Robotic Shaving Technique in 25 Patients Affected by Deep Infiltrating Endometriosis of the Rectovaginal Space.

Minimally invasive surgery represents the gold standard for the management of deep infiltrating endometriosis (DIE) involving the rectovaginal septum (RVS). This analysis aimed to evaluate the feasibility of robotic-assisted laparoscopy (RAL) and clinical outcomes in terms of long-term complications, pain relief, and recurrence rate for the treatment of DIE of the RVS. A prospective cohort study of robotic procedures was performed between October 2010 and July 2014, including removal of endometriotic nodules from the RVS with rectal shaving alone or in combination with accessory procedures. In all cases, the revised American Society for Reproductive Medicine (rASRM) score for endometriosis was >40 points (stage IV). Twenty-five consecutive patients underwent RAL, with a successful complete nodule debulking by the wall shaving technique. Pathology confirmed the adequacy of the surgical specimen and the median largest endometriotic nodule was of 21 mm (range, 10-60 mm), with free margins in all cases. The median operative time from skin opening to closure was 174 minutes (range, 75-300 minutes), and blood loss was close to 0 mL. The median revised Enzian score for location A (RVS) was 2 (range, 1-3). The most frequent Enzian class was A2B0C0 (48%), followed by A3B0C0 (12%). In 3 cases (12%), partial vaginal resection was required to remove endometriotic nodules of the RVS (1 each in classes A3B0C1FI, A3B0C0FO, and A3B0C0). No intraoperative complications occurred. This series has a median long-term follow up of 22 months (range, 6-50 months) currently available with an optimal operative time, demonstrating good long-term outcomes. Our data support robotics as a safe and attractive alternative for comprehensive surgical treatment of DIE.

Drawing data for a 3D historical reconstruction of Shakespeare's first Globe Theatre.

The first Globe Theatre was one of the main outdoor playhouses in London in the early 17th century. Although it was built in 1599 and was destroyed in a fire in 1613, its history has survived to the present day as the theatre that was able to accommodate most of William Shakespeare's plays. Extensively studied during the last century, it has been attempted to be reconstructed several times in different parts of the world, although the information present does not allow for an exact reconstruction. The data presented here have been collected from the various interpretations offered in literature by the main scholars of the first Globe Theatre and re-elaborated according to criteria of coherence with vernacular building techniques and ease and feasibility of construction. What is presented is the methodology probably used by the Globe's carpenter Peter Street to draw the plan and then build the theatre. The data presented were used to provide a virtual reconstruction of the first Globe Theatre, featured in the article " Towards reconstructing the Shakespeare's first Globe Theatre: A virtual model for research and development", published in the Frontiers of Architectural Research by the same authors [1]. The data can be used to confirm, improve, or reconstruct the first Globe, as well as most Elizabethan theatres, similar in type and form.

Vaginal cuff dehiscence resulting in small-bowel evisceration. A case report.

Vaginal cuff dehiscence is a rare complication of hysterectomies which seems to be more frequent after surgery with laparoscopic suture of the cuff. We present a clinical case of evisceration of the small bowel emerging from vaginal cuff dehiscence, successfully repaired by positioning a low profile polypropylene ePTFE mesh*.

Robotic approach using simple and radical hysterectomy for endometrial cancer with long-term follow-up evaluation.

BACKGROUND: Feasibility and outcome of robotic-assisted laparoscopy (RAL) for endometrial cancer was evaluated with a mean follow-up of 4 years. METHODS: Robotic hysterectomy (RH) and type B robotic radical hysterectomy (RRH), with or without pelvic lymphadenectomy (PLH), was performed on 51 consecutive patients. Records were reviewed for demographic data, medical/surgical history and comorbidities, perioperative findings and outcomes, as well as long-term complications and recurrences. Regarding stage, according to 2009 FIGO, 25% of cases were IA, while 20%, 53% and 2% of cases were, respectively, IB, II and IIIA stage. RESULTS: Twenty-eight patients underwent RRH + PLH (54.9%), four patients underwent RH with concurrent nodal sampling (NS) (7.8%); a total of 32 PLH were performed (62.6%).The median operative time for RRH + PLH was 255 min (range: 160-435). Pathology confirmed the adequacy of the surgical specimen. CONCLUSION: Our data support the adoption of RAL staging in patients with endometrial cancer, including those with cervical involvement, and demonstrate good long-term outcomes.