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Gynecological Surgery: Current Perspectives and Future Challenges
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Gynecological Surgery: Current Perspectives and Future Challenges

A special issue of Journal of Personalized Medicine (ISSN 2075-4426). This special issue belongs to the section "Clinical Medicine, Cell, and Organism Physiology".

Deadline for manuscript submissions: closed (20 August 2024) | Viewed by 14005

Special Issue Editors

Dr. Luigi Della Corte

E-Mail Website
Guest Editor
Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
Interests: oncological gynecology; ovarian cancer; vulvar cancer; endometriosis; PCOS
Special Issues, Collections and Topics in MDPI journals
Dr. Antonio Mercorio

E-Mail Website
Guest Editor
Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80138 Naples, Italy
Interests: minimally invasive surgery; endometriosis; infertility; reproductive disorders; uterine fibroids; endoscopy; polycystic ovarian syndrome

Special Issue Information

Dear Colleagues,

The world of benign and malignant gynecologic surgery is constantly expanding thanks to the improvement of minimally invasive surgical techniques and the ever-growing experience of gynecologists of the third millennium. The purpose of this Special Issue is to present studies on new surgical frontiers for the treatment of benign and, above all, malignant diseases, from endometrial cancers passing through that of the ovary, to those of the cervix and vulva. Alongside laparotomic and laparoscopic surgeries, the use of robot-assisted laparoscopic (RAL) surgery and vaginal natural orifice transluminal endoscopic surgery (vNOTES) has been increasing for years, allowing excellent surgical results as well as reduced operating times, shorter hospital stays, better aesthetic results and the possibility of carrying out the surgery under regional anesthesia.

As with medical therapy, surgery can now also be performed on the basis of not only the type of disease, but also the type of patient. Especially for malignant conditions, there is a need to highlight current perspectives with an eye to the future, allowing surgeons to work in harmony with clinicians—in particular, oncologists and radiotherapists. For these reasons, original articles, as well as systematic and narrative reviews of the literature, are welcome to be submitted to this Special Issue.

Dr. Luigi Della Corte
Dr. Antonio Mercorio
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Personalized Medicine is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

 

Keywords

  • laparoscopy
  • robot-assisted laparoscopic surgery
  • vNOTES
  • gynecological benign disease
  • endometrial cancer
  • ovarian cancer
  • cervical cancer
  • vulvar cancer

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Published Papers (5 papers)

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Research

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13 pages, 2319 KiB  
Article
Intraoperative Fluorescent Navigation of the Ureters, Vessels, and Nerves during Robot-Assisted Sacrocolpopexy
by Hye Sun Jun, Nara Lee, Bohye Gil, Yoon Jang, Na Kyung Yu, Yong Wook Jung, Bo Seong Yun, Mi Kyoung Kim, Seyeon Won and Seok Ju Seong
J. Pers. Med. 2024, 14(8), 827; https://doi.org/10.3390/jpm14080827 - 4 Aug 2024
Viewed by 1002
Abstract
In this study, we aimed to demonstrate the feasibility and safety of navigating the ureters, middle sacral artery (MSA), and superior hypogastric nerve (SHN) using indocyanine green (ICG) and near-infrared fluorescence (NIRF) imaging during robot-assisted sacrocolpopexy (RSCP). Overall, 15 patients who underwent RSCP [...] Read more.
In this study, we aimed to demonstrate the feasibility and safety of navigating the ureters, middle sacral artery (MSA), and superior hypogastric nerve (SHN) using indocyanine green (ICG) and near-infrared fluorescence (NIRF) imaging during robot-assisted sacrocolpopexy (RSCP). Overall, 15 patients who underwent RSCP for apical vaginal prolapse were retrospectively enrolled. All patients underwent cystoscopic intraureteric instillation of 5 cc ICG (2.5 mg/mL) before RSCP and intravenous injection of 3 cc ICG during presacral dissection and mesh fixation. In all patients, the fluorescent right ureter was clearly identified in real time. The MSA was visualized on ICG-NIRF images in 80% (13/15) of patients. The mean time from ICG injection to MSA visualization was 43.7 s; the mean duration of the arterial phase was 104.3 s. Fluorescent SHN was detected in 73.3% (11/15) of patients. The time from ICG injection to SHN fluorescence was 48.4 s; the duration of fluorescence was 177.2 s. There was no transfusion, iatrogenic ureteral injury, or bowel or urinary dysfunction. Our results indicated that intraoperative ureter, MSA, and SHN mapping using ICG-NIRF images during RSCP is a valuable and safe technique to avoid iatrogenic ureteral, vascular, and neural injuries and to simplify surgical procedures. Nonetheless, further studies are required. Full article
(This article belongs to the Special Issue Gynecological Surgery: Current Perspectives and Future Challenges)
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10 pages, 984 KiB  
Article
Vaginal Cuff Dehiscence and a Guideline to Determine Treatment Strategy
by Kyung Jin Eoh, Young Joo Lee, Eun Ji Nam, Hye In Jung and Young Tae Kim
J. Pers. Med. 2023, 13(6), 890; https://doi.org/10.3390/jpm13060890 - 24 May 2023
Cited by 4 | Viewed by 5962
Abstract
In this retrospective study, our aim was to investigate a novel treatment strategy guideline for vaginal cuff dehiscence after hysterectomy based on the mode of operation and time of occurrence in patients who underwent hysterectomy at Severance Hospital between July 2013 and February [...] Read more.
In this retrospective study, our aim was to investigate a novel treatment strategy guideline for vaginal cuff dehiscence after hysterectomy based on the mode of operation and time of occurrence in patients who underwent hysterectomy at Severance Hospital between July 2013 and February 2019. We analyzed the characteristics of 53 cases of vaginal cuff dehiscence according to the mode of hysterectomy and time of occurrence. Out of a total of 6530 hysterectomy cases, 53 were identified as vaginal cuff dehiscence (0.81%; 95% confidence interval: 0.4–1.6%). The incidence of dehiscence after minimally invasive hysterectomy was significantly higher in patients with benign diseases, while malignant disease was associated with a higher risk of dehiscence after transabdominal hysterectomy (p = 0.011). The time of occurrence varied significantly based on menopausal status, with dehiscence occurring relatively earlier in pre-menopausal women compared to post-menopausal women (93.1% vs. 33.3%, respectively; p = 0.031). Surgical repair was more frequently required in cases of late-onset vaginal cuff dehiscence (≥8 weeks) compared to those with early-onset dehiscence (95.8% vs. 51.7%, respectively; p < 0.001). Patient-specific factors, such as age, menopausal status, and cause of operation, may influence the timing and severity of vaginal cuff dehiscence and evisceration. Therefore, a guideline may be indicated for the treatment of potentially emergent complications after hysterectomy. Full article
(This article belongs to the Special Issue Gynecological Surgery: Current Perspectives and Future Challenges)
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Review

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20 pages, 1459 KiB  
Review
Medical and Surgical Strategies in Vulvar Paget Disease: Let’s Throw Some Light!
by Luigi Della Corte, Valeria Cafasso, Carmine Conte, Lara Cuomo, Pierluigi Giampaolino, Giada Lavitola and Giuseppe Bifulco
J. Pers. Med. 2023, 13(1), 100; https://doi.org/10.3390/jpm13010100 - 1 Jan 2023
Cited by 5 | Viewed by 2471
Abstract
Background: Vulvar Paget’s disease (VPD) is defined as a neoplasm of epithelial origin, mostly in postmenopausal women. Due to the extreme rarity of VPD, limited data about recommended treatment options are available. Surgical excision has been the treatment of choice although in the [...] Read more.
Background: Vulvar Paget’s disease (VPD) is defined as a neoplasm of epithelial origin, mostly in postmenopausal women. Due to the extreme rarity of VPD, limited data about recommended treatment options are available. Surgical excision has been the treatment of choice although in the recent decade medical treatments have been proposed. Methods: A systematic computerized search of the literature was performed in the main electronic databases (MEDLINE, EMBASE, Web of Science, PubMed, and Cochrane Library), from 2003 to September 2022, in order to analyze all medical and surgical strategies used for the treatment of VPD. Results: Thirty-four articles were included in this review with findings as follows: 390 patients were treated with medical or other conservative treatment while 2802 patients were treated surgically; 235/434 (54%) patients had a complete response, 67/434 (15%) a partial response, 10/434 (2.3%) a stable disease, 3/434 (0.7%) disease progress, 3/434 (0.7%) died of the disease, 55/434 (13%) died of other causes during follow up while 7/434 (1.6%) had to stop topical treatments with 5% imiquimod cream because of side effects; 239/434 patients (55%) had a recurrence and 11/434 (2.5%) were lost to follow-up. The length of follow-up was variable, according to the different studies analyzed. Conclusion: VPD is a chronic disease with a high recurrence rate and low mortality. There are no significant differences in recurrence rates in patients who undergo surgery and those who do not and the margin status at the time of primary surgery and recurrence. Several surgical and medical approaches providing both local control of the disease and minimal tissue damage have been developed. Clock mapping, a recent preoperative vulvo-vaginal workup tool, can predict the invasiveness and the extension of VPD. However, to date, due to the different treatment options available and in the absence of a global consensus, it is critical to tailor treatments to individual patient characteristics and biopsy histopathologic findings, to ensure the best type of therapy. Full article
(This article belongs to the Special Issue Gynecological Surgery: Current Perspectives and Future Challenges)
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Other

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7 pages, 3379 KiB  
Case Report
Laparoscopic Management of Cesarean Scar Pregnancy with Temporary Clipping of Anterior Trunk of Hypogastric Arteries: A Case Report
by Ioana-Flavia Bacila, Ligia Balulescu, Alexandru Dabica, Simona Brasoveanu, Marilena Pirtea, Adrian Ratiu and Laurentiu Pirtea
J. Pers. Med. 2024, 14(5), 469; https://doi.org/10.3390/jpm14050469 - 28 Apr 2024
Viewed by 1312
Abstract
A cesarean scar ectopic pregnancy (CSP) represents an uncommon yet potentially life-threatening condition requiring immediate and efficient management. We present a case of a 32-year-old woman diagnosed with a scar pregnancy at 8 weeks of gestation. Laparoscopic surgical management was chosen due to [...] Read more.
A cesarean scar ectopic pregnancy (CSP) represents an uncommon yet potentially life-threatening condition requiring immediate and efficient management. We present a case of a 32-year-old woman diagnosed with a scar pregnancy at 8 weeks of gestation. Laparoscopic surgical management was chosen due to its minimally invasive nature and potential for preserving fertility. During the procedure, temporary clipping of uterine arteries was employed to control intraoperative bleeding. The patient recovered well postoperatively with no complications. This case highlights the feasibility and effectiveness of laparoscopic intervention combined with temporary uterine artery clipping in the management of scar pregnancies, offering a valuable approach for clinicians faced with similar cases. Through this report, we aim to contribute to the existing literature on the optimal management of CSP and highlight the efficacy of laparoscopic surgery in this context. Full article
(This article belongs to the Special Issue Gynecological Surgery: Current Perspectives and Future Challenges)
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9 pages, 2155 KiB  
Brief Report
Intraoperative Fluorescent Ureter Visualization in Complex Laparoscopic or Robotic-Assisted Gynecologic Surgery
by Jiyoun Kim, Yoon Jang, Su Hyeon Choi, Yong Wook Jung, Mi-La Kim, Bo Seong Yun, Seok Ju Seong and Hye Sun Jun
J. Pers. Med. 2023, 13(9), 1345; https://doi.org/10.3390/jpm13091345 - 31 Aug 2023
Cited by 7 | Viewed by 2197
Abstract
This study aimed to demonstrate the feasibility of ureteral navigation using intraoperative indocyanine green (ICG) and near-infrared fluorescence (NIRF) imaging during complex laparoscopic or robot-assisted gynecologic surgery (LRAGS). Twenty-six patients at high risk of ureteral injury with complex pelvic pathology (CPP) due to [...] Read more.
This study aimed to demonstrate the feasibility of ureteral navigation using intraoperative indocyanine green (ICG) and near-infrared fluorescence (NIRF) imaging during complex laparoscopic or robot-assisted gynecologic surgery (LRAGS). Twenty-six patients at high risk of ureteral injury with complex pelvic pathology (CPP) due to pelvic organ prolapse (POP), multiple myomas, large intraligamentary or cervical myoma, severe pelvic adhesions, or cervical atresia underwent LRAGS. All patients underwent cystoscopic intraureteral ICG instillation before LRAGS and ureteral navigation under NIRF imaging intraoperatively. Both ureteral pathways were identified from the pelvic brim downwards through NIRF imaging in all patients, even though some were not visualized under the white light mode. The fluorescent ureters were visualized immediately after the beginning of surgery and typically lasted for >5 h during surgery. There were no cases of iatrogenic ureteral injury. The hemoglobin decrement was 1.47 ± 1.13 g/dL, and no transfusion was required. In our study, both ureters in all patients were identified with ICG-NIRF imaging during LRAGS, and these techniques made surgeries easier and safer. Despite the CPP, there was no ureteral injury or transfusion following surgery. Further prospective studies are needed to introduce intraoperative ureteral guidelines for ICG-NIRF imaging during LRAGS with CPP. Full article
(This article belongs to the Special Issue Gynecological Surgery: Current Perspectives and Future Challenges)
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