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- Angeles Martinez-Maestre, Maria, et al.
(author)
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Total Laparoscopic Hysterectomy With and Without Robotic Assistance : A Prospective Controlled Study
- 2014
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In: Surgical Innovation. - : SAGE Publications. - 1553-3506 .- 1553-3514. ; 21:3, s. 250-255
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Journal article (peer-reviewed)abstract
- Background. Hysterectomies are very common, and most of them are still performed abdominally. The minimally invasive alternatives are perceived as difficult by gynecologists. Robotic assistance is thought to facilitate laparoscopic surgery. The aim of this study was to compare the surgical outcomes of robotic-assisted and conventional total laparoscopic hysterectomy. Methods. Patients, candidate to hysterectomy for benign indications, were allocated to either robotic or conventional laparoscopy in a quasi-randomized fashion. Patients were operated following a standardized surgical protocol. Main outcome measures were total surgical time, conversions to laparotomy, blood loss, hospital stay, and complications. Results. Fifty-one patients underwent robotic hysterectomy (mean age = 46.59 years) and 54 conventional laparoscopy (mean age = 50.02 years). The groups were homogeneous in body mass index and uterine weight. Robotic-assisted hysterectomies were significantly shorter (154.63 +/- 36.57 vs 185.65 +/- 42.98 minutes in the control group; P =.0001). Patients in the robotic group also had a significantly smaller reduction in hemoglobin (9.69% +/- 8.88% vs 15.29% +/- 8.39% in controls; P =.0012) and hematocrit (10.56% +/- 8.3% vs 14.89% +/- 8.11%; P =.008). No intraoperative conversions to laparotomy were required. Complication rate was low and similar in both groups. All patients were fully recovered at 1-month follow-up outpatient visit. Conclusions. Significantly lower operative times and blood loss indicate that robotic assistance can facilitate surgery already during the learning curve period. Nevertheless, proficiency can be reached in conventional laparoscopy through training, and the cost-effectiveness of robotic hysterectomy for benign conditions is yet to be confirmed.
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| 3. |
- Gambadauro, Pietro, et al.
(author)
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The relevance of endometrial polyps : A bibliometric study
- 2013
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In: Gynecological Surgery. - : Springer Science and Business Media LLC. - 1613-2076 .- 1613-2084. ; 10:2, s. 103-108
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Journal article (peer-reviewed)abstract
- © Springer-Verlag Berlin Heidelberg 2013. The aim of this study was to explore and describe the status and trends of scientific literature on endometrial polyps. We have conducted a systematic search for publications related to endometrial polyps from 1982 to 2012 using Scopus. The original search was refined with the additional keywords: “infertility”, “bleeding”, and “cancer”. We have collected and analyzed quantitative data on number of publications, journals, language, and origin of each article. Descriptive statistics and charts were used to analyze data and provide information on publication trends. Out of a database of 12,125,345 articles published in the past 30 years, our systematic search retrieved 1,144 relevant publications. The amount of articles/year related to endometrial polyps has been significantly growing throughout the study period (1982-1996, 14±11.988; 1997-2012, 58.38± 11.506; p < 0.0001). A similar positive trend is observed for relative number of yearly publications (% retrieved/indexed; 1982-1996, 0.0044 %±0.0035; 1997-2012, 0.0127 %±0.0025; p < 0.0001). The proportion of articles related to “infertility” and “bleeding” has been growing more than that of papers related to “cancer”. English is the dominant language (79 %), and the USA is the most prolific country (19 %), followed by Italy (8 %) and the UK (7,8 %). During the last 5 years, Gynecological Surgery has been the journal with the highest proportion of publications on endometrial polyps (2.11 % of all its articles). In conclusion, the publications related to endometrial polyps have increased steadily during the last 30 years, particularly those related to bleeding and infertility. Not all the journals publishing regularly on “endometrial polyps” are indexed in Medline/Pubmed. Scholars interested in this field should consider comprehensive bibliographic search strategies.
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- Gambadauro, Pietro, et al.
(author)
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The "tele" factor in surgery today and tomorrow : implications for surgical training and education
- 2013
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In: Surgery today (Print). - : Springer Science and Business Media LLC. - 0941-1291 .- 1436-2813. ; 43:2, s. 115-122
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Research review (peer-reviewed)abstract
- New technological developments in the field of telecommunications have allowed a wide range of potentially novel surgical applications. The introduction of the World Wide Web in 1991 has been followed by a steep rise of the relevance of telemedicine, as it is witnessed in the latest scientific literature. There has been a consistent, positive trend in publications dealing, respectively, with telemedicine and the Internet. This article reviews telemedicine and other surgery-related innovations that benefit from telecommunication advances, and presents data from a quantitative bibliographic analysis. A number of applications, such as telementoring, teleproctoring and robotic telesurgery are described and their huge potentials are discussed. The integration between surgery and telecommunications could constitute one of the major achievements of modern medicine, and its safe integration into clinical practice should be a priority for modern surgeons.
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| 5. |
- Herrera Cappelletti, Erica, et al.
(author)
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Chances of pregnancy and live birth among women undergoing conservative management of early-stage endometrial cancer: a systematic review and meta-analysis
- 2021
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In: Human Reproduction Update. - : Oxford University Press. - 1355-4786 .- 1460-2369. ; 28:2, s. 282-295
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Journal article (peer-reviewed)abstract
- BACKGROUND Endometrial cancer is common and usually occurs after menopause, but the number of women diagnosed during reproductive age is increasing. The standard treatment including hysterectomy is effective but causes absolute uterine factor infertility. In order to avoid or postpone surgery, conservative management of endometrial cancer (CMEC) has been proposed for younger women who want to retain their fertility.OBJECTIVE AND RATIONALE The main objective of this study was to estimate the chances of pregnancy and live birth for women with early-stage endometrial cancer (EEC) who are managed conservatively for fertility preservation.SEARCH METHODS The PRISMA recommendations for systematic reviews and meta-analyses were followed. Structured searches were performed in PubMed, Embase and the Cochrane Library, from inception until 13 June 2021. Inclusion was based on the following criteria: group or subgroup of women with Clinical Stage IA, well-differentiated, endometrioid endometrial cancer (from now on, EEC); CMEC for fertility preservation; and reported frequencies of women achieving pregnancy and/or live birth after CMEC. The following exclusion criteria applied: impossibility to isolate/extract outcome data of interest; second-line CMEC for persistent/recurrent disease; CMEC in the presence of synchronous tumours; case reports; non-original or duplicated data; and articles not in English. Qualitative synthesis was performed by means of tabulation and narrative review of the study characteristics. Study quality was assessed with an ad hoc instrument and several moderator and sensitivity analyses were performed.OUTCOMES Out of 1275 unique records, 133 were assessed in full-text and 46 studies were included in the review. Data from 861 women with EEC undergoing CMEC were available. Progestin-based treatment was reported in all but three studies (93.5%; 836 women). Complete response to treatment was achieved in 79.7% of women, with 35.3% of them having a disease recurrence during follow-up. Of 286 pregnancies obtained after CMEC; 69.4% led to live birth (9% of them multiple births) and 66.7% were achieved through fertility treatment. Based on random-effects meta-analyses, women treated with progestin-based CMEC have a 26.7% chance of achieving pregnancy (95% CI 21.3–32.3; I2 = 53.7%; 42 studies, 826 women) and a 20.5% chance to achieve a live birth (95% CI 15.7–25.8; I2 = 40.2%; 39 studies, 650 women). Sample size, average age, publication year, study design and quality score were not associated with the outcomes of progestin-based CMEC in moderator analyses with meta-regression. However, mean follow-up length (in months) was positively associated with the chances of pregnancy (regression coefficient [B] = 0.003; 95% CI 0.001–0.005; P = 0.006) and live birth (B = 0.005; 95% CI 0.003–0.007; P < 0.001). In sensitivity analyses, the highest chances of live birth were estimated in subsets of studies including only women of age 35 or younger (30.7%), the combination of progestins with hysteroscopic resection (30.7%), or at least 3 years of follow-up (42.4%).WIDER IMPLICATIONS Progestin-based CMEC is viable for women with well-differentiated, Clinical Stage 1A, endometrioid endometrial cancer who want to preserve their fertility, but there is room for improvement as only one-fifth of them are estimated to achieve live birth according to this meta-analysis. Further investigations on prognosis-driven selection, hysteroscopic resection and long-term surveillance are arguably needed to improve the reproductive outcomes of CMEC.
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