Training in Diagnostic Hysteroscopy: The "Arbor Vitae" Method.

Background and Objectives: Diagnostic hysteroscopy is the gold standard in the diagnosis of intrauterine pathology and is becoming an essential tool in the daily practice of gynecology. Training programs for physicians are necessary to ensure adequate preparation and learning curve before approaching patients. The aim of this study was to describe the "Arbor Vitae" method for training in diagnostic hysteroscopy and to test its impact on the knowledge and skills of trainees using a customized questionnaire. Materials and Methods: A three-day hysteroscopy workshop combining theory and practical "hands on "sessions with dry and wet labs has been described. The aim of the course is to teach indications, instruments, the basic principles of the technique by which the procedure should be performed, and how to recognize and manage the pathologies that can be identified by diagnostic hysteroscopy. To test this training method and its impact on the knowledge and skills of the trainees, a customized 10-question questionnaire was administered before and after the course. Results: The questionnaire was administered to 34 participants. All trainees completed the questionnaire, and no missing responses were recorded. Regarding the characteristics of the participants, 76.5% had less than 1 year of experience in performing diagnostic hysteroscopy and 55.9% reported performing fewer than 15 procedures in their career. For 9 of the 10 questions embedded in the questionnaire, there was a significant improvement in the scores between pre- and post-course, demonstrating a perceived significant improvement in theoretical/practical skills by the trainees. Conclusions: The Arbor Vitae training model is a realistic and effective way to improve the theoretical and practical skills required to perform correct diagnostic hysteroscopy. This training model has great potential for novice practitioners to achieve an adequate level of proficiency before performing diagnostic hysteroscopy on live patients.

Vitamin D, reproductive disorders and assisted reproduction: evidences and perspectives.

Vitamin D is an important nutrient involved in many fundamental health outcomes. However, its influence on female reproductive function remains ambiguous. Cholecalciferol seems to have a role in the reproductive processes and in the patients affected by polycystic ovary syndrome, endometriosis, uterine myomas and premature ovarian failure. Moreover, it may play an important role in the assisted reproductive techniques, given that it is capable of influencing oocyte quality, but also an adequate preparation of the endometrium for embryonic implantation. Although promising, available evidence is based on a limited number of in vitro, in vivo and clinical studies. We provide an overview of the association between vitamin D and female infertility reporting the most recent data published in the literature. Nevertheless, properly randomised clinical trials are mandatory to achieve more conclusive results about the promising role of vitamin D in the management of female assisted reproduction.

The Technique of Vaginal Septum as Uterine Septum: A New Approach for the Hysteroscopic Treatment of Vaginal Septum.

STUDY OBJECTIVE: To evaluate the outcomes of a new hysteroscopic technique for the treatment of a longitudinal vaginal septum. DESIGN: A retrospective study. SETTING: Arbor Vitae Center for Endoscopic Gynecology, Rome, Italy. PATIENTS: Thirty women who underwent hysteroscopic treatment for a vaginal septum. INTERVENTION: All enrolled patients underwent pelvic examination, hysteroscopy, and 2-dimensional ultrasound. In case of a diagnosis of a partial or complete uterine septum, magnetic resonance imaging or 3-dimensional ultrasound were performed, and surgical procedures were performed after diagnostic laparoscopy was used to better visualize the uterine fundus. All patients were treated with the technique using vaginal septum as uterine septum or the same methodology applied for a uterine septum. MEASUREMENTS AND MAIN RESULTS: The procedure was successfully accomplished in all patients, and longitudinal vaginal septa were totally resected. There were no perioperative complications, and in only 1 case, vaginal bleeding occurred because of an erroneous identification of the excision line that was easily remedied with coagulation by resectoscope. Dyspareunia has improved or completely disappeared in all patients. CONCLUSION: The technique of vaginal septum as uterine septum for the resectoscope of a longitudinal vaginal septum appears to be safe and effective with good outcomes, even in terms of dyspareunia.

An overview on the relationship between endometriosis and infertility: the impact on sexuality and psychological well-being.

Purpose: Women with endometriosis represent a significant proportion of all outpatient gynecological consultations. Endometriosis is a benign chronic condition characterized by the spreading of endometrial-like tissue outside the uterus. A correlation between endometriosis and infertility has been strongly underlined in the literature about the topic: recent data suggest that up to 50% of women with infertility may suffer from this disease. The aim of this brief commentary is to focus the attention on the importance of a multidisciplinary approach for patients with endometriosis, including an accurate psychological and sexological counselling.Materials and Methods: We propose a brief point of view about a multidisciplinary approach in the treatment of endometriosis and associated infertility.Results and conclusions: Endometriosis is associated to a worse quality of life. Women with endometriosis also report higher levels of psychological conditions such as anxiety and depression. For this reason, an integrative approach is strongly advisable in order to improve social functions and mental health of these women and their partners. This may allow a more correct therapeutic management of these patients, reducing the potential negative impact of the disease on the mental wellbeing of the couple.

Hysteroscopic Evaluation of Endometrial Changes in Breast Cancer Women with or without Hormone Therapies: Results from a Large Multicenter Cohort Study.

STUDY OBJECTIVE: The primary aim of our study was to investigate the incidence of endometrial pathologies, especially endometrial cancer, in women with breast cancer treated with tamoxifen (TAM), aromatase inhibitors (AIs), or receiving no treatment (NT). The secondary aim was to identify, in this cohort, ultrasonographic findings that represent robust indications for hysteroscopy and endometrial biopsy, to avoid unnecessary second-level diagnostic procedures. DESIGN: Multicenter retrospective cohort study (Clinical Trial ID: NCT03898947). SETTING: Data were collected from different Italian centers: Regina Elena National Cancer Institute of Rome, Arbor Vitae Centre of Rome, Gaetano Martino University Hospital of Messina, and Villa Sofia-Cervello Hospital of Palermo. PATIENTS: We selected and consecutively included patients with a history of breast cancer who had undergone hysteroscopy for ultrasonographic or clinical indications between January 2007 and December 2016. INTERVENTIONS: Diagnostic hysteroscopy with endometrial biopsy or operative hysteroscopy, when clinically indicated. MEASUREMENTS AND MAIN RESULTS: A higher percentage of patients in the TAM and AI groups had a normal endometrium compared with those in the NT group, whereas the incidence of endometrial polyps was higher in the NT group than in the others; no significant differences were observed among the 3 groups for other benign conditions or for premalignant and malignant uterine diseases, such as endometrial atypical hyperplasia and adenocarcinoma. CONCLUSION: TAM treatment does not seem to be associated with a higher rate of endometrial cancer in women with breast cancer compared with women treated with AIs or NT.

May intraperitoneal irrigation with Betadine improve cesarean delivery outcomes? Results of a 6 years' single centre experience.

PURPOSE: Cesarean presents increased risk of adverse outcomes, such as endometritis, bacteremia, peritonitis, and maternal fever. This retrospective study aims to evaluate, for the first time in Literature, the effects Betadine washing versus normal saline washing after uterine closure in women undergoing cesarean delivery (CD) at ≥36 gestational weeks. METHODS: Of the 2080 patients identified retrospectively for the analysis at Department of Obstetrics and Gynecology of San Camillo Hospital of Rome, 1042 were assigned to "Betadine group" and 1038 to "No Betadine group". There were no differences noted for maternal and obstetric characteristics. The outcomes of the present study were to evaluate the incidence of postoperative infections or fever; the reduction of blood white cells among preoperative and postoperative exams; mean and median time of intestinal recanalization, of postoperative ambulation and of 24-h post-CD pain, evaluated using VAS scale. RESULTS: Betadine group patients reported a statistically significant lower white cells increment, a lower mean time to ambulation and intestinal recanalization after CD and a lower 24-h post-CD pain and infections. CONCLUSIONS: Betadine intraperitoneal irrigation during CD seems to improve postoperative CD outcomes and patients' quality of life.