Firefly® System and Organ Transillumination in Robotic Gynecologic Surgery.

BACKGROUND AND OBJECTIVES: Near-infrared fluorescence (NIRF) of the Firefly® system has become a useful and widespread technique for the visualization and detection of tumors, sentinel lymphnodes, and vascular/anatomical structures. METHODS: Between February 1, 2017 to September 30, 2019, a total of 25 patients affected by benign and malignant pathologies underwent robotic surgery by the use of organ transillumination with the concomitant Firefly®. We analyzed the pre-operative patients' characteristics (age and body mass index [BMI], previous abdominal surgeries and systemic disease); pre-operative diagnosis, surgical procedure and approach (multiport or single site), transilluminated organ, surgical outcomes (operating time, incidence of intraoperative complications, and incidence of conversion to other surgery); and postoperative outcome. The surgical procedures included: four bladder endometriosis nodules resections, one pelvic lymphadenectomy with ureterolysis, and 23 hysterectomies. RESULTS: The average operating time was 283.3 (+/- 76.9) minutes, there were no intra-operative complications or laparotomic conversions. The average recovery days were 5.9. There have been three grade 2 post-surgical complications, following the Memorial Sloan Kettering Cancer Center Surgical Secondary Events System classification. The combination of NIRF and transillumination allows a clear view of the anatomical landmarks and the resection margins. CONCLUSIONS: It's likely that improvement in the anatomical detail could confer a greater surgical safety with lower percentage of intra and post-surgical complications and sparing of safe tissue. To evaluate the validity of these techniques in a larger number of patients and compare these new surgical procedures with standard ones, further studies are needed.

Eosinophilic gastroenteritis in pregnancy: A review of the literature.

Eosinophilic gastroenteritis (EGE) is an uncommon and heterogeneous disease characterized by eosinophilic infiltration of the gastrointestinal tract. There are very few reports in literature describing pregnancies in EGE patients, and no review has ever been published. We found a total of 12 cases including one that occurred in our clinic. In 5 out of 12 cases, EGE was diagnosed after delivery and pregnancies are described as uneventful. Of the 5 patients who already had a diagnosis of EGE before pregnancy, only one registered an improvement of symptoms during gestation, while the rest had no significant changes, and their pregnancies needed to be monitored as high risk. Regarding pregnancy complications, only two patients had a pre-term delivery. Both patients had not only EGE, but a remarkable obstetrical history, that could slightly complicate the interpretation of the events that occurred in their pregnancies. More studies are necessary to demonstrate if EGE is connected with pre-term onset of labor. It's not easy to define the reasons of some patient's pre term labor, and we could suppose that a combination of different mechanisms leads to this condition of breakdown of maternal-fetal tolerance. Nevertheless, we know that spontaneous preterm labor is a syndrome attributable to multiple pathologic processes and most of them are yet to be understood. However, we cannot exclude that EGE is related to late preterm delivery. We hope that this review will provide some measures of guidance to those clinicians who must satisfy the questions of young female patients diagnosed with EGE and wishing for a pregnancy.

Laparoendoscopic single-site surgery for treatment of concomitant ovarian cystectomy and cholecystectomy.

Since the first laparoscopic appendectomy was performed by Semm in 1983, laparoscopic surgery has become the criterion standard surgical route for treatment of several pathologic conditions across disciplines. Attempts to minimize access-related injuries and complications resulted in development of laparoendoscopic single-site surgery (LESS), which, because of the decreased number of ports used, may be the next generation of minimally invasive surgery. Laparoscopic single-site surgery has been reported in nephrectomy, pyeloplasty, radical prostatectomy, cholecystectomy, and colorectal, bariatric, and gynecologic surgery. This technique may increase the benefits of traditional minimally invasive surgery such as decreased blood loss and postoperative pain, faster recovery time, fewer complications, and better cosmetic results, without increasing costs. Herein, we present a case report of single-port laparoscopic ovarian cystectomy and concomitant cholecystectomy performed with a multi-instrument access port (TriPort; Olympus America Inc., Center Valley, Pennsylvania). Single-port surgery eliminates the problem of multiple and different site placement for accessory ports, typical of these procedures when performed simultaneously at conventional laparoscopy.

Peritoneal psammocarcinoma diagnosed by a Papanicolau smear: a case report.

BACKGROUND: Serous psammocarcinoma is a rare variant of epithelial neoplasia that can arise from the ovaries or peritoneum. It is characterized by massive psammoma body formation, invasiveness and low grade cytologic features. CASE: A 70-year-old woman was admitted to our hospital; a bimanual examination with cervicovaginal smear was performed. The smears revealed neoplastic cells with psammoma bodies; afterward, endocervical curettage revealed microaggregates of epithelial neoplastic cells with psammoma bodies. Computed tomography of the abdomen showed a diffuse peritoneal carcinosis with left ovarian calcification. An exploratory laparotomy was carried out. Final pathologic findings showed peritoneal serous psammocarcinoma with ovarian implants. CONCLUSION: Our report suggests that a Pap smear can play a role in the detection of peritoneal psammocarcinoma and underlines the significance of psammoma bodies as a cytologic marker of this rare tumor.

Narrow-band imaging in diagnosis of endometrial cancer and hyperplasia: a new option?

STUDY OBJECTIVE: To estimate whether the use of narrow-band imaging (NBI) hysteroscopy increases concordance between visual identification and a histologic diagnosis of endometrial cancer and hyperplasia. DESIGN: Prospective study (Canadian Task Force classification: II-2). SETTING: Department of obstetrics and gynecology, University of Eastern Piedmont, Novara, Italy. PATIENTS: 209 consecutive patients with abnormal uterine bleeding. INTERVENTIONS: White-light hysteroscopy and NBI hysteroscopy followed by direct biopsy. MEASUREMENTS AND MAIN RESULTS: The sensitivity and specificity of conventional hysteroscopy in predicting a diagnosis of cancer and hyperplasia were, respectively, 84.21% (95% confidence interval [CI], 79.27-89.15) and 99.47% (95% CI, 98.49-100.0), and 64.86% (95% CI, 58.39-71.34) and 98.77% (95% CI, 97.27-100.0), and of NBI hysteroscopy were 94.74% (95% CI, 91.71-97.76) and 97.89% (95% CI, 95.95-99.84), and 78.38% (95% CI, 72.8-83.96) and 97.67% (95% CI, 96.63-99.72). The concordance of conventional and NBI hysteroscopy with the histopathologic findings (measured using the Cohen kappa) was, respectively, 88.80% (95% CI, 86.2%-96.3%) and 91.78% (95% CI, 89.6%-98.2%), a difference of 2.98% (95% CI, 0-9) in favor of NBI. CONCLUSION: Narrow-band imaging hysteroscopy can accurately predict a histologic diagnosis of endometrial cancer or hyperplasia.

Minilaparotomy in spinal anaesthesia: a surgical choice in treatment of benign gynaecologic disease.

PURPOSE: Minilaparotomic access in spinal anaesthesia represents an example of mininvasive surgery and could be a valid cost-benefit alternative in the surgical treatment of benign gynaecologic diseases. METHODS: The study is a randomized study. We analyzed a consecutive series of 80 patients treated for benign gynaecological diseases with spinal (group A) or with general anaesthesia (group B). RESULTS: The median length of incision was 5 cm. The average operating time was 40.5 +/- 9.39 min, without differences between groups. The average hospital stay was 0.71 days shorter (p < or = 0.0001) and the postoperative pain was lower at 2 and 6 h from the surgery and at 10 p.m. in the group A (p < or = 0.0001). CONCLUSIONS: Minilaparotomy in spinal anaesthesia carries advantages from economic point of view with reduction of length of stay in hospital which is an important parameter for the evaluation of the quality of surgical treatments.

Long-term outcome of hysteroscopic endometrial ablation without endometrial preparation.

OBJECTIVE: To describe the three-step hysteroscopic endometrial ablation (EA) technique without endometrial preparation, and its long-term outcomes. STUDY DESIGN: Four hundred and thirty-eight premenopausal women with menorrhagia or menometrorrhagia underwent three-step hysteroscopic EA, which consists of rollerball ablation of the fundus and cornual regions, a cutting loop endomyometrial resection of the rest of the cavity, and rollerball redessication of the whole pre-ablated uterine cavity. The main outcome measures were menstrual status, level of satisfaction with the procedure, and the need for repeat ablation or hysterectomy. Questionnaires were completed for 385 women (87.9%) with a mean follow-up of 48.2 months. RESULTS: One hundred and eighty-four responders (47.8%) reported amenorrhea; 177 (46%) had light to normal flow. One patient (0.3%) underwent repeat ablation and 20 (5.2%) underwent hysterectomy: 15 (3.9%) because of endometrial ablation failure and 5 (1.3%) because of indications unrelated to the ablation (three cases of atypical endometrial hyperplasia and two cases of fibroids). Two hundred and ninety-two patients (75.8%) were very satisfied, and 78 (20.3%) satisfied with the results. No major complications occurred and three women (0.8%) became pregnant during the follow-up period. CONCLUSIONS: EA is safe and effective means of treating of menorrhagia and menometrorrhagia in premenopausal women, and helps avoid hysterectomy in 95% of patients suffering from heavy bleeding, with or without uterine fibroids. Women should be informed that the procedure is not contraceptive and that pregnancy is possible after treatment.

Arsenic trioxide and breast cancer: analysis of the apoptotic, differentiative and immunomodulatory effects.

Arsenic trioxide (As2O3) is used clinically to treat acute promyelocytic leukemia and has activity in vitro against several solid tumour cell lines, where induction of differentiation and apoptosis are the prime effects. To investigate the potential therapeutic application of As2O3 to breast cancer, we analysed the effects of As2O3 on the growth of four human breast cancer cell lines: MCF7, MDA-MB-231, T-47D and BT-20. Cells were cultured in 0.5, 2 and 5 microM AS2O3, a range of pharmacologically achievable concentrations of AS2O3. At > or = 2 microM, AS2O3 rapidly induced cell death by apoptosis in MCF7 and MDA-MB-231 while T-47D and BT-20 were partially resistant. At 0.5 microM, As2O3 was subapoptotic but induced features of differentiation consisting in upregulation of ICAM-1 (CD54), a marker of mammary epithelial differentiation, and cell cultures appeared morphologically more organized. Furthermore, we demonstrate by standard cytotoxicity assays that As2O3 treatment can augment breast cancer cell lysis by lymphokine-activated killer cells and demonstrate an important role of the ICAM-1/LFA-1 interaction in this process. This additional activity of As2O3 could translate into improved antitumour immunosurveillance in vivo. In conclusion, As2O3 induced varying degrees of differentiation, apoptosis and lysis in these model cell lines, and may be a promising adjuvant to current treatments of breast cancer by virtue of its triple apoptotic, differentiative and immunomodulatory effects.