Challenges and Controversies in Minimally Invasive Surgery: What Is Really New in 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: 24 May 2024 | Viewed by 35574

Special Issue Editors


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Guest Editor
Inter-Departmental Project Unit of "Minimally-Invasive Gynecologic Surgery", Integrated Department of Medicine (D.I.M.), University of Bari "Aldo Moro", Bari, Italy
Interests: minimally invasive surgery; hysteroscopy; gynecologic surgery; endometriosis; endoscopy; fertility sparing surgery; sterility; laparoscopy

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Guest Editor
Clinic of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology, Pius-Hospital Oldenburg, Carl von Ossietzky University of Oldenburg, Georgstreet 12, 26121 Oldenburg, Germany
Interests: reproductive surgery; oncological surgery; minimal-access surgery; endometriosis surgery; gynecological surgery
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Special Issue Information

Dear Colleagues,

Our future consists of exciting, new emerging technologies, which are making surgery even more efficient, exciting, and safe due to faster recoveries, reduced pain, and fewer adverse events, thus reducing costs and improving outcomes.

The requirements for tailored treatments and quality of life are gradually increasing: women care about treatment results, but also demand for less collateral damage to their body image.

Minimally invasive surgery (MIS) plays a crucial role in gynecology as an alternative to traditional open surgery as well as traditional laparoscopic techniques. MIS nowadays includes: natural orifice endoscopic surgery (NOTES), single-port laparoscopy, office hysteroscopy, robotic platforms equipped with stereotactic 3D immersive and ergonomic handles, intraoperative ultrasound (IOUS), etc., for both benign gynecology and in gynecological oncology, even for complex gynecological procedures.

The technological progress and adoption of some innovations in the last decade have, however, not been uniform.

My aim as Guest Editor for this Special Issue is to provide a full immersion in the most promising innovations in the landscape of minimally invasive gynecologic surgery, collecting experiences from our friends and colleagues running the best centers worldwide with expertise in the field.

Dr. Stefano Bettocchi
Prof. Dr. Rudy Leon de Wilde
Guest Editor

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Keywords

  • gynecology
  • endometriosis
  • quality of life
  • fertility sparing surgery
  • gynecology
  • laparoscopy
  • hysteroscopy
  • robotic surgery
  • gynecologic cancer
  • oncology

Published Papers (13 papers)

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Research

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11 pages, 787 KiB  
Article
The Effect of Virtual Reality on the Reduction of Pain in Women with an Indication for Outpatient Diagnostic Hysteroscopy: A Randomized Controlled Trial
by Jesus A. Pelazas-Hernández, David Varillas-Delgado, Teresa González-Casado, Ignacio Cristóbal-Quevedo, Agustina Alonso-Bermejo, Marina Ronchas-Martínez and Ignacio Cristóbal-García
J. Clin. Med. 2023, 12(11), 3645; https://doi.org/10.3390/jcm12113645 - 24 May 2023
Cited by 5 | Viewed by 1555
Abstract
Background: The cognitive distraction caused by Virtual Reality (VR) seems to cause a decrease both in pain and its perception as in the time spent thinking about possible pain, among anxiety about hysteroscopy procedure. The main objective of this investigation was to evaluate [...] Read more.
Background: The cognitive distraction caused by Virtual Reality (VR) seems to cause a decrease both in pain and its perception as in the time spent thinking about possible pain, among anxiety about hysteroscopy procedure. The main objective of this investigation was to evaluate the efficacy of virtual reality for pain relief during outpatient hysteroscopy. Method: A total of 83 patients underwent outpatient diagnostic hysteroscopy in a single-centre, open-label, randomized control trial. Overall, 180 women with medical indication for an outpatient diagnostic hysteroscopy were randomized. Ten were excluded due to the impossibility of entering the endometrial cavity caused by a cervical canal that was not permeable, and 15 did not tolerate the pain at the beginning and during the procedure, excluding themselves from the final model. Finally, 154 were analysed per protocol to use VR (n = 82, study group) or standard treatment (n = 72, control group) assessing the differences between both groups by reduction in pain using Visual Analogue Scale score (VAS: 0–10 cm) and clinical data (arterial pressure, heart rate, and oxygen saturation) at the end of hysteroscopy, at 15 and 30 min after hysteroscopy. Results: Women with VR outpatient diagnostic hysteroscopy experienced less pain at final (VAS score 2.451 vs. 3.972, standard mean difference (SMD) −1.521, 95% CI −2.601 to −0.440; p = 0.006), at 15 min (VAS 1.769 vs. 3.300, SMD −1.531, 95% CI −2.557 to −0.504; p = 0.004), and at 30 min (VAS 1.621 vs. 2.719, SMD −1.099, 95% CI −2.166 to −0.031; p = 0.044) after the ending of the hysteroscopy, compared with no VR. Conclusions: The use of VR during outpatient diagnostic hysteroscopy proved effective in the reduction of pain in this randomized control trial. It shows wide potential role in ambulatory gynaecologic procedures to avoid repeating tests, perform surgeries without anaesthesia, and the use of medication and its side effects. Full article
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9 pages, 544 KiB  
Article
New Insights on the Minimal-Invasive Therapy of Cervical Cancer
by Khayal Gasimli, Lisa Wilhelm, Sven Becker, Rudy Leon De Wilde and Morva Tahmasbi Rad
J. Clin. Med. 2022, 11(16), 4919; https://doi.org/10.3390/jcm11164919 - 22 Aug 2022
Viewed by 1544
Abstract
Objective: The ideal management of early-stage cervical cancer has become the subject of a global controversy following the publication of a prospective study in 2018 that reported a worse oncologic outcome when comparing the minimally invasive approach to the laparotomy approach. The discussion [...] Read more.
Objective: The ideal management of early-stage cervical cancer has become the subject of a global controversy following the publication of a prospective study in 2018 that reported a worse oncologic outcome when comparing the minimally invasive approach to the laparotomy approach. The discussion involves both prospective and retrospective data and general and theoretical considerations. We wanted to look at the data available today and review the different opinions, offering an impartial assessment of the ongoing controversy. Methods: The available literature was reviewed, focusing on articles arguing for and against minimally invasive surgery in cervical cancer. We tried to avoid any fundamental bias, as is often evident in the available reviews on the subject. Literature both before and after the 2018 publication was taken into consideration. Results: As is usual in discussions of concepts, the literature that is now available provides arguments for both sides of this challenging issue, depending on one’s standpoint. Science-related writing is not immune to trends. There is a curious shift in opinion seen before and after 2018. One must question whether there was a prejudice in favor of minimally invasive surgery prior to the publication of the NEJM articles and a bias against it afterward. Conclusion: Whether further minimally invasive surgery for cervical cancer is invariable is tied to the more pressing question of how this surgery will have to be centralized in the future. Unless these questions are linked, no satisfactory solution can be found. Full article
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8 pages, 1668 KiB  
Article
To Laparoscopically Preserve Fertility in Intraabdominal Giant Myoma with Application of Contained In-Bag Morcellation: Mission Impossible?
by Rajesh Devassy, Luz Angela Torres-de la Roche, Johannes San Juan, Harald Krentel, Sven Becker, Rudy Leon De Wilde and Amr Soliman
J. Clin. Med. 2022, 11(15), 4531; https://doi.org/10.3390/jcm11154531 - 3 Aug 2022
Viewed by 1944
Abstract
A technical video was produced to demonstrate in step-by-step fashion a multiple contained myomectomy of a 20 × 30 cm giant myoma and seven additional fibroids found in the same patient, which required two different types of specimen retrieval bags for the electronic [...] Read more.
A technical video was produced to demonstrate in step-by-step fashion a multiple contained myomectomy of a 20 × 30 cm giant myoma and seven additional fibroids found in the same patient, which required two different types of specimen retrieval bags for the electronic power morcellation. This complete surgical procedure included leiomyomata enucleation, contained in-bag electronic power morcellation, uterine reconstruction and the application of an adhesion prophylactic medical product. Full article
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10 pages, 8871 KiB  
Article
Laparoscopic Fluorescence Guided Detection of Uterine Niche—The Next Step in Surgical Diagnosis and Treatment
by Harald Krentel, Lisa-Kathrin Lauterbach, Georgios Mavrogiannis and Rudy Leon De Wilde
J. Clin. Med. 2022, 11(9), 2657; https://doi.org/10.3390/jcm11092657 - 9 May 2022
Cited by 7 | Viewed by 5525
Abstract
(1) Background: Uterine niche is a frequent condition in patients with a history of cesarean section. Although the relation to uterotomy seems to be clear, the exact pathogenesis is not fully understood. Uterine niche can easily be diagnosed by transvaginal ultrasound. It can [...] Read more.
(1) Background: Uterine niche is a frequent condition in patients with a history of cesarean section. Although the relation to uterotomy seems to be clear, the exact pathogenesis is not fully understood. Uterine niche can easily be diagnosed by transvaginal ultrasound. It can be related to symptoms like dysmenorrhea, bleeding disorders, dysuria and dyspareunia. Uterine niche can be the cause of scar pregnancy, a rare form of ectopic pregnancy which can be related to severe complications; (2) Methods: We present a series of nine cases with different uterine niche related findings and discuss the diagnostic and therapeutic options reviewing the current literature and introduce a novel intrauterine ICG use for laparoscopic niche detection in one case; (3) Results: Most of uterine niche related symptoms and complications can be treated by a minimally invasive approach. Laparoscopic fluorescence guided niche detection is feasible; (4) Conclusions: Hysteroscopic and laparoscopic techniques allow the treatment of uterine niche related symptoms and complications. Intrauterine ICG application during fluorescence guided laparoscopy may allow easy niche detection. Full article
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14 pages, 5246 KiB  
Article
Ultrasound-Guided Tru-Cut Biopsy in Gynecological and Non-Gynecological Pelvic Masses: A Single-Center Experience
by Francesca Buonomo, Sofia Bussolaro, Clarice de Almeida Fiorillo, Danilo Oliveira de Souza, Fabiola Giudici, Federico Romano, Andrea Romano and Giuseppe Ricci
J. Clin. Med. 2022, 11(9), 2534; https://doi.org/10.3390/jcm11092534 - 30 Apr 2022
Cited by 3 | Viewed by 2718
Abstract
Aim: The aim of this study was to evaluate the feasibility of adequacy, accuracy, and safety of ultrasound-guided tru-cut biopsy in managing malignant and benign abdominopelvic masses in a selected population and critically discuss some issues in different situations, which deserve some reflections [...] Read more.
Aim: The aim of this study was to evaluate the feasibility of adequacy, accuracy, and safety of ultrasound-guided tru-cut biopsy in managing malignant and benign abdominopelvic masses in a selected population and critically discuss some issues in different situations, which deserve some reflections on those practices. Materials and Methods: This is a retrospective study involving 42 patients who underwent transvaginal or transabdominal tru-cut biopsy between August 2017 and November 2021. The inclusion criteria were poor health status or primary inoperable advanced tumor, suspicion of recurrence or metastasis to the ovaries or peritoneum in gynecological and non-gynecological pelvic malignancies. Tissue samples were considered adequate if it was possible to determine the origin of the tumor, and immunohistochemistry could be performed. Diagnostic accuracy was assessed considering the agreement between tru-cut biopsy histology and final postoperative histology. Results: It total, 44 biopsies were obtained from 42 patients (2 patients had repeat biopsies). The pathologist considered all pathological samples adequate (adequacy 100%). The final histology was consistent with tru-cut biopsy diagnosis in all but 2 cases (diagnostic accuracy 88.2%). If we consider only the cases that have carried out at least two diagnostic samples, accuracy rose to 94.1%. Pathological examinations from tru-cut samples showed 2 benign lesions (4.8%) and 40 malignant tumors (95.2%), divided into 19 advanced primary inoperable ovarian cancers, 7 primary advanced cervical cancers, 4 recurrent endometrial cancers, 3 recurrent cervical cancers, 3 recurrent ovarian cancers, 1 case of primitive peritoneal malignancy (leiomyosarcoma), and 3 non-gynecological cancers with a strong suspicion of metastases at ultrasound (2 cases of ovarian, colorectal cancer metastasis, and 1 case of pelvic site type B lymphoma metastasis). However, one case of minor complication related to the procedure was reported but not significant. Conclusions: The diagnostic adequacy, accuracy of the tru-cut biopsy, and safety were high. Pathological samples are representative of the disease and suitable for histological and immunohistochemical analysis. Full article
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9 pages, 1000 KiB  
Article
The Future of Adhesion Prophylaxis Trials in Abdominal Surgery: An Expert Global Consensus
by Rudy Leon De Wilde, Rajesh Devassy, Richard P. G. ten Broek, Charles E. Miller, Aizura Adlan, Prudence Aquino, Sven Becker, Ferry Darmawan, Marco Gergolet, Maria Antonia E. Habana, Chong Kiat Khoo, Philippe R. Koninckx, Matthias Korell, Harald Krentel, Olarik Musigavong, George Pistofidis, Shailesh Puntambekar, Ichnandy A. Rachman, Fatih Sendag, Markus Wallwiener and Luz Angela Torres-de la Rocheadd Show full author list remove Hide full author list
J. Clin. Med. 2022, 11(6), 1476; https://doi.org/10.3390/jcm11061476 - 8 Mar 2022
Cited by 12 | Viewed by 4244
Abstract
Postoperative adhesions represent a frequent complication of abdominal surgery. Adhesions can result from infection, ischemia, and foreign body reaction, but commonly develop after any surgical procedure. The morbidity caused by adhesions affects quality of life and, therefore, it is paramount to continue to [...] Read more.
Postoperative adhesions represent a frequent complication of abdominal surgery. Adhesions can result from infection, ischemia, and foreign body reaction, but commonly develop after any surgical procedure. The morbidity caused by adhesions affects quality of life and, therefore, it is paramount to continue to raise awareness and scientific recognition of the burden of adhesions in healthcare and clinical research. This 2021 Global Expert Consensus Group worked together to produce consented statements to guide future clinical research trials and advise regulatory authorities. It is critical to harmonize the expectations of research, to both develop and bring to market improved anti-adhesion therapies, with the ultimate, shared goal of improved patient outcomes. Full article
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7 pages, 2029 KiB  
Article
An Innovative Minimally Invasive Oncoplastic Technique for Early Breast Cancer: The Spoon-Shape Technique
by Zhilin Chen, Xuefeng Shi, Wenjie Shi, Zihao Chen, Jiajia Zeng, Jie Dong, Rui Zhuo and Rudy Leon De Wilde
J. Clin. Med. 2022, 11(5), 1379; https://doi.org/10.3390/jcm11051379 - 2 Mar 2022
Viewed by 2118
Abstract
Here, we describe a step-by-step novel level I oncoplastic technique and present the aesthetic results of 58 breast cancer patients who underwent the spoon-shape technique for primary tumor resection. The Paris Breast Center’s 5-point scale was used to evaluate the aesthetic outcomes. The [...] Read more.
Here, we describe a step-by-step novel level I oncoplastic technique and present the aesthetic results of 58 breast cancer patients who underwent the spoon-shape technique for primary tumor resection. The Paris Breast Center’s 5-point scale was used to evaluate the aesthetic outcomes. The median age of the participants was 52 years old. The average size of the resected tumor was 22.1 mm; two intraoperative re-excisions were required due to positive margins. Postoperative localized seroma was observed in four patients, and one patient presented signs of wound infection. Skin flap necrosis and fat liquefaction were not observed. The average aesthetic score was 4.86. None of the patients presented cancer recurrence in the following two years. The spoon-shape technique showed good aesthetic results because it provided the surgeons an adequate amount of surrounding tissue from which to reshape the breast after tumor removal. We encourage surgeons to apply this approach in early-stage breast cancer, regardless of the quadrant where the tumor is located. Full article
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12 pages, 2540 KiB  
Article
Chemically Modified Hyaluronic Acid for Prevention of Post-Surgical Adhesions: New Aspects of Gel Barriers Physical Profiles
by Luz Angela Torres-de la Roche, Véronique Bérard, Maya Sophie de Wilde, Rajesh Devassy, Markus Wallwiener and Rudy Leon De Wilde
J. Clin. Med. 2022, 11(4), 931; https://doi.org/10.3390/jcm11040931 - 11 Feb 2022
Cited by 2 | Viewed by 2487
Abstract
This study was conducted to provide information regarding the chemistry—including structure, synthesis, formulation, and mechanical properties—of two types of chemically modified anti-adhesion gels made of hyaluronic acid. Gel A (Hyalobarrier®) and gels B and C (HyaRegen® and MetaRegen®) [...] Read more.
This study was conducted to provide information regarding the chemistry—including structure, synthesis, formulation, and mechanical properties—of two types of chemically modified anti-adhesion gels made of hyaluronic acid. Gel A (Hyalobarrier®) and gels B and C (HyaRegen® and MetaRegen®) that are used in postsurgical adhesion prevention. To date, little information is available on their physicochemical attributes. This information is necessary in order to understand the differences in their in vivo behavior. Methods: Comparative analyses were conducted under laboratory-controlled conditions, including measuring the shear viscosity, storage modulus G’, peel strength, and extrusion forces. Results: All polymers exhibited viscoelastic behavior. Polymer A showed a shear viscosity approximately three times larger than both polymers B and C (114 Pa.s−1 vs. 36–38 Pa.s−1) over the shear-rate range measured, indicating a possible better ability to resist flows and potentially remain in place at the site of application in vivo. The results of storage modulus (G’) measurements showed 100 Pa for polymer A and 16 Pa and 20 Pa for polymers B and C, respectively. This translated into a weaker elastic behavior for gels B and C, and a lower ability to resist sudden deformation. The peel test results showed a rupture strength of 72 mN (0.016 lbf) for polymer A, 39.6 mN (0.0089 lbf) for polymer B, and 38.3 mN (0.0086 lbf) for polymers C, indicating possible higher adhesive properties for polymer A. Tests measuring the extrudability of the hyaluronic acid gels in their commercial syringes showed an average extrusion force of 20 N (4.5 lbf) for polymer A, 28 N (6.33 lbf) for polymer B, and 17 N (3.79 lbf) for polymer C. Conclusions: Modified anti-adhesion gels made of hyaluronic acid differed in mechanical properties and concentration. Further clinical studies are needed to confirm whether these differences make one polymer easier to apply during surgery and more likely to stay in place longer after in vivo application, and to determine which is potentially superior in terms of preventing adhesions. Full article
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Review

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16 pages, 380 KiB  
Review
The Future in Standards of Care for Gynecologic Laparoscopic Surgery to Improve Training and Education
by Vlad I. Tica, Andrei A. Tica and Rudy L. De Wilde
J. Clin. Med. 2022, 11(8), 2192; https://doi.org/10.3390/jcm11082192 - 14 Apr 2022
Cited by 2 | Viewed by 1927
Abstract
Standards of care offer doctors and patients the confidence that an established quality, evidence-based, care is provided, and represent a tool for optimal responding to the population’s needs. It is expected that they will increasingly express a multimodal relationship with gynecologic laparoscopy. Laparoscopy [...] Read more.
Standards of care offer doctors and patients the confidence that an established quality, evidence-based, care is provided, and represent a tool for optimal responding to the population’s needs. It is expected that they will increasingly express a multimodal relationship with gynecologic laparoscopy. Laparoscopy is, now, a standard procedure in operative gynecology, standards are embedded in many laparoscopic procedures, standardization of the skills/competency assessment has been progressively developed, and the proof of competency in laparoscopy may become a standard of care. A continuous development of surgical education includes standard equipment (that may bring value for future advance), standardized training, testing (and performance) assessment, educational process and outcome monitoring/evaluation, patients’ care, and protection, etc. Standards of care and training have a reciprocally sustaining relationship, as training is an essential component of standards of care while care is provided at higher standards after a structured training and as credentialing/certification reunites the two. It is envisaged that through development and implementation, the European wide standards of care in laparoscopic surgery (in close harmonization with personalized medicine) would lead to effective delivery of better clinical services and provide excellent training and education. Full article
13 pages, 528 KiB  
Review
Is Computer-Assisted Tissue Image Analysis the Future in Minimally Invasive Surgery? A Review on the Current Status of Its Applications
by Vasilios Tanos, Marios Neofytou, Ahmed Samy Abdulhady Soliman, Panayiotis Tanos and Constantinos S. Pattichis
J. Clin. Med. 2021, 10(24), 5770; https://doi.org/10.3390/jcm10245770 - 9 Dec 2021
Cited by 2 | Viewed by 1928
Abstract
Purpose: Computer-assisted tissue image analysis (CATIA) enables an optical biopsy of human tissue during minimally invasive surgery and endoscopy. Thus far, it has been implemented in gastrointestinal, endometrial, and dermatologic examinations that use computational analysis and image texture feature systems. We review and [...] Read more.
Purpose: Computer-assisted tissue image analysis (CATIA) enables an optical biopsy of human tissue during minimally invasive surgery and endoscopy. Thus far, it has been implemented in gastrointestinal, endometrial, and dermatologic examinations that use computational analysis and image texture feature systems. We review and evaluate the impact of in vivo optical biopsies performed by tissue image analysis on the surgeon’s diagnostic ability and sampling precision and investigate how operation complications could be minimized. Methods: We performed a literature search in PubMed, IEEE, Xplore, Elsevier, and Google Scholar, which yielded 28 relevant articles. Our literature review summarizes the available data on CATIA of human tissues and explores the possibilities of computer-assisted early disease diagnoses, including cancer. Results: Hysteroscopic image texture analysis of the endometrium successfully distinguished benign from malignant conditions up to 91% of the time. In dermatologic studies, the accuracy of distinguishing nevi melanoma from benign disease fluctuated from 73% to 81%. Skin biopsies of basal cell carcinoma and melanoma exhibited an accuracy of 92.4%, sensitivity of 99.1%, and specificity of 93.3% and distinguished nonmelanoma and normal lesions from benign precancerous lesions with 91.9% and 82.8% accuracy, respectively. Gastrointestinal and endometrial examinations are still at the experimental phase. Conclusions: CATIA is a promising application for distinguishing normal from abnormal tissues during endoscopic procedures and minimally invasive surgeries. However, the efficacy of computer-assisted diagnostics in distinguishing benign from malignant states is still not well documented. Prospective and randomized studies are needed before CATIA is implemented in clinical practice. Full article
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19 pages, 1441 KiB  
Review
Hysterolaparoscopy: A Gold Standard for Diagnosing and Treating Infertility and Benign Uterine Pathology
by Valentin Varlas, Yassin Rhazi, Eliza Cloțea, Roxana Georgiana Borș, Radu Mihail Mirică and Nicolae Bacalbașa
J. Clin. Med. 2021, 10(16), 3749; https://doi.org/10.3390/jcm10163749 - 23 Aug 2021
Cited by 7 | Viewed by 3888
Abstract
Background: Combined hysteroscopy and laparoscopy is a valuable method for diagnosing and treating infertility and benign uterine pathology. Both procedures are minimally invasive, reliable, and safe, with a low complication rate. Aim: In this review, we expose the efficiency and safety of hysterolaparoscopy [...] Read more.
Background: Combined hysteroscopy and laparoscopy is a valuable method for diagnosing and treating infertility and benign uterine pathology. Both procedures are minimally invasive, reliable, and safe, with a low complication rate. Aim: In this review, we expose the efficiency and safety of hysterolaparoscopy in the management of infertility and other benign uterine pathologies. Method: We performed a systematic literature review on several databases: PubMed®/MEDLINE, PMC, Crossref.org, and Web of Science in the last 10 years. Inclusion criteria: Women of reproductive age with primary or secondary infertility and/or benign uterine pathology. Exclusion criteria: pre-puberty, menopause, couple with male infertility. Conclusion: Hysterolaparoscopy is a useful tool to assess infertility and simultaneously diagnose and treat pelvic and uterine lesions. Full article
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Other

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9 pages, 257 KiB  
Opinion
Hysteroscopic Findings and Operative Treatment: All at Once?
by Valentina D’Urso, Ferdinando Antonio Gulino, Giosuè Giordano Incognito, Monia Cimino, Valentina Dilisi, Alessandra Di Stefano, Marianna Gulisano, Francesco Cannone, Stella Capriglione and Marco Palumbo
J. Clin. Med. 2023, 12(13), 4232; https://doi.org/10.3390/jcm12134232 - 23 Jun 2023
Cited by 4 | Viewed by 976
Abstract
Hysteroscopy is considered not only a diagnostic instrument but also a therapeutic tool for many uterine pathologies. In the early 1990s, advances in technology and techniques made hysteroscopy less painful and invasive, allowing to increase in the number of gynecological procedures performed in [...] Read more.
Hysteroscopy is considered not only a diagnostic instrument but also a therapeutic tool for many uterine pathologies. In the early 1990s, advances in technology and techniques made hysteroscopy less painful and invasive, allowing to increase in the number of gynecological procedures performed in an ambulatory setting without significant patient discomfort and with potentially significant cost savings. This is the so-called “office hysteroscopy” or “see-and-treat hysteroscopy”, whose spread has permitted the decrease of the number of procedures performed in the operating room with the benefit of obviating the need for anesthesia and dilatation of the cervical canal. Full article
21 pages, 665 KiB  
Opinion
Should Ultrasound-Guided High Frequency Focused Ultrasound Be Considered as an Alternative Non-Surgical Treatment of Uterine Fibroids in Non-Asiatic Countries? An Opinion Paper
by Luz Angela Torres-de la Roche, Sarah Rafiq, Rajesh Devassy, Hugo Christian Verhoeven, Sven Becker and Rudy Leon De Wilde
J. Clin. Med. 2022, 11(3), 839; https://doi.org/10.3390/jcm11030839 - 5 Feb 2022
Cited by 6 | Viewed by 2837
Abstract
Minimally invasive interventions for myomata treatment have gained acceptance due to the possibility of preserving fertility with reduced trauma induced by laparotomy as way of entrance. There are insufficient data regarding outcomes of high intensity focused ultrasound (HIFU) in non-Asiatic women. Therefore, we [...] Read more.
Minimally invasive interventions for myomata treatment have gained acceptance due to the possibility of preserving fertility with reduced trauma induced by laparotomy as way of entrance. There are insufficient data regarding outcomes of high intensity focused ultrasound (HIFU) in non-Asiatic women. Therefore, we revised the available evidence to present an expert opinion that could support physicians, patients and policy-makers for considering this approach in other populations. We revisited systematic reviews, randomized controlled trials and cohort studies from January 2018 to August 2021 using PubMed and Google scholar, regarding short and long term outcomes after ablation with focused ultrasound waves. In total, 33 studies, including 114,810 adult patients showed that outcomes of this approach depend on several parameters directly related with resistance to thermal ablation, especially fibroid size and vascularization. Two studies report satisfactory outcomes in Afro-American women. In accordance to the technique used, fibroid volume reduction showed to be higher in fibroids <300 cm3 after ultrasound guided HIFU than after MRI guided. Compared to myomectomy and uterine artery embolization, HIFU seems to have shorter hospital stay, higher pregnancy rates and similar adverse events rates, with skin burn being the most reported. Symptoms and quality of life improvement is similar to myomectomy but lower than embolization, however reintervention rate is higher after HIFU. Lacks evidence about long-term sarcoma risk after ablation. Available evidence shows that HIFU can be considered as a uterine sparing treatment for women of different ethnicities suffering of uterine myomatosis, especially for those wishing to preserve their fertility. Full article
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