Robotic surgery and standard laparoscopy: a surgical hybrid technique for use in colorectal endometriosis.

AIM: The aim of our work was to assess the feasibility and possible benefits of a novel hybrid surgical technique in rectosigmoidal resection in patients with bowel endometriosis. MATERIAL AND METHODS: A total of seven symptomatic and infertile women with severe bowel endometriosis underwent segmental bowel resection using the da Vinci surgical system and conventional laparoscopy. Statistical analysis was performed by Friedman test for non-parametric multiple comparisons. RESULTS: The surgical procedure has a determined short mean operative time (210min) and short postoperative hospitalization (five days). In 100% of patients, the resected area showed disease-free margins. Follow-up, carried out at three, six and 12months after operation, showed a regression of painful symptoms in all operated patients (100%). Two patients (28.6%) aged≥35years eventually had natural pregnancies. CONCLUSION: To the best of our knowledge, this report is the first concerning the use of a hybrid technique for intestinal resection in severe endometriosis, and comparing our data with that in the literature, its methodological and clinical advantages are evident. Moreover, the complete removal of endometriotic implants seems to offer good results in terms of postoperative fertility, although the study data do not allow us to draw definitive conclusions on the management of fertility.

Differential Diagnosis of Endometriosis by Ultrasound: A Rising Challenge.

Ultrasound is an effective tool to detect and characterize endometriosis lesions. Variances in endometriosis lesions' appearance and distorted anatomy secondary to adhesions and fibrosis present as major difficulties during the complete sonographic evaluation of pelvic endometriosis. Currently, differential diagnosis of endometriosis to distinguish it from other diseases represents the hardest challenge and affects subsequent treatment. Several gynecological and non-gynecological conditions can mimic deep-infiltrating endometriosis. For example, abdominopelvic endometriosis may present as atypical lesions by ultrasound. Here, we present an overview of benign and malignant diseases that may resemble endometriosis of the internal genitalia, bowels, bladder, ureter, peritoneum, retroperitoneum, as well as less common locations. An accurate diagnosis of endometriosis has significant clinical impact and is important for appropriate treatment.

Exploring strengths and limits of urinary D-chiro inositol phosphoglycans (IPG-P) as a screening test for preeclampsia: A systematic review and meta-analysis.

Preeclampsia is a severe complication of human pregnancy as it leads to significant maternal and perinatal mortality and morbidity worldwide. A prompt recognition of women that develop this syndrome can improve clinical management, increase surveillance and, finally, improve outcomes. Different methods (based on history, ultrasound, serum and urinary biomarkers) were proposed a screening tests for this disease but their performance showed limited results. Urinary inositol phosphoglycans P-type (IPG-P) were shown to identify in advance most of the women who will develop preeclampsia in case-control and longitudinal studies, so we undertook a systematic review and meta-analysis of published studies. Seven studies met the entry criteria so were evaluated. All case-control studies showed excellent statistical performances in a quality statistical assessment. The meta-analysis considered three longitudinal, prospective studies that showed high sensitivity and specificity with ranges of 0.82- 0.99 and 0.90-1.00, respectively. Univariate measures of accuracy revealed a positive and negative likelihood ratio respectively of 3.61 (95% CI 1.56-5.67) and -2.35 (95% CI -3.79 to -0.91). By univariate approach, we found a pooled logarithm of diagnostic odds ratio of 6.15 (95% CI 2.64-9.67). A limitation of this analysis is that, although conducted in different settings (UK, Italy, France, South Africa, and Mauritius) and different clinical groups, they were based on a single academic group. According to our findings, IPG-P test showed very encouraging results as a rapid noninvasive screening test for preeclampsia. Further studies are needed to verify and to validate the reported findings.

Non-puerperal uterine inversion due to uterine sarcoma.

BACKGROUND: Uterine inversion is a very rare pathological condition that usually occurs in puerperium. Non- puerperal uterine inversion is exceptional and to our knowledge only a few cases of uterine inversion due to a uterine sarcoma have been reported. CASE REPORT: A 79-year-old woman, gravida 0, para 0, presented with vaginal bleeding. Pelvic examination under anesthesia revealed a huge mass coming from the cervix filling the vagina to the introitus, and rectal examination could not identify the uterus. Diagnosis of uterine inversion was made and the patient was submitted to total abdominal hysterectomy with bilateral salpingo-oophorectomy and pelvic lymph node sampling. The postoperative course was uneventful and the patient was discharged on the 5th postoperative day. She underwent postoperative pelvic radiation, and no recurrence was found during the 19-month follow-up period. CONCLUSION: Chronic non-puerperal uterine inversion can be considered a rare complication of malignant mixed mullerian tumor of the uterus.

Two cases of endometrial cancer diagnosis associated with bone metastasis.

BACKGROUND: Endometrial adenocarcinoma is commonly seen in postmenopausal women and uterine bleeding is the first sign in 90% of the cases. Bone metastasis as the presenting feature is extremely rare. We report two endometrial cancer patients with metastasis to the tibia and cervical vertebra at the time of primary disease. CASES: Two patients were diagnosed with stage IVB endometrial cancer with involvement of the tibia and cervical column, respectively. The first case was treated with 8 cycles of platinum, doxorubicin, and cyclophosphamide, but she died 3 months after the completion of chemotherapy as a result of progressive disease. The second case received surgery followed by chemotherapy with cisplatin and doxorubicin, but she died 2 months later. CONCLUSIONS: These cases highlight the rare and unusual presentation of endometrial cancer. For this reason a review of the literature is also provided for all cases with evidence of bone metastasis at presentation of the disease, and as a recurrence.

Pseudo-Meigs syndrome and elevated CA125 associated with struma ovarii.

BACKGROUND: Struma ovarii is a rare form of ovarian neoplasm composed entirely and predominantly of thyroid tissue. The association of pseudo-Meigs syndrome, elevation of CA125 and hyperthyroidism to struma ovarii is a rare condition. CASE: We report an unusual presentation of a postmenopausal woman with benign struma ovarii associated with pseudo-Meigs syndrome, hypertiroidism, and elevated CA125 serum level, and a large complex right pelvic mass thereby mimicking an ovarian cancer. CONCLUSIONS: Struma ovarii is a rare cause of ascites, hydrothorax, elevated CA125, and hyperthyroidism. This rare condition should be considered in the differential diagnosis in patients with ascites and pleural effusions but with negative cytology.

The role of office hysteroscopy in menopause.

We evaluated the efficacy of office hysteroscopic treatment of benign intrauterine pathologies using 5F mechanical instruments (scissors, grasping forceps). Subjects were 4863 women who underwent the procedure without analgesia or anesthesia. We treated cervical and endometrial polyps (0.2-3.7 cm), intrauterine adhesions, and anatomic impediments. At 3 months postoperatively, pathology persisted in 364 women (5.6%). Many operative procedures may be performed in the office setting with simple instruments, provided that correct indications are observed.