Conization and lymph node evaluation in low-risk cervical cancer. Is it time to avoid radical surgery? Retrospective series and literature review.

OBJECTIVES: To evaluate the oncologic and obstetric outcomes of patients with low-risk cervical cancer who underwent conization and lymphatic evaluation to preserve fertility. METHODS: Data were collected retrospectively from September 2013 to February 2021. Eligibility criteria included Women with cervical cancer (aged <45 years) who underwent fertility preservation treatment, [stage IA1 with positive lymphovascular space invasion (LVSI), stage IA2, or stage IB1 (≤2 cm) with less <10 mm cervical stromal invasion, according to the International Federaltion of Gynecology and Obstetrics (FIGO) 2018 staging system] aged ≤45 years who wished to preserve their fertility were included in this study. All patients were treated with cervical conization(s) and laparoscopic lymph node evaluation [pelvic lymphadenectomy and/or sentinel lymph node (SLN) mapping]. Oncologic and obstetric outcomes were evaluated. RESULTS: Overall, 31 patients met the inclusion criteria; 15 (48.3%) women were nulliparous. There were 8 IA1LVSI+ (25.8%), 11 IA2 (35.4%) and 12 IB1 (31.7%) tumours, according to 2018 FIGO stage classification. Most patients had squamous cell carcinoma (77.4%). Lymphovascular space involvement was found in thirteen patients (41.9%). Reconization was performed in 17 (54.8%) patients, of which 6(35.2%) were done due to compromised margins, 4(23.5%) for margins under than 3 mm, 3(17.6%) for unreported or coagulated margins and 4(23.5%) because previous conization was done in another institution and we could not obtain the paraffin blocks for pathology review. Twenty patients had MRI and eleven CT scan. Nine (30%) patients had a complete bilateral pelvic lymph node dissection, 9 (26.6%) had SLN mapping with pelvic lymphadenectomy, and 13 (43.3%) had SLN mapping alone after bilateral SLN identification at surgery. After a median follow-up of 41.4 months (range 2-90 months), no recurrences have been detected. In terms of obstetrial outcome, 11 patients attempted pregnancy and 9 became pregnant. First-trimester miscarriage occurred in one patient. Five patients delivered at term by caesarean section, one of them requiring hysterectomy at the time of delivery. Pathology did not show residual disease. Two patients had a vaginal delivery at 38 weeks. One pregnancy is still ongoing. CONCLUSION: Cervical conization with lymph node assessment by SLN mapping/lymphadenectomy is an oncologic safe procedure in patients with low-risk cervical cancer.

Single-Port/Pneumovagina Technique for Two Further Applications.

OBJECTIVE: To demonstrate a novel technique to surgically treat certain vaginal conditions. DESIGN: Technical video demonstrating 2 cases in which the technique is used. SETTING: Gynecological Minimally Invasive and Robotic Surgery Unit at Clínica Universitaria (private clinic), Concepción, Chile. INTERVENTIONS: Local institutional review board was consulted, and this study was exempted from approval. Institutional ethics committee approved the study and publication of these data. A 35-year-old woman with a bicornuate unicollis uterus presented with dyspareunia. Her examination revealed an incomplete longitudinal vaginal septum. Her right hemivagina was slightly wider than the left one. With the patient under spinal anesthesia, we performed a complete resection of the septum using the single-port/pneumovagina technique (SPPT). A 36-year-old woman who was nulligravida presented with dyspareunia. On clinical exam she had a 3-cm leiomyoma in the proximal vaginal third. Doppler-powered pelvic ultrasound ruled out any vascular communication with the cervix. We performed a vaginal myomectomy using the SPPT under spinal anesthesia. In this particular case we used a fourth trocar in the gel cap to use a myoma screw. With this technique we created a pneumovagina occluding the introitus with the aid of a single-port device (GelPoint Path; Applied Medical, Rancho Santa Margarita, CA). We selected this particular device, designed for transanal surgery, because its access channel avoids gas leakage after applying gentle pressure on the cap. The working cannel is 4 × 4.5 cm, and up to 4 trocars can be inserted in the gel cap. We use 12 mm Hg of pressure to create the pneumovagina and 5 L/min flow to maintain it. Similar approaches have been described for treating eroded and/or infected sacrocolpopexy mesh [1-3]. One could question the utility of this approach over conventional vaginal surgery, and in this sense we believe it provides both the surgeon and surgical assistant a much more comfortable and ergonomic position while performing surgery. It also improves the view of anatomic structures for the surgical team, which in conventional vaginal surgery is limited only to the surgeon. Both procedures were uneventful. The operation time for the first patient was 5 minutes, and the patient was discharged 4 hours later. The operation time for the second patient lasted 35 minutes, and she was discharged 12 hours later. CONCLUSION: The creation of a pneumovagina with the application of a single-port device provides an excellent view of vaginal structures and allows the application of laparoscopic techniques to perform vaginal surgeries in a much more ergonomic fashion compared with conventional vaginal surgery.

Tap test en la evaluación rápida de la madurez pulmonar fetal / Tap test in the quick evaluation of the fetal lung maturity

Se realizó el Tap test y la prueba de Clements para evaluar madurez pulmonar fetal en 260 muestras de líquido amniótico obtenidas por amniocentesis transabdominal. El Tap test informó madurez en todas las muestras con prueba de Clements positiva (n = 156) e inmadurez en 20 de las 104 (19,2%) muestras con prueba de Clements intermedia y negativa. Ocurrieron 54 nacimientos dentro de las 72 horas de realizada la amniocentesis. Ninguno de los RN del grupo con prueba de Clements positiva (n = 50) o intermedia (n = 3) y Tap test inmaduro y presentó SDR. Nuestros resultados demuestran que el Tap test en un examen confiable y al parecer de mayor especificidad que la prueba de Clements para evaluar en forma rápida la madurez pulmonar fetal

Arteria umbilical única: revisión de 12 casos / Single umbilical artery: review of 12 cases

El cordón umbilical normalmente está formado por tres vasos, dos de arterias y una vena. La ausencia congénita de una arteria umbilical oarteria umbilical única (AUU) se ha relacionado con una serie de eventos perinatales desfavorables, tales como recién nacidos de bajo peso, prematuridad, malformaciones fetales y muerte perinatal. Se revisan retrospectivamente 12 casos de AUU con comprobación histológica y se analizan las principales características tanto maternas como perinatales. Se encontró un 58% de prematuridad, un 66% de bajo peso de nacimiento y una letalidad perinatal de 580/1000 RN (cuatro mortinatos y tres mortineonatos). En cinco casos se encontró asociación con malformaciones mayores (42%). Se preconiza una búsqueda dirigida de esta anomalía vascular en el momento del parto, debido a que es un importante índice para detectar malformaciones congénitas asociadas