New Advances in Gynecological Surgery

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

Deadline for manuscript submissions: closed (20 February 2023) | Viewed by 3958

Special Issue Editors

Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
Interests: gynecological surgery; hysteroscopy; laparoscopy; endometriosis; gynecological oncology; urogynecology
Special Issues, Collections and Topics in MDPI journals
Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
Interests: laparoscopic surgery; hysteroscopic surgery; gynecological surgery; endometriosis; gynecological oncology; obstetrics; assisted reproductive techniques
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Over the years, gynecological surgery has evolved thanks to the numerous technological innovations that have paved the way for new therapeutic approaches.

Minimally invasive surgery is the standard approach to the performance of several gynecologic procedures. Surgical innovations in hysteroscopic surgery (mini-resectoscopes, intrauterine morcellators, tissue retrieval systems, diode laser, new miniaturized mechanical instruments, endometrial ablation devices, and portable and entry-level hysteroscopes) have radically changed the way of treating intrauterine pathologies. Robotic-assisted surgery has been adopted widely in several countries. Robotics may offer technological and ergonomic benefits that overcome limitations associated with conventional laparoscopy. In this Special Issue, we would like to move this field forward by inviting original clinical and basic research articles, meta-analyses, and systematic reviews focusing on new advances in gynecological surgery.

The purpose of this Special Issue is to address recent developments of gynecological surgical procedures and new technological advances. We look forward to receiving your submissions to move the field of gynecological surgery forward.

Dr. Felice Sorrentino
Prof. Dr. Luigi Nappi
Guest Editors

Manuscript Submission Information

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Keywords

  • hysteroscopy
  • laparoscopy
  • robotics
  • gynecological surgery
  • resectoscope

Published Papers (2 papers)

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12 pages, 1098 KiB  
Article
Survival and Chemosensitivity in Advanced High Grade Serous Epithelial Ovarian Cancer Patients with and without a BRCA Germline Mutation: More Evidence for Shifting the Paradigm towards Complete Surgical Cytoreduction
Medicina 2022, 58(11), 1611; https://doi.org/10.3390/medicina58111611 - 08 Nov 2022
Cited by 4 | Viewed by 1755
Abstract
Background and Objectives: Approximately 10–15% of high-grade serous ovarian cancer (HGSOC) cases are related to BRCA germline mutations. Better survival rates and increased chemosensitivity are reported in patients with a BRCA 1/2 germline mutation. However, the FIGO stage and histopathological entity may [...] Read more.
Background and Objectives: Approximately 10–15% of high-grade serous ovarian cancer (HGSOC) cases are related to BRCA germline mutations. Better survival rates and increased chemosensitivity are reported in patients with a BRCA 1/2 germline mutation. However, the FIGO stage and histopathological entity may have been confounding factors. This study aimed to compare chemotherapy response and survival between patients with and without a BRCA 1/2 germline mutation in advanced HGSOC receiving neoadjuvant chemotherapy (NACT). Materials and Methods: A cohort of BRCA-tested advanced HGSOC patients undergoing cytoreductive surgery following NACT was analyzed for chemotherapy response and survival. Neoadjuvant chemotherapy served as a vehicle to assess chemotherapy response on biochemical (CA125), histopathological (CRS), biological (dissemination), and surgical (residual disease) levels. Univariate and multivariate analyses for chemotherapy response and survival were utilized. Results: Thirty-nine out of 168 patients had a BRCA ½ germline mutation. No differences in histopathological chemotherapy response between the patients with and without a BRCA ½ germline mutation were observed. Survival in the groups of patients was comparable Irrespective of the BRCA status, CRS 2 and 3 (HR 7.496, 95% CI 2.523–22.27, p < 0.001 & HR 4.069, 95% CI 1.388–11.93, p = 0.011), and complete surgical cytoreduction (p = 0.017) were independent parameters for a favored overall survival. Conclusions: HGSOC patients with or without BRCA ½ germline mutations, who had cytoreductive surgery, showed comparable chemotherapy responses and subsequent survival. Irrespective of BRCA status, advanced-stage HGSOC patients have a superior prognosis with complete surgical cytoreduction and good histopathological response to chemotherapy. Full article
(This article belongs to the Special Issue New Advances in Gynecological Surgery)
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Case Report
Tertiary Cytoreduction for Isolated Lymphnode Recurrence (ILNR) Ovarian Cancer in a BRCA2 Mutated Patient: Our Experience and Prevalence of BRCA 1 or 2 Genes Mutational Status in ILNR
Medicina 2023, 59(3), 606; https://doi.org/10.3390/medicina59030606 - 19 Mar 2023
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Abstract
We report the case of a tertiary cytoreductive surgery for isolated lymph-node recurrence (ILNR) in a 54-years old Brest cancer 2 (BRCA 2) mutated patients, with a personal history of ovarian cancer previously treated elsewhere. She was admitted to our department for a [...] Read more.
We report the case of a tertiary cytoreductive surgery for isolated lymph-node recurrence (ILNR) in a 54-years old Brest cancer 2 (BRCA 2) mutated patients, with a personal history of ovarian cancer previously treated elsewhere. She was admitted to our department for a suspected isolated lymph-nodal pelvic recurrence. A positron emission tomography acquisition with contrast enhanced computed tomography (PET-CT) scan revealed an increased node at the level of the right external iliac (SUV 6.9) in correspondence with the obturator nerve, which was confirmed by transvaginal ultrasound. Since the recurrence was in a single site and the patient had previously undergone three lines of chemotherapy and maintenance with Poly(ADP-ribose) polymerase (PARP) inhibitors, we decided to perform tertiary cytoreductive surgery by minimally invasive laparoscopic approach. After gradual and careful isolation of the obturator nerve, lumbo-sacral trunk and venous vessels afferent to the external and internal iliac vein, the suspected node has been removed. No intra- and postoperative complications occurred. The patient was discharged three days after procedure. We decided to quarterly follow-up; actually, after 16 months no recurrence was detected. Several studies have reported ILNR as a unique clinical disease with low growth rate and less chemosensitivity; this can lead to considered ILNR more susceptible to take advantage of surgical treatment, even in case of second or third recurrence. The BRCA mutational status seems to play a role in the decision-making process in the approach to patients with platinum sensitive relapse of ovarian cancer or in specific isolated forms of recurrence such as the hepatic one. However, data on frequency and prognostic impact of BRCA gene mutation in ILNR are very limited. In this article we investigated the role of BRCA 1 or 2 mutational status in this rare pattern of recurrence according to more recent advances in literature. Full article
(This article belongs to the Special Issue New Advances in Gynecological Surgery)
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