Morcellation equipment: past, present, and future.

PURPOSE OF REVIEW: This review was written in an effort to describe the evolution of power morcellation equipment from their creation to their current state. In addition, this review addresses the continuously evolving equipment involved with power morcellation and looks to describe where the field is headed in the future. In addition, recent professional and federal recommendations have changed the way power morcellation is being approached and has led to the development of contained morcellation systems, which, although in their infancy, are also being proven to be well tolerated options. RECENT FINDINGS: This article will review the most current research on electronic power morcellation and the multiple attempts to prove superiority from the many different types of equipment, and also the many different approaches to morcellation. In addition, with the adaptation to contained morcellation, this review will cover research focused on optimizing a containment system and the techniques involved. SUMMARY: In summary, this review is aimed at describing many of the currently available power morcellation products and contained morcellation systems in an effort to allow physicians to understand the different options available, and to discuss well tolerated, effective, and clinically proven techniques that can lead to improved surgical outcomes in the future.

Hallmarks in the evolution of gynaecological cancer surgery: the famous pioneers in children.

At the beginning of the 19th century, gynaecological cancer, mainly cancer of the uterus and cervix was a dreadful, incurable affection. However, the popularization of the three fundamentals in surgery, anesthesia, asepsis and haemostasis, ushered the golden age of operative gynaecology. During that period distinguished surgeons/gynaecologists such as Friedrich Benjamin Osiander (1759-1822), Elias von Siebold (1775-1828) and Joseph-Claude-Anthelme Récamier (1774-1852) contributed to the development of the operative techniques, providing a therapeutic solution in gynaecological cancer.

[Lucy's cancer(s): A prehistorical origin?] / Le(s) cancer(s) de Lucy : une origine préhistorique ?

OBJECTIVES: The recent discovery of the earliest hominin cancer, a 1.7-million-year-old osteosarcoma from South Africa has raised the question of the origin of cancer and its determinants. We aimed to determine whether malignant and benign tumors exist in the past societies. METHODS: A review of literature using Medline database and Google about benign and malignant tumors in prehistory and antiquity. Only cases with morphological and paraclinical analysis were included. The following keywords were used: cancer; paleopathology; malignant neoplasia; benign tumor; leiomyoma; myoma; breast cancer; mummies; soft tissue tumor; Antiquity. RESULTS: Thirty-five articles were found in wich there were 34 malignant tumors, 10 benign tumors and 11 gynecological benign tumors. CONCLUSIONS: The fact that there were some malignant tumors, even few tumors and probably underdiagnosed, in the past may be evidence that cancer is not only a disease of the modern world. Cancer may be indeed a moving target: we have likely predisposing genes to cancer inherited from our ancestors. The malignant disease could therefore appear because of our modern lifestyle (carcinogens and risk factors related to the modern industrial society).

[Ian Vladimirovich Bokhman and the St. Petersburg School of Oncogynecology].

The article describes the history of the formation of the St. Petersburg school of oncogynecology based at the Department of Oncogynecology of the N. N. Petrov Research Institute of Oncology since 1927 until the present day. The contribution of the Heads of this Department is characterized in the creation of the St. Petersburg school of oncogynecology for the period of its existence. A brief biography of Professor Y. V. Bokhman is presented who has made the most significant contribution to the development of domestic oncogynecology. The main scientific directions of the Department of Oncogynecology are discussed in historical aspect.

Controlling female cancer in Argentina. Divergent initiatives and the road to fragmentation

This article analyses the organisation of cancer control in Argentina, with a special focus on the initiatives, institutions, and models that targeted female or gynaecological cancers. It identifies and examines the main factors in the process of elaborating a national policy to control the disease drawing on a series of actors and instruments such as the state, medical professionals, institutions and services, and the use of technology (notably diagnostic tools) for the detection of the disease. It traces the developments in the organisation highlighting its transformations from a centralising to a decentralised model of service provision. Using the concept of «path-dependence» the article examines the continuities and changes observed in the organisation of female cancer critically signalling the particular time at which a path was taken where «fragmentation» became consolidated within the health system. It also argues that it was within the field of cancer diagnosis that Argentinian doctors first sought to create the foundational structures of cancer organisation. The article contends that the path-dependence analytical approach helps us acknowledge the importance of historical analysis in the identification of factors that led to the lack of service coordination, including the persistent strain between national/provincial states that hampered the development of comprehensive programmes, aspects that have continued to mark efforts in the elaboration of cancer policies to the present day (AU)

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[Professor Drago Vrbanic - the important contribution to the development of oncology in Rijeka]. / Professor Dr. SC. Drago Vrbanic-vrijedan doprinos razvoju onkologije u Rijeci

In Rijeka of the 1950s professor Drago Vrbanic was well-known as an excellent gynaecologist and surgeon, especially in the field of gynaecological malignant tumours. He headed the gynaecological and radiology departments of the Sobol Brothers General Hospital, and successfully applied several radiotherapy methods. Later in the 1960s, he introduced modern classification of tumours and multidisciplinary expertise in the diagnostics and treatment of gynaecological cancers. He combined a variety of operation procedures and methods with modern radiotherapy, significantly improving the results of malignant tumour therapy.

Of leaves and butterflies: how methotrexate came to be the savior of women.

A little more than half a century ago, young women were frequently dying of reproductive sequelae such as ectopic pregnancies and gestational trophoblastic disease. Mortality from these conditions was as high as 90% in the case of metastatic choriocarcinoma. If lives could be saved, it was in the operating theater and often at the expense of future reproductive potential. By the 1940s, however, targeted chemotherapy was starting to be explored, and the development of methotrexate for the treatment of childhood leukemia in 1949 eventually resulted in an unexpected, but nevertheless long and happy association with the field of gynecology. Here we trace the origins of methotrexate and how it came to be an effective medical treatment for two life-threatening gynecologic conditions. It illustrates how the contributions of many clinicians and scientists from many disciplines, over the greater part of a century, come together to improve the care of a single patient today.

The history of the Gynecologic Cancer Study Group (GCSG) of the Japan Clinical Oncology Group (JCOG).

The Gynecologic Cancer Study Group (GCSG) of the Japan Clinical Oncology Group (JCOG) was organized in 1994. The GCSG has developed under the leadership of three successive group representatives, five principal study investigators, the cooperation of group members and the support of several public research funds. At present, 38 institutions are participating as active members of the GCSG of the JCOG. In addition to gynecologic oncologists, medical oncologists, pathologists and radiotherapists are participating in our group. Our group manages female genital malignancies including uterine cervical, endometrial, ovarian, tubal and vulvar cancers. Because the incidences of uterine cervical (in younger women), endometrial and ovarian cancer have increased in Japan in recent years, we are developing new standard treatments especially for these malignancies. As of 31 May 2011, our group has conducted six JCOG clinical trials (three completed and three ongoing) and completed one JCOG accompanying study, which is now in preparation for publication. Our group has also conducted several retrospective studies, and Phase I and II trials independent of the JCOG Data Center. Our aim is to conduct unique and high-quality clinical trials which we can appeal to the world. In this review, we present the organization and achievements of our group, along with a list of participating institutions, as the history of the GCSG of the JCOG.

Establishing specialty jurisdictions in medicine: the case of American obstetrics and gynaecology.

The profession of medicine has evolved into an extremely specialised occupation. Yet, recent research has neglected the intra-occupational processes influencing medical specialisation. This article aims to correct this oversight. It develops an historical account of intra-occupational factors influencing the decision to establish gynaecologic oncology as American ob/gyn's surgical subspecialty in 1972. Working within the framework initially developed by Everett C. Hughes and his students, the article examines this development as the outcome of a three-party relationship among gynaecologic oncologists, American ob/gyns, and gynaecologic pelvic surgeons. Aggressive movement by the gynaecologic pelvic surgeons challenging the established élite's identity definition for the ob/gyn specialty helped spur official recognition of gynaecologic oncology, a less threatening subspecialty. The article draws theoretical implications from the case regarding the role of a threatening other in influencing the specialisation process.

Howard Kelly establishes gynecologic brachytherapy in the United States.

PURPOSE: Exploration of Howard Atwood Kelly's contributions to gynecologic brachytherapy. METHODS AND MATERIALS: Review of contemporary journals, texts, newspaper accounts, and the memoirs of Kelly's associates. Information from unpublished material, including Kelly's handwritten notes and diaries, was culled from the Alan Mason Chesney Archives of the Johns Hopkins Medical Institutions. RESULTS: Despite European reports of radium's efficacy, gynecologists on both sides of the Atlantic resisted its adoption. The endorsement of radium therapy by America's foremost gynecologist, Howard Kelly, was instrumental in its acceptance. His consummate skill as clinician, investigator, publicist, and entrepreneur established brachytherapy as the primary treatment modality for carcinoma of the cervix and vagina. The technique he pioneered in the second decade of the 20th century, a combination of brachytherapy and megavoltage-equivalent teletherapy, presaged modern practice. CONCLUSION: Principles for the management of female genital neoplasia, outlined by Howard Kelly nine decades ago, remain relevant today.

History of the FIGO cancer staging system.

The main objectives of any good staging system - essential to an evidence-based approach to cancer - are: to aid the clinician in planning treatment; to provide indication of prognosis; to assist the physician in evaluating the results of treatment; to facilitate the exchange of information between treatment centers, thus disseminating knowledge; and to contribute to continuing investigations into human malignancies. A good staging system must have 3 basic characteristics: it must be valid, reliable, and practical. The first staging system for gynecological cancers appeared around the turn of the 20th century and applied to the carcinoma of the cervix uteri-the most common cancer affecting women in high income countries at that time. The classification and staging of the other gynecological malignancies was not put forward until the 1950s. Over the years, these staging classifications - with the exception of cervical cancer and gestational trophoblastic neoplasia - have shifted from a clinical to a surgical-pathological basis. This paper reviews the history of the International Federation of Gynecology and Obstetrics (FIGO) cancer staging system, how it was developed, and why.

Classics in brachytherapy: Margaret Cleaves introduces gynecologic brachytherapy.

Intracavitary treatment of gynecologic cancers has been the anchor of brachytherapy, and perhaps the greatest success of radiotherapy, for over a century. The woman who first performed the procedure was neither a surgeon nor radiologist, but an electrotherapeutist who began her career as an alienist. She pursued a prolific academic career despite being disabled by a disease that is no longer recognized. The fascinating life of Margaret Cleaves, the initiator of gynecologic brachytherapy, is recounted.