Combined robotic surgery for concomitant treatment of endometrial cancer and obesity.

BACKGROUND: Endometrial Cancer (EC) is strongly linked to obesity. Bariatric surgery is recognized as a long-term solution for weight loss in severely obese patients. This pilot study investigates the feasibility, intraoperative and 30-day morbidity outcomes of integrating gynecological surgical staging and bariatric robotic surgery in class II and III obese patients affected by early EC or Endometrial Intraepithelial Neoplasia (EIN). METHODS: Patients aged over 18 years old with early EC or EIN and class II and III obesity (Body mass index (BMI) ≥ 35 kg/m2) who are surgical and anesthesiologic candidates. Standard robotic surgery for early EC staging performed alone (THBSO group) or in conjunction with sleeve gastrectomy (THBSO + SG group) for obesity management was proposed. RESULTS: Of the 13 patients who met the inclusion criteria, 5 (38.46%) opted for combined surgery. The groups showed a significant difference in preoperative BMI (49.68 kg/m2 vs. 40.24 kg/m2 p = 0.017 with and without SG), preoperative weight (143.92 kg vs. 105.62 kg p = 0.004 with and without SG), preoperative (p = 0.01) and postoperative (p = 0.005) aspartate transaminase (AST). The THBSO + SG group had higher anesthesia induction end-tidal carbon dioxide (ETCO2) (p = 0.05), final Partial pressure of carbon dioxide (PaCO2) (p = 0.044), anesthesia induction lactate (p = 0.001) and final lactate (p = 0.011) without a significant difference in final pH (p = 0.31). Operative time was longer in the THBSO + SG group (p < 0.001), but this did not result in longer ICU (p = 0.351), total hospital stays (p = 0.208), nor increased blood loss and transfusion. The simultaneous combined approach had an 80% success rate. At 6 months, the THBSO + SG group achieved significantly greater weight loss than the THBSO group (ΔBMI - 11.81 kg/m2 vs - 1.72 kg/m2, p = 0.003, with and without SG). CONCLUSION: Integrating robotic EC staging with SG in obese women with early EC increased the operative time without increasing intraoperative risks, early and 30 days post-surgery complication and offering a promising approach to simultaneously treating both conditions.

Laser Therapy in Heavily Treated Oncological Patients Improves Vaginal Health Parameters.

This study aimed to investigate the efficacy and duration of multiple non-ablative intravaginal CO2 laser (V-lase®) cycles in breast cancer patients, gynecological and other pelvic cancers previously subjected to multiple oncological treatments. This prospective study enrolled women under the age of 65 years who reported vaginal symptoms. Data on the Vaginal Health Index (VHI), vaginal length (VL), vaginal pain measured using a Visual Analog Scale (VAS), and the Female Sexual Function Index (FSFI) were collected at baseline and before each laser application, and at subsequent follow-up visits. A total of 170 laser applications were performed on 113 women with various types of cancer. Most patients (57.5%) had received radiotherapy-based treatments before receiving laser treatment. Vaginal health parameters and sexual function improved significantly with each laser application. However, a temporary decline in these improvements occurred during the intervals between cycles. Such worsening was reversed with the subsequent cycle in all groups of patients, irrespective of the type of oncological treatments they had undergone. Multiple course vaginal laser therapy showed promising results as a potential treatment for vaginal atrophy in heavily treated gynecological and breast cancer patients, necessitating further research to determine the optimal time interval between cycles to ensure sustained positive effects.

Combined Robotic and Vaginal Surgery for Pelvic Exenteration due to Vaginal Sarcoma Relapse in an Obese Woman.

STUDY OBJECTIVE: Pelvic exenteration (PE) is an aggressive surgical procedure that implies a large hard-to-fill pelvic defect. Different reconstruction techniques were proposed to improve abdominal organ support and reduce complications (infections, pelvic organs herniation, vaginal stump dehiscence, bowel prolapse and obstruction) [1], with conflicting results [2]. Because of young age and survival greater than 50% at 5 years in patients with no residual tumor after surgery [3], a new approach with better clinical results to pelvic reconstruction is needed. DESIGN: The aim of this surgical film is to present an unusual presentation of vaginal sarcoma, successfully managed with a minimally invasive approach, and to illustrate our contextual multilayer technique of pelvic reconstruction using a combination of pedicled omental flap (POF) and human acellular dermal matrix (HADM). SETTING: Tertiary level academic hospital. A 42-year-old obese patient with recurrent and symptomatic myxoid leiomyosarcoma, previously underwent vaginal-assisted laparoscopic surgery at a primary care center for the removal of a vaginal swelling. INTERVENTIONS: The multidisciplinary board determined anterior PE as the optimal therapeutic approach. Given the patient's body mass index (33 kg/m2), young age, and the favorable outcomes of robotic surgery in obese patients compared with other approaches [3,4], we proposed a combined robotic and vaginal surgery for both exenteration and reconstructive procedures [5]. During surgery, we initially explored the abdominal cavity to exclude macroscopic metastasis, followed by anterior PE. Urinary diversion was achieved with a Bricker ileal conduit by means of an ileoileal laterolateral anastomosis and an uretero-ileo-cutaneostomy. The pelvic dead space was partially filled with a POF on the left gastroepiploic artery. Subsequently, the pelvic defect was covered by a 15 × 10 mm HADM inlay inserted circumferentially at the pelvic brim, fixed with a barbed thread suture on residual pelvic structures. The final pathology confirmed the recurrence of myxoid leiomyosarcoma and indicated tumor-free resection margins. The intraoperative and postoperative periods were uneventful. The patient was discharged 14 days after surgery and underwent adjuvant doxorubicin- and dacarbazine-based chemotherapy, which was initiated 45 days after the surgery. Currently the patient is asymptomatic and disease free at the sixth month of follow-up. CONCLUSION: Robotic PE proves to be a feasible technique in obese patients, reducing postoperative hospital stay and complications. The contextual pelvic floor reconstruction with a POF and HADM supports abdominal viscera, diminishing interorgan adhesions and bowel prolapse. VIDEO ABSTRACT.

Tailoring the Coefficient of Friction by Direct Laser Writing Surface Texturing.

The modification of the surface topography at the micro- and nanoscale is a widely established as one of the best ways to engineering the surface of materials, to improve the tribological performances of materials in terms of load capacity and friction. The present paper reviews the state of the art on laser surface texturing by exploiting the technique of direct laser writing for tailoring the coefficient of friction, highlighting the effect of the textures' arrangement on the lubricated conformal and non-conformal contact behavior.

Computed Tomography-assessed Skeletal Muscle Index and Skeletal Muscle Radiation Attenuation in Patients With Ovarian Cancer Treated With Primary Surgery Followed by Platinum-based Chemotherapy: A Single-center Italian Study.

AIM: To assess the prognostic relevance of baseline and post-treatment skeletal muscle index (SMI) and skeletal muscle radiation attenuation (SMRA) at the level of third lumbar vertebra in patients with ovarian cancer who underwent primary surgery and platinum-based chemotherapy. PATIENTS AND METHODS: This retrospective investigation analyzed 134 patients who underwent staging computed tomography, surgery, chemotherapy and post-treatment computed tomography. RESULTS: At univariate analysis, stage (p<0.0001), histotype (p=0.01), residual disease (p<0.0001) and treatment response (p<0.0001) correlated with progression-free survival (PFS), whereas age (p=0.004), stage (p=0.006), residual disease (p<0.0001) and treatment response (p<0.0001) were associated with overall survival (OS). Neither baseline nor post-treatment SMI and SMRA had prognostic relevance. At multivariate analysis, residual disease and treatment response correlated with PFS (p<0.0001 and p<0.0001) and OS (p=0.007 and p<0.0001), whilst age was an independent prognostic variable for OS (p=0.02). CONCLUSION: Baseline and post-treatment SMI and SMRA did not correlate with patient outcome in this clinical setting.

Terahertz Frequency Combs Exploiting an On-Chip, Solution-Processed, Graphene-Quantum Cascade Laser Coupled-Cavity.

The ability to engineer quantum-cascade-lasers (QCLs) with ultrabroad gain spectra, and with a full compensation of the group velocity dispersion, at terahertz (THz) frequencies, is key for devising monolithic and miniaturized optical frequency-comb-synthesizers (FCSs) in the far-infrared. In THz QCLs four-wave mixing, driven by intrinsic third-order susceptibility of the intersubband gain medium, self-locks the optical modes in phase, allowing stable comb operation, albeit over a restricted dynamic range (∼20% of the laser operational range). Here, we engineer miniaturized THz FCSs, comprising a heterogeneous THz QCL, integrated with a tightly coupled, on-chip, solution-processed, graphene saturable-absorber reflector that preserves phase-coherence between lasing modes, even when four-wave mixing no longer provides dispersion compensation. This enables a high-power (8 mW) FCS with over 90 optical modes, through 55% of the laser operational range. We also achieve stable injection-locking, paving the way to a number of key applications, including high-precision tunable broadband-spectroscopy and quantum-metrology.

Versatile Multimodality Imaging System Based on Detectorless and Scanless Optical Feedback Interferometry-A Retrospective Overview for A Prospective Vision.

In this retrospective compendium, we attempt to draw a "fil rouge" along fifteen years of our research in the field of optical feedback interferometry aimed at guiding the readers to the verge of new developments in the field. The general reader will be moved at appreciating the versatility and the still largely uncovered potential of the optical feedback interferometry, for both sensing and imaging applications. By discovering the broad range of available wavelengths (0.4-120 µm), the different types of suitable semiconductor lasers (Fabry-Perot, distributed feedback, vertical-cavity, quantum-cascade), and a number of unconventional tenders in multi-axis displacement, ablation front progression, self-referenced measurements, multispectral, structured light feedback imaging and compressive sensing, the specialist also could find inspirational suggestions to expand his field of research.

Ultrafast terahertz saturable absorbers using tailored intersubband polaritons.

Semiconductor heterostructures have enabled a great variety of applications ranging from GHz electronics to photonic quantum devices. While nonlinearities play a central role for cutting-edge functionality, they require strong field amplitudes owing to the weak light-matter coupling of electronic resonances of naturally occurring materials. Here, we ultrastrongly couple intersubband transitions of semiconductor quantum wells to the photonic mode of a metallic cavity in order to custom-tailor the population and polarization dynamics of intersubband cavity polaritons in the saturation regime. Two-dimensional THz spectroscopy reveals strong subcycle nonlinearities including six-wave mixing and a collapse of light-matter coupling within 900 fs. This collapse bleaches the absorption, at a peak intensity one order of magnitude lower than previous all-integrated approaches and well achievable by state-of-the-art QCLs, as demonstrated by a saturation of the structure under cw-excitation. We complement our data by a quantitative theory. Our results highlight a path towards passively mode-locked QCLs based on polaritonic saturable absorbers in a monolithic single-chip design.

Tunable and compact dispersion compensation of broadband THz quantum cascade laser frequency combs.

Miniaturized frequency combs (FCs) can be self-generated at terahertz (THz) frequencies through four-wave mixing in the cavity of a quantum cascade laser (QCL). To date, however, stable comb operation is only observed over a small operational current range in which the bias-depended chromatic dispersion is compensated. As most dispersion compensation techniques in the THz range are not tunable, this limits the spectral coverage of the comb and the emitted output power, restricting potential applications in, for example, metrology and ultrashort THz pulse generation. Here, we demonstrate an alternative architecture that provides a tunable, lithographically independent, control of the free-running coherence properties of THz QCL FCs. This is achieved by integrating an on-chip tightly coupled mirror with the QCL cavity, providing an external cavity and hence a tunable Gires Tournois interferometer (GTI). By finely adjusting the gap between the GTI and the back-facet of an ultra-broadband, high dynamic range QCL, we attain wide dispersion compensation regions, where stable and narrow (~3 kHz linewidth) single beatnotes extend over an operation range that is significantly larger than that of dispersion-dominated bare laser cavity counterparts. Significant reduction of the phase noise is registered over the whole QCL spectral bandwidth (1.35 THz). This agile accommodation of a tunable dispersion compensator will help enable uptake of QCL-combs for metrological, spectroscopic and quantum technology-oriented applications.

Fully phase-stabilized quantum cascade laser frequency comb.

Miniaturized frequency comb sources across hard-to-access spectral regions, i.e. mid- and far-infrared, have long been sought. Four-wave-mixing based Quantum Cascade Laser combs (QCL-combs) are ideal candidates, in this respect, due to the unique possibility to tailor their spectral emission by proper nanoscale design of the quantum wells. We demonstrate full-phase-stabilization of a QCL-comb against the primary frequency standard, proving independent and simultaneous control of the two comb degrees of freedom (modes spacing and frequency offset) at a metrological level. Each emitted mode exhibits a sub-Hz relative frequency stability, while a correlation analysis on the modal phases confirms the high degree of coherence in the device emission, over different power-cycles and over different days. The achievement of fully controlled, phase-stabilized QCL-comb emitters proves that this technology is mature for metrological-grade uses, as well as for an increasing number of scientific and technological applications.

Photo-generated metamaterials induce modulation of CW terahertz quantum cascade lasers.

Periodic patterns of photo-excited carriers on a semiconductor surface profoundly modifies its effective permittivity, creating a stationary all-optical quasi-metallic metamaterial. Intriguingly, one can tailor its artificial birefringence to modulate with unprecedented degrees of freedom both the amplitude and phase of a quantum cascade laser (QCL) subject to optical feedback from such an anisotropic reflector. Here, we conceive and devise a reconfigurable photo-designed Terahertz (THz) modulator and exploit it in a proof-of-concept experiment to control the emission properties of THz QCLs. Photo-exciting sub-wavelength metastructures on silicon, we induce polarization-dependent changes in the intra-cavity THz field, that can be probed by monitoring the voltage across the QCL terminals. This inherently flexible approach promises groundbreaking impact on THz photonics applications, including THz phase modulators, fast switches, and active hyperbolic media.

Role of heat accumulation on the incubation effect in multi-shot laser ablation of stainless steel at high repetition rates.

We study the incubation effect during laser ablation of stainless steel with ultrashort pulses to boost the material removal efficiency at high repetition rates. The multi-shot ablation threshold fluence has been estimated for two pulse durations, 650-fs and 10-ps, in a range of repetition rates from 50 kHz to 1 MHz. Our results show that the threshold fluence decreases with the number of laser pulses N due to damage accumulation mechanisms, as expected. Moreover, approaching the MHz regime, the onset of heat accumulation enhances the incubation effect, which is in turn lower for shorter pulses at repetition rates below 600 kHz. A saturation of the threshold fluence value is shown to occur for a significantly high number of pulses, and well fitted by a modified incubation model.

Closed loop control of penetration depth during CO2 laser lap welding processes.

In this paper we describe a novel spectroscopic closed loop control system capable of stabilizing the penetration depth during laser welding processes by controlling the laser power. Our novel approach is to analyze the optical emission from the laser generated plasma plume above the keyhole, to calculate its electron temperature as a process-monitoring signal. Laser power has been controlled by using a quantitative relationship between the penetration depth and the plasma electron temperature. The sensor is able to correlate in real time the difference between the measured electron temperature and its reference value for the requested penetration depth. Accordingly the closed loop system adjusts the power, thus maintaining the penetration depth.

Real time ablation rate measurement during high aspect-ratio hole drilling with a 120-ps fiber laser.

We report on the instantaneous detection of the ablation rate as a function of depth during ultrafast microdrilling of metal targets. The displacement of the ablation front has been measured with a sub-wavelength resolution using an all-optical sensor based on the laser diode self-mixing interferometry. The time dependence of the laser ablation process within the depth of aluminum and stainless steel targets has been investigated to study the evolution of the material removal rate in high aspect-ratio micromachined holes.

Simultaneous measurement of multiple target displacements by self-mixing interferometry in a single laser diode.

We demonstrate that a single all-optical sensor based on laser diode self-mixing interferometry can monitor the independent displacement of individual portions of a surface. The experimental evidence was achieved using a metallic sample in a translatory motion while partly ablated by a ps-pulsed fiber laser. A model based on the Lang-Kobayashi approach gives an excellent explanation of the experimental results.

High-resolution monitoring of the hole depth during ultrafast laser ablation drilling by diode laser self-mixing interferometry.

We demonstrate that diode laser self-mixing interferometry can be exploited to instantaneously measure the ablation front displacement and the laser ablation rate during ultrafast microdrilling of metals. The proof of concept was obtained using a 50-µm-thick stainless steel plate as the target, a 120 ps/110 kHz microchip fiber laser as the machining source, and an 823 nm diode laser with an integrated photodiode as the probe. The time dependence of the hole penetration depth was measured with a 0.41 µm resolution.