[Proteomics in endometriosis]. / Zastosowanie proteomiki do badan nad endometroza.

Despite significant scientific progress, etiology of endometriosis remains enigmatic. New advances in molecular biology have allowed the use of proteomics in demystifying this puzzling disease. Proteomics is a technology that permits the visualization of thousands of proteins inside a cell, tissue, or organism, and simultaneous observation of any alterations in protein expression and post-translational modification that may have important, clinical implications. Owing to its capacity to reveal the structural and functional properties of proteins, proteomics might illuminate the biology of the disease much better than genomics can. This state-of-the-art technology allows us to globally compare the expression and regulation profiles of proteins found in endometriosis with normal eutopic tissues (endometrium and peritoneum), as well as to compare those found in the different forms of endometriosis (i.e., peritoneal endometriosis, endometrioma, and adenomyoma). Proteomic analysis has been employed in endometriosis research in hope of discovering endometriosis-specific proteins, pathways, and potential biomarkers for precise, early detection. In recent years, several published studies have compared serum and peritoneal fluid protein content in women with and without endometriosis, as well as protein composition in endometrial implants, eutopic endometrium, endometriomas, menstrual blood and urine. It appears that use of proteomics could revolutionize our understanding of etiopathogenesis of the disease. Some of the identified proteins could indeed be responsible for the onset and progression of endometriotic implants. Because early stages of endometriosis may be difficult to diagnose, it would be of the utmost importance to identify specific biological markers of the disease. Additionally specific implant proteins could become targets for molecular treatment of endometriosis. It is very challenging, however to draw clear conclusions from the analysis of the obtained samples. First of all, the samples are usually pathologically confirmed to be endometriotic, but from a molecular stand point, the particular portion of the sample that is analyzed may matter greatly; none of the methods allow us to gain information about the molecular and pathological pattern of the same sample. Secondly it is very difficult to define an 'unaffected peritoneum' as a control for the endometriotic lesions. Thirdly the variety of options in each individual makes it difficult to see the molecular picture of the diseased area (such as the ovary or peritoneum) clearly ideally the samples would be of greater value if obtained at an early age, that is, before puberty in each individual and then again when endometriosis occurs later in reproductive age. Such a project cannot be performed prospectively although it may be considered as retrospective analysis of obtained material in some patients after successful chemotherapy due to oncological conditions.

[Robotic surgery in gynecology]. / Zastosowanie robotów w chirurgii ginekologicznej.

Introduction of robotic surgery in the first decade of the 21 century was one of the biggest breakthroughs in surgery since the introduction of anesthesia. For the first time in history the surgeon was placed remotely from the patient and was able to operate with the device that has more degrees of freedom than human hand. Initially developed for the US Military in order to allow surgeons to be removed from the battlefield, surgical robots quickly made a leap to the mainstream medicine. One of the first surgical uses for the robot was cardiac surgery but it is urology and prostate surgery that gave it a widespread popularity Gynecologic surgeons caught on very quickly and it is estimated that 31% of hysterectomies done in the United States in 2012 will be done robotically. With over half a million hysterectomies done each year in the US alone, gynecologic surgery is one of the main driving forces behind the growth of robotic surgery Other applications in gynecology include myomectomy oophorectomy and ovarian cystectomy resection of endometriosis and lymphadenectomy Advantages of the surgical robot are clearly seen in myomectomy The wrist motion allows for better more precise suturing than conventional "straight stick" laparoscopy The strength of the arms allow for better pulling of the suture and the third arm for holding the suture on tension. Other advantage of the robot is scaling of the movements when big movement on the outside translates to very fine movement on the inside. This enables much more precise surgery and may be important in the procedures like tubal anastomosis and implantation of the ureter Three-dimensional vision provides excellent depth of field perception. It is important for surgeons who are switching from open surgeries and preliminary evidence shows that it may allow for better identification of lesions like endometriosis. Another big advantage of robotics is that the surgeon sits comfortably with his/her arms and head supported. This results in much less fatigue and therefore increases precision and potentially may decrease the number of medical errors. The eyes of the surgeon are directed at where the hands should be, which is more natural, allows for a more natural body position and mimics open surgery Robot also enables better teaching, especially when two consoles are used. The surgeon and the student may be either sharing the instruments with two consoles or switching between one another. In a situation where the student operates, the surgeon can use the telestation to teach. Robotic simulator attached to one of the consoles allows students to practice after hours. In summary surgical robot is a great tool, especially in gynecology but also in urology cardiac surgery general surgery and laryngology The device will evolve and most likely with time will eliminate laparoscopy