Laparoscopic Single-Port versus Mini-Laparoscopic Hysterectomy: An International Study.

OBJECTIVES: Laparoendoscopic single-site surgery (LESS) and mini-laparoscopic surgery (Mini-LPS) have been performed with comparable results to conventional laparoscopy. However, there are few data on the comparison between them. Our main objective was to compare LESS and Mini-LPS in terms of surgical time, postoperative pain, and hospital stay in patients who underwent hysterectomy for benign pathology. DESIGN: It is a retrospective international multicentric study carried out in 5 centers including 2 Spanish and 3 Italian. METHODS: Data from patients who underwent hysterectomy for benign pathology between January 1, 2010, and December 31, 2015, were reviewed. We collected the clinical-pathological characteristics of the patients and the perioperative results. The main variables of the study were surgical time, the switch to oral analgesia, and the hospital stay. The two comparison groups in the study included patients undergoing hysterectomy for benign pathology by LESS or by Mini-LPS. The decision to perform the type of procedure was left to the discretion of the surgeon, based primarily on the surgical skills and experience of the center. All data were collected retrospectively by an online encrypted platform. RESULTS: 161 patients were included in the study. 104 (64.6%) patients underwent LESS hysterectomy and 57 (35.4%) Mini-LPS. Median surgical time was significantly longer in the LESS group when compared to the Mini-LPS group (120 vs. 75 min, respectively; p < 0.001). Moreover, longer median hospital stay was observed in the LESS group compared to Mini-LPS (48 vs. 36 h, respectively; p < 0.001). Conversion of the technique to conventional LPS was performed in 4 (2.5%) patients, all of them in the Mini-LPS group (p = 0.015). LIMITATIONS: It is a retrospective study with the biases that this implies. Furthermore, some variables have been incompletely registered in the database, which implies loss of information. This is a nonrandomized study since the decision to intervene with one or another technique was made by the surgeon, which generated 2 nonhomogeneous groups in terms of the number of patients. On the other hand, all the patients who underwent Mini-LPS hysterectomy belonged to the same center, which may have made these results center dependent. CONCLUSIONS: Significant shorter surgical time and shorter hospital stay were observed in patients undergoing Mini-LPS hysterectomy compared to LESS technique; however, intraoperative complications related to instrumentation flaws were higher in the mini-LPS group that required conversion to standard laparoscopy in all cases. Both ultra-minimally invasive techniques seem safe to perform hysterectomies for benign pathology and emphasize the importance in surgical training to adapt them to our current practice.

Evaluation of Fetal Lung Maturity by Quantitative Analysis (quantusFLM) in Women with Gestational Diabetes Mellitus.

OBJECTIVES: The aim of the present study was to evaluate fetal lung maturity using the noninvasive method of quantitative ultrasound analysis of fetal lung texture (quantusFLM) in women with gestational diabetes mellitus (GDM). METHODS: A total of 96 women at 36-38 weeks of gestation were enrolled. They were classified as follows: 33 GDM cases treated with diet, 30 GDM cases treated with diet plus insulin, and 33 normoglycemic women (control group). A quantitative analysis of lung texture was performed. RESULTS: There were significant differences in the lung maturity results among groups (p = 0.004). These differences were established between the insulin-treated group of patients and both the control (p = 0.006) and diet-only (p = 0.003) groups. While none of the women in the control group or in the diet group had a high risk of immaturity, 16.7% of those treated with insulin (5/30) did (p = 0.003). There was no statistically significant correlation between HbA1c and the result of the test. CONCLUSIONS: Quantitative ultrasound study of fetal lung texture suggests that a significant percentage of pregnant women with GDM treated with insulin had fetal lung immaturity in the late preterm to early term.

Laparoscopic Sentinel Node Biopsy Using Real-time 3-dimensional Single-photon Emission Computed Tomographic Guidance in Endometrial Cancer.

In endometrial cancer, the histopathological analysis of the lymphatic nodes is essential to establish a correct prognosis and tailored adjuvant treatment. It is well-known that patients with early-stage endometrial cancer have a low incidence of nodal disease. In this group, systematic lymphadenectomy is not recommended. To improve the detection rate of sentinel nodes in clinical practice, new techniques are emerging like real-time 3-dimensional single-photon emission computed tomographic (SPECT) imaging. We report our experience using this innovative technique for intraoperative detection of sentinel nodes in endometrial cancer. The real-time 3-dimensional SPECT sentinel node biopsy seems to be feasible and accurate in endometrial cancer although further studies are needed to set the precision and predictive values compared with the current differed SPECT techniques and blue dye techniques.

Role of single-site and mini-laparoscopy in gynecologic surgery.

INTRODUCTION: Laparoscopy is a surgical procedure that has been used widely in medicine over the last thirty years. In gynecology, laparoscopy is the "gold standard" for the majority of gynecological procedures, as its superiority over laparotomy has been widely demonstrated. In recent years, the current trend of gynecologists is to make laparoscopy surgery even less invasive by reducing the number of incisions in the skin, as it happens with laparoendoscopic single-site surgery, or by reducing the size of them as in mini-laparoscopy. The aim of this work was to perform an extensive review and update of the evolution of single-port surgery and mini-laparoscopic surgery in gynecology as well as to evaluate its current role in this field. EVIDENCE ACQUISITION: A systematic review was performed during April and May 2020. PRISMA guidelines were followed for the literature search. EVIDENCE SYNTHESIS: The main objective of performing less invasive procedures is to reduce both intraoperative complications (decreased risk of bleeding or damage to internal organs), and postoperative ones (hernias through the trocar) and improve cosmetic results. Results of studies about LESS and mini-LPS showed encouraging results, being both of them safe with a similar perioperative and postoperative outcome. They have the approval of the international surgical community as well as patients' satisfaction with cosmetic results. CONCLUSIONS: Minimally invasive surgery is the present and future in gynecological surgery. More prospective randomized trials are needed in order to obtain valid results and affirm that both LESS and Mini-LPS are superior to conventional laparoscopy.

The role of surgery in advanced epithelial ovarian cancer.

Nowadays, the standard management of advanced epithelial ovarian cancer is correct surgical staging and optimal tumour cytoreduction followed by platinum and taxane-based chemotherapy. Standard surgical staging consists of peritoneal washings, total hysterectomy, and bilateral salpingo-oophorectomy, inspection of all abdominal organs and the peritoneal surface, biopsies of suspicious areas or randomised biopsies if they are not present, omentectomy and para-aortic lymphadenectomy. After this complete surgical staging, the International Federation of Gynaecology and Obstetrics (FIGO) staging system for ovarian cancer is applied to determine the management and prognosis of the patient. Complete tumour cytoreduction has shown an improvement in survival. There are some criteria to predict cytoreduction outcomes based on serum biomarkers levels, preoperative imaging techniques, and laparoscopic-based scores. Optimised patient selection for primary cytoreduction would determine patients who could benefit from an optimal cytoreduction and might benefit from interval surgery. The administration of intraperitoneal chemotherapy after debulking surgery has shown an increase in progression-free survival and overall survival, especially in patients with no residual disease after surgery. It is considered that 3-17% of all epithelial ovarian carcinoma (EOC) occur in young women that have not fulfilled their reproductive desires. In these patients, fertility-sparing surgery is a worthy option in early ovarian cancer.

Leiomioma vaginal con núcleos atípicos. Informe de un caso / Vaginal leiomyoma with bizarre nuclei. A case report

Resumen ANTECEDENTES: Los tumores vaginales benignos son excepcionales: papilomas, hemangiomas, pólipos y leiomiomas. Estos últimos son los más raros (4-5% de todas las neoplasias vaginales) pues solo se han reportado alrededor de 300 casos. CASO CLÍNICO: Paciente de 47 años, acudió a la consulta ginecológica con una tumoración vaginal de dos meses de evolución, sin manifestaciones clínicas adicionales. En la exploración física se observó una tumoración elástica, en la cara posterolateral derecha de la vagina. La ecografía transvaginal no mostró la alteración. Después del tratamiento expectante inicial, en la siguiente revisión se comprobó el rápido crecimiento de la lesión y la manifestación de los síntomas vaginales. Se decidió la extirpación quirúrgica de la lesión. El estudio anatomopatológico reportó un leiomioma vaginal, con células con núcleos atípicos. Durante el seguimiento la paciente permaneció asintomática, sin signos de recidiva local. CONCLUSIÓN: Si bien los leiomiomas son los tumores benignos más frecuentes en mujeres en edad reproductiva, su manifestación vaginal es excepcional. El diagnóstico definitivo se establece en el estudio anatomopatológico y el tratamiento de elección es la extirpación quirúrgica completa. Los tumores con elevada celularidad, alta concentración de células atípicas y actividad mitótica incrementada pueden tener un comportamiento benigno. Las recidivas también son excepcionales.

Abstract BACKGROUND: Benign vaginal tumors are a very rare entity which includes papillomas, hemangiomas, polyps and leiomyomas. Leiomyomas are especially infrequent, constituting only 4-5% of all vaginal tumors. In literature, about 300 cases have been reported. CLINICAL CASE: 47-year-old patient, who attended a gynecological consultation with a vaginal tumor of two months evolution, without additional clinical manifestations. Physical examination refers to an elastic tumor on the right posterolateral aspect of the vagina. The transvaginal ultrasound did not show the alteration. After the initial expected treatment, in the following review the rapid growth of the lesion was observed, in addition to the manifestation of vaginal symptoms. Surgical removal of the lesion will be applied. The anatomopathological study reported a vaginal leiomyoma, and cells with bizarre nuclei. During the follow-up, the asymptomatic patient was observed, without signs of local recurrence. CONCLUSION: Although leiomyomas represent the most frequent benign tumors in women of reproductive age, their vaginal manifestation is exceptional. The gold treatment is complete surgical extirpation and the definitive diagnosis is established by anatomopathological study. Tumors with high cellularity, high concentration of bizarre cells and increased mitotic activity appear to have a benign behavior. Although it is rare, there are cases of recurrence.