
  • natural orifice endoscopy
  • pelvic reconstructive surgery
  • urinary incontinence

Published Papers (3 papers)

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11 pages, 2117 KiB  
Article
Quality of Life and Sexual Function after Laparoscopic Posterior Vaginal Plication Plus Sacral Colpopexy for Severe Posterior Vaginal Prolapse
by Andrea Morciano, Michele Carlo Schiavi, Matteo Frigerio, Giulio Licchetta, Andrea Tinelli, Mauro Cervigni, Giuseppe Marzo and Giovanni Scambia
J. Clin. Med. 2024, 13(2), 616; https://doi.org/10.3390/jcm13020616 - 22 Jan 2024
Viewed by 643
Abstract
Background: Laparoscopic sacral colpopexy (LSC) is the gold standard treatment for women with apical/anterior pelvic organ prolapse (POP). For isolated posterior vaginal prolapse, instead, the literature suggests fascial native tissue repair. This is a retrospective 2-year quality-of-life follow-up study after laparoscopic posterior plication [...] Read more.
Background: Laparoscopic sacral colpopexy (LSC) is the gold standard treatment for women with apical/anterior pelvic organ prolapse (POP). For isolated posterior vaginal prolapse, instead, the literature suggests fascial native tissue repair. This is a retrospective 2-year quality-of-life follow-up study after laparoscopic posterior plication (LPP) combined with LSC in patients with anterior/apical prolapse combined with severe posterior colpocele. The primary endpoint was to evaluate the subjective outcomes quality of life (QoL), sexual function, and patient satisfaction rate. The secondary endpoint was to evaluate perioperative and anatomical outcomes at the 2-year follow-up. Methods: A total of 139 consecutive patients with anterior and/or apical prolapse (POP-Q stage ≥ II) and severe posterior vaginal prolapse (posterior POP-Q stage ≥ III) were retrospectively selected from our database among women who underwent, from November 2018 to February 2021, a “two-meshes” LSC. The patients were classified into Group A (81 patients; LSC plus LPP) and Group B (67 patients; LSC alone). The primary endpoint was evaluated using the Patient Global Impression of Improvement (PGI-I), the Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6), the Pelvic Floor Impact Questionnaire-7 (PFIQ-7), the Female Sexual Distress Scale (FSDS), the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12), and the EuroQol (EQ-5D). The secondary endpoint was studied using the POP-Q study and an intra-, peri-, and post-operative complications assessment. Two-year follow-up data were analyzed for the study. Results: At 2 years, all women showed a statistically significant amelioration of their symptoms on the QoL questionnaires. We found a statistical difference in favor of posterior plication in terms of the PGI-I successful outcome rate (Group A versus B: 85.3% versus 67.1%), FSDS (median 11 versus 21), and PISQ-12 (median 89 versus 62) (p < 0.05 for all comparisons). A significant improvement of all EQ-5D values was observed from baseline to 2-year follow-up, and only for the “pain/discomfort” domains did we observe a significant improvement in LSC plus LPP patients versus LSC alone (p < 0.05). LSC plus LPP women showed, at 2 years, a significant amelioration of their Ap and GH POP-Q points. We observed no statistical differences in terms of intra-post-operative complications or anatomic failure rate between groups. Conclusions: Our LPP approach to LSC appears to be a safe, feasible, and effective treatment for advanced pelvic organ prolapse with a significant impact on the patient’s general health and sexual quality of life. Adding laparoscopic posterior vaginal plication to “two-meshes” sacral colpopexy is recommended in patients with apical/anterior prolapse and concomitant severe posterior colpocele. This surgical approach, in addition to improving the anatomical results of these patients, is associated with a significant improvement in sexual and quality of life indexes. Full article
(This article belongs to the Special Issue Gynecologic Mini-Invasive Operations: Current Updates and Perspectives)
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11 pages, 619 KiB  
Article
Applying the Modified Ten-Group Robson Classification in a Spanish Tertiary Hospital
by Serena Gutiérrez-Martínez, María Nélida Fernández-Martínez, José Manuel Adánez-García, Camino Fernández-Fernández, Beatriz Pérez-Prieto, Ana García-Gallego, Juan Gómez-Salgado, María Medina-Díaz and Daniel Fernández-García
J. Clin. Med. 2024, 13(1), 252; https://doi.org/10.3390/jcm13010252 - 31 Dec 2023
Viewed by 745
Abstract
Background: Caesarean section is necessary to save the lives of mothers and newborns at times, but it is important to perform it only when it is essential due to all the risks involved. This study aimed to examine the rate of caesarean sections [...] Read more.
Background: Caesarean section is necessary to save the lives of mothers and newborns at times, but it is important to perform it only when it is essential due to all the risks involved. This study aimed to examine the rate of caesarean sections performed at a tertiary hospital using the Robson classification to detect methods for the detection of and/or reduction in these caesarean section rates. Methods: A descriptive, cross-sectional study of a retrospective database was carried out. Results: A total of 10,317 births were assessed. The Robson classification was used to assess these interventions and verify whether the indication for performed caesarean sections was appropriate. In total, 2036 births by caesarean section were performed in the whole sample. The annual caesarean section rate varied between 18.67% and 21.18%. Conclusions: Caesarean sections increased by about 20% in 2021 compared to 2020 even though the trend over the years of study was decreasing. Vaginal delivery after caesarean section is a reasonable and safe option. Caesarean section rates could be improved, mostly in Robson’s Group 2. The Robson classification facilitated progress in the implementation of measures aimed at improving care and adjusting caesarean section rates. Full article
(This article belongs to the Special Issue Gynecologic Mini-Invasive Operations: Current Updates and Perspectives)
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13 pages, 1118 KiB  
Systematic Review
The Role of Adjuvant Therapy for the Treatment of Micrometastases in Endometrial Cancer: A Systematic Review and Meta-Analysis
by Carlo Ronsini, Stefania Napolitano, Irene Iavarone, Pietro Fumiento, Maria Giovanna Vastarella, Antonella Reino, Rossella Molitierno, Lugi Cobellis, Pasquale De Franciscis and Stefano Cianci
J. Clin. Med. 2024, 13(5), 1496; https://doi.org/10.3390/jcm13051496 - 05 Mar 2024
Viewed by 708
Abstract
Endometrial cancer is the most incident gynecological cancer. Lymph node dissemination is one of the most important factors for the patient’s prognosis. Pelvic lymph nodes are the primary site of extra-uterine dissemination in endometrial cancer (EC), setting the 5-year survival to 44–52%. It [...] Read more.
Endometrial cancer is the most incident gynecological cancer. Lymph node dissemination is one of the most important factors for the patient’s prognosis. Pelvic lymph nodes are the primary site of extra-uterine dissemination in endometrial cancer (EC), setting the 5-year survival to 44–52%. It is standard practice for radiation therapy (RT) and/or chemotherapy (CTX) to be given as adjuvant treatments to prevent the progression of micrometastases. Also, administration of EC patients with RT and/or CTX regimens before surgery may decrease micrometastases, hence the need for lymphadenectomy. The primary aim of the systematic review and meta-analysis is to assess whether adjuvant RT and/or CTX improve oncological outcomes through the management of micrometastases and nodal recurrence. We performed systematic research using the string “Endometrial Neoplasms” [Mesh] AND “Lymphatic Metastasis/therapy” [Mesh]. The methods for this study were specified a priori based on the recommendations in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Outcomes were 5-year overall survival, progression-free survival, recurrence rate, and complications rate. We assessed the quality of studies using the Newcastle–Ottawa Scale (NOS). A total of 1682 patients with stage I-to-IV EC were included. Adjuvant treatment protocols involved external-beam RT, brachytherapy, and CTX either alone or in combination. The no-treatment group showed a non-statistically significant higher recurrence risk than any adjuvant treatment group (OR 1.39 [95% CI 0.68–2.85] p = 0.36). The no-treatment group documented a non-statistically significant higher risk of death than those who underwent any adjuvant treatment (RR 1.47 [95% CI 0.44–4.89] p = 0.53; I2 = 55% p = 0.000001). Despite the fact that early-stage EC may show micrometastases, adjuvant treatment is not significantly associated with better survival outcomes, and the combination of EBRT and CTX is the most valid option in the early stages. Full article
(This article belongs to the Special Issue Gynecologic Mini-Invasive Operations: Current Updates and Perspectives)
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