[Endometriosis: the gynecologist's opinion]. / Endometriosi: Il parere del ginecologo.

Endometriosis is defined as the presence of endometrial glands and stroma outside the uterine cavity. Endometriosis affects 7-10% of women of reproductive age, 60% of women with pelvic pain, and up to 50% of women with infertility. Etiology and pathogenesis of the disease are still unclear, with the theory of retrograde menstruation, and possibly associated cofactors, as the most important. The definitive method to diagnose endometriosis is visualization at surgery, preferably at laparoscopy, with histology confirmation of disease. The revised classification of the American Society for Reproductive Medicine is used to stage the disease and determine the patient's prognosis. The treatment of the disease depends on the patient's age, associated symptoms, and disease stage. Medical or surgical therapy may be used in case of pain associated with endometriosis, whereas surgery is the mainstay of treatment in case of endometriosis-associated infertility.

Learning curve and pitfalls of a laparoscopic score to describe peritoneal carcinosis in advanced ovarian cancer.

OBJECTIVE: To prospectively estimate the agreement between a fellow in training in gynecologic oncology and a senior surgeon performing a laparoscopic score to describe peritoneal carcinosis diffusion in patients with advanced ovarian cancer. DESIGN: Single-institutional non-inferiority trial. SETTING: University hospital tertiary care center. POPULATION: Ninety consecutive patients with primary advanced ovarian cancer. METHODS: The patients underwent staging-laparoscopy by a fellow in gynecologic oncology and a senior surgeon, sequentially and blindly. Single laparoscopic parameters (omental cake, peritoneal and diaphragmatic carcinosis, mesenteric retraction, bowel stomach infiltration, superficial liver metastasis) and a comprehensive laparoscopic score (PIV) were assessed in each procedure and registered. MAIN OUTCOME MEASURES: No differences in the score discriminating performance for predicting optimal cytoreduction were observed between fellows' and seniors' evaluations. RESULTS: The median number of staging laparoscopies performed by each fellow was 30 (range 28-32). The median score was 6 (0-10) for the fellows and 6 (0-14) for senior surgeons (p=ns). Results were superimposable in 57 of 90 patients (63.3%). Dividing the study period into two blocks, cases 1-45 and cases 46-90, differences were equally distributed over time (16.6 vs. 20%; p=0.9). The area under the curve of the receiver operating characteristic (ROC) curves for the score of fellows and seniors was 0.86 and 0.89, respectively (p=ns). CONCLUSIONS: The laparoscopic assessment of peritoneal cancer diffusion according to a laparoscopic score can reliably be carried out by a fellow in gynecologic oncology after 12 months' experience without significant differences from a senior surgeon's assessment.

Risk of postoperative pelvic abscess in major gynecologic oncology surgery: one-year single-institution experience.

PURPOSE: This study was undertaken to evaluate risk factors for the occurrence of postoperative abscesses in a large single-institution series of gynecologic cancer patients undergoing major surgery. MATERIALS AND METHODS: Patients admitted to the Division of Gynecologic Oncology, Catholic University of Sacred Hearth, Rome, Italy, between January 2008 and February 2009, were retrospectively analyzed. The occurrence of pelvic abscesses was identified by sign and symptoms and confirmed with radiological and microbiological examinations. RESULTS: A total of 360 patients were analyzed for the study. Exenteration and use of fibrillar absorbable hemostat were significantly associated with the presence of postoperative abscesses (P < .0001) by multiple regression analysis, whereas operative time, type of surgery, lymphadenectomy, or other associated surgical procedures failed to result statistically relevant. CONCLUSIONS: The use of fibrillar oxidized regenerated cellulose as hemostatic agent may represent a risk factor for postoperative abscesses, especially when used during pelvic exenteration.