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Giannini A, Massimello F, Caretto M, Cosimi G, Mannella P, Luisi S, Gadducci A, Simoncini T. Factors in malignant transformation of ovarian endometriosis: A narrative review. Gynecol Endocrinol 2024; 40:2409911. [PMID: 39445672 DOI: 10.1080/09513590.2024.2409911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 06/12/2024] [Accepted: 09/19/2024] [Indexed: 10/25/2024] Open
Abstract
Endometriosis is a common estrogen-dependent inflammatory disease with a chronic course and a tendency to recur. The association between endometriosis and cancer has been studied for several years. Numerous reports have demonstrated a strong association between specific ovarian malignancies and endometriotic lesions. Atypical endometriosis has been widely described as a malignant precursor to ovarian epithelial tumors, particularly clear cell carcinomas and endometrioid carcinomas. These histological types associated with endometriosis develop predominantly in the ovary rather than in extragonadal sites. The detailed molecular mechanism of etiology remains unclear. Recent studies have analyzed the genetic and molecular mechanisms involved in endometriosis-associated ovarian cancer. A critical role appears to be played by a carcinogenic model based on iron-induced oxidative stress, which is typical of the endometriosis microenvironment. It has been hypothesized that trans-tubal reflux of blood, endometrial cells and associated iron-induced oxidative stress underlie the development of endometriosis-associated ovarian cancer. However, the multifactorial mechanisms of this malignant transformation are not fully understood. The aim of this review is to summaries the current epidemiological, histopathological, genetic and molecular findings in the progression of endometriosis-associated ovarian cancer.
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Affiliation(s)
- Andrea Giannini
- Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology, University of Pisa, Pisa, Italy
| | - Francesca Massimello
- Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology, University of Pisa, Pisa, Italy
| | - Marta Caretto
- Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology, University of Pisa, Pisa, Italy
| | - Giulia Cosimi
- Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology, University of Pisa, Pisa, Italy
| | - Paolo Mannella
- Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology, University of Pisa, Pisa, Italy
| | - Stefano Luisi
- Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology, University of Pisa, Pisa, Italy
| | - Angiolo Gadducci
- Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology, University of Pisa, Pisa, Italy
| | - Tommaso Simoncini
- Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology, University of Pisa, Pisa, Italy
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Application of robotic single-site surgery with optional additional port for endometriosis: a single institution's experience. J Robot Surg 2021; 16:127-135. [PMID: 33651315 DOI: 10.1007/s11701-021-01217-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 02/20/2021] [Indexed: 10/22/2022]
Abstract
To evaluate the safety and feasibility of treating stage I-IV endometriosis patients with robotic single-site surgery (RSSS). A retrospective chart review was conducted on 334 patients with endometriosis treated by a single surgeon at a university hospital from January 2015 to November 2019. Surgeries were performed in a single institution between 2015 and 2019. All patients presented with pelvic pain and underwent surgical resection of the lesion. American Society of Reproductive Medicine (ASRM) standards were used to classify endometriosis. The primary goal of this study is to investigate the feasibility and safety of RSSS for surgical resection of stage I-IV endometriosis patients. We will compare patient characteristics and surgical parameters, such as blood loss, operating time, and postoperative complications, across different endometriosis stages to evaluate the effectiveness of this novel technique. RSSS was used for all cases, with no conversions to laparotomy or traditional laparoscopy. One to two additional ports were placed in 41 patients with deeply infiltrating endometriosis (DIE) involving the colorectal and urinary tract and/or extensive pelvic adhesions. Across patient groups, there were no significant differences in age, BMI, fertility history, abdominal surgery history, and hysterectomy ratio (P > 0.05). The median operation time was 140.25 min (range: 85.50-260.00 min, P < 0.05) and median blood loss was 31.25 mL (range: 15-100 mL, P < 0.05). Histopathology supported the diagnosis in 259/334 patients. The undiagnosed patients were associated with lower ASRM scores. For 83.3% of patients (295/334), the length of hospital stay was < 24 h. The postoperative complication rate was 6.0% (20/334), although only two cases were severe. Our results indicate that RSSS is an alternative, safe, and acceptable platform for the surgical treatment of all stages of endometriosis.
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Gkegkes ID, Iavazzo C, Iatrakis G, Iavazzo PE, Pechlivani F, Antoniou E, Bakalianou K. Robotic Management of Endometriosis: Discussion of Use, Criteria and Advantages: a Review of the Literature. ACTA MEDICA (HRADEC KRÁLOVÉ) 2020; 62:147-149. [PMID: 32036846 DOI: 10.14712/18059694.2020.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Endometriosis is a very common benign condition affecting fertility and quality of life. Different methods, either definitive or fertility sparing are used for its management by using open, laparoscopic, and robotic techniques. This is a literature review presenting the role and the advantages of robotic surgery in endometriosis. Such a management is effective, safe, and feasible in hands of well-trained multidisciplinary teams even for severe cases of endometriosis.
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Affiliation(s)
- Ioannis D Gkegkes
- Department of Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.
| | - Christos Iavazzo
- Department of Gynaecological Oncology, The Christie Hospital, Manchester, UK
| | - George Iatrakis
- Department of Obstetrics and Gynaecology, Technological Educational Institution of Athens, Athens, Greece
| | | | - Fani Pechlivani
- Department of Obstetrics and Gynaecology, Technological Educational Institution of Athens, Athens, Greece
| | - Evangelia Antoniou
- Department of Obstetrics and Gynaecology, Technological Educational Institution of Athens, Athens, Greece
| | - Konstadia Bakalianou
- Department of Obstetrics and Gynecology, General Hospital "Agia Olga", Athens, Greece
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Poujois J, Mézan De Malartic C, Callec R, Bresler L, Hubert N, Judlin P, Morel O. Deep infiltrating endometriosis: Interest of the robotic approach for a fledgling team. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2019. [DOI: 10.1177/2284026519850369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Mini-invasive surgery of deep endometriosis is challenging. Surgical difficulties related to the technical limitations of classical laparoscopic approach might be overcome with the use of robotic assistance. The aim of this study was to evaluate the safety and feasibility of robotic surgery for deep infiltrating endometriosis in the learning phase of our team. Methods: The 20 first cases of robotic-assisted laparoscopies for endometriosis were included over a 2-year period. Baseline characteristics of patients and surgical data were reviewed. Surgical outcomes and follow-up information of the patients were analyzed. Results: Twenty women were included. The mean age was 31.9 years (range: 25–44) and mean body mass index was 23 kg/m2 (range: 16–35). Ten patients had rectovaginal or uterosacral location only (50%) and nine women had deep infiltrating endometriosis with digestive or urinary tract lesions (45%). In addition to the gynecologic surgeon, urologic or visceral surgeons were required in 10 cases, and there were 3 cases where the three specialties were needed. The mean operative time was 183.9 min (range: 85–398) and no difference was observed between the first five cases and the last five cases. There was one laparoconversion, and only two urologic postoperative complications occurred. Conclusion: Thanks to the use of robotic surgical assistance and a multidisciplinary approach, and despite the start of the team for deep endometriosis care, no learning curve effect was observed regarding surgical procedures’ success, safety, or duration. The use of robotic assistance might improve the quality of care for women facing deep endometriosis.
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Affiliation(s)
- Julie Poujois
- Department of Obstetrics and Gynecology, Maternité, CHRU de Nancy, Nancy, France
| | | | - Ronan Callec
- Department of Obstetrics and Gynecology, Maternité, CHRU de Nancy, Nancy, France
| | - Laurent Bresler
- Department of Digestive Surgery, Hôpital Brabois Adultes, CHRU de Nancy, Nancy, France
| | - Nicolas Hubert
- Department of Urology, Hôpital Brabois Adultes, CHRU de Nancy, Nancy, France
| | - Philippe Judlin
- Department of Obstetrics and Gynecology, Maternité, CHRU de Nancy, Nancy, France
| | - Oliver Morel
- Department of Obstetrics and Gynecology, Maternité, CHRU de Nancy, Nancy, France
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Purohit R, Sharma JG, Meher D, Rakh SR, Malik S. Completion of vaginal hysterectomy by electro surgery using anteroposterior approach in benign cases faced with obliterated posterior cul-de-sac. Int J Womens Health 2018; 10:529-536. [PMID: 30271220 PMCID: PMC6147202 DOI: 10.2147/ijwh.s171575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Obliterated posterior cul-de-sac has been a real surgical challenge during vaginal hysterectomy. The present study demonstrates an anteroposterior approach to accomplish the vaginal hysterectomy in cases faced with an obliterated posterior cul-de-sac. Methods In a retrospective study in private setup, 51 consecutive cases with obliterated posterior cul-de-sac during vaginal hysterectomy due to severe benign pelvic adhesions were studied to know the feasibility of the anteroposterior approach. The upper limit of uterus size was that of 16 weeks of gestation. Results Vaginal hysterectomy was completed in 49 (96.08%) cases with obliterated posterior cul-de-sac due to severe benign pelvic adhesions. Two (3.92%) cases needed laparoscopic assistance to complete vaginal hysterectomy. Mean operation time was 109.92±40.13 (45-217) minutes due to the need for careful separation of adhesions from the uterus and indicated additional procedures. Mean weight of specimen uterus was 162±106.51 (40-460) grams. There was no major intra- or postoperative morbidity. Conclusion Completion of vaginal hysterectomy was feasible using the anteroposterior approach in most of the cases with obliterated posterior cul-de-sac due to severe benign pelvic adhesions.
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Affiliation(s)
- Ramkrishna Purohit
- Department of Obstetrics and Gynaecology, Purohit General Hospital, Bargarh, India,
| | - Jay Gopal Sharma
- Department of Obstetrics and Gynaecology, Purohit General Hospital, Bargarh, India,
| | - Devajani Meher
- Department of Obstetrics and Gynaecology, Purohit General Hospital, Bargarh, India,
| | - Sanjay Raosaheb Rakh
- Department of Obstetrics and Gynaecology, Purohit General Hospital, Bargarh, India,
| | - Surya Malik
- Department of Obstetrics and Gynaecology, Purohit General Hospital, Bargarh, India,
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Berlanda N, Frattaruolo MP, Aimi G, Farella M, Barbara G, Buggio L, Vercellini P. 'Money for nothing'. The role of robotic-assisted laparoscopy for the treatment of endometriosis. Reprod Biomed Online 2017. [PMID: 28624343 DOI: 10.1016/j.rbmo.2017.05.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Despite higher costs for robotic-assisted laparoscopy (RAL) than standard laparoscopy (SL), RAL treatment of endometriosis is performed without established indications. PubMed/MEDLINE was searched for 'robotic surgery' and 'endometriosis' or 'gynaecological benign disease' from January 2000 to December 2016. Full-length studies in English reporting original data were considered. Among 178 articles retrieved, 17 were eligible: 11 non-comparative (RAL only) and six comparative (RAL versus SL). Non-comparative studies included 445 patients. Mean operating time, blood loss and hospital stay were 226 min, 168 ml and 4 days. Major complications and laparotomy conversions were 3.1% and 1.3%. Eight studies reported pain improvement at 15-month follow-up. Comparative studies were all retrospective; 749 women underwent RAL and 705 SL. Operating time was longer for RAL in five studies. Major complications and laparotomy conversions for RAL and SL were 1.5% versus 0.3% and 0.3% versus 0.5%. One study reported pain reduction for RAL at 6-month follow-up. RAL treatment of endometriosis did not provide benefits over SL, overall and among subgroups of women with severe endometriosis, peritoneal endometriosis and obesity. Available evidence is low-quality, and data regarding long-term pain relief and pregnancy rates are lacking. RAL treatment of endometriosis should be performed only within controlled studies.
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Affiliation(s)
- Nicola Berlanda
- Unità Operativa Dipartimentale Ginecologia Chirurgica e Endometriosi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Italy.
| | - Maria Pina Frattaruolo
- Unità Operativa Dipartimentale Ginecologia Chirurgica e Endometriosi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Italy
| | - Giorgio Aimi
- Unità Operativa Dipartimentale Ginecologia Chirurgica e Endometriosi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Italy
| | - Marilena Farella
- Unità Operativa Dipartimentale Ginecologia Chirurgica e Endometriosi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Italy
| | - Giussy Barbara
- Unità Operativa Dipartimentale Ginecologia Chirurgica e Endometriosi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Italy
| | - Laura Buggio
- Unità Operativa Dipartimentale Ginecologia Chirurgica e Endometriosi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Italy
| | - Paolo Vercellini
- Unità Operativa Dipartimentale Ginecologia Chirurgica e Endometriosi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Italy
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Nezhat FR, Sirota I. Perioperative outcomes of robotic assisted laparoscopic surgery versus conventional laparoscopy surgery for advanced-stage endometriosis. JSLS 2016; 18:JSLS-D-14-00094. [PMID: 25489208 PMCID: PMC4254472 DOI: 10.4293/jsls.2014.00094] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background and Objectives: To determine perioperative outcome differences in patients undergoing robotic-assisted laparoscopic surgery (RALS) versus conventional laparoscopic surgery (CLS) for advanced-stage endometriosis. Methods: This retrospective cohort study at a minimally invasive gynecologic surgery center at 2 academically affiliated, urban, nonprofit hospitals included all patients treated by either robotic-assisted or conventional laparoscopic surgery for stage III or IV endometriosis (American Society for Reproductive Medicine criteria) between July 2009 and October 2012 by 1 surgeon experienced in both techniques. The main outcome measures were extent of surgery, estimated blood loss, operating room time, intraoperative and postoperative complications, and length of stay, with medians for continuous measures and distributions for categorical measures, stratified by body mass index values. Robotically assisted laparoscopy and conventional laparoscopy were then compared by use of the Wilcoxon rank sum, χ2, or Fisher exact test, as appropriate. Results: Among 86 conventional laparoscopic and 32 robotically assisted cases, the latter had a higher body mass index (27.36 kg/m2 [range, 23.90–34.09 kg/m2] versus 24.53 kg/m2 [range, 22.27–26.96 kg/m2]; P < .0079) and operating room time (250.50 minutes [range, 176–328.50 minutes] versus 173.50 minutes [range, 123–237 minutes]; P < .0005) than did conventional laparoscopy patients. After body mass index stratification, obese patients varied in operating room time (282.5 minutes [range, 224–342 minutes] for robotic-assisted laparoscopy versus 174 minutes [range, 130–270 minutes] for conventional laparoscopy; P < .05). No other significant differences were noted between the robotic-assisted and conventional laparoscopy groups. Conclusion: Despite a higher operating room time, robotic-assisted laparoscopy appears to be a safe minimally invasive approach for patients, with all other perioperative outcomes, including intraoperative and postoperative complications, comparable with those in patients undergoing conventional laparoscopy.
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Affiliation(s)
- Farr R Nezhat
- Department of Obstetrics and Gynecology, Mount Sinai Roosevelt and Mount Sinai St. Luke's, New York, NY, USA
| | - Ido Sirota
- Department of Obstetrics and Gynecology, Mount Sinai Roosevelt and Mount Sinai St. Luke's, New York, NY, USA
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Sinha R, Sanjay M, Rupa B, Kumari S. Robotic surgery in gynecology. J Minim Access Surg 2015; 11:50-9. [PMID: 25598600 PMCID: PMC4290120 DOI: 10.4103/0972-9941.147690] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 08/18/2014] [Indexed: 01/05/2023] Open
Abstract
FDA approved Da Vinci Surgical System in 2005 for gynecological surgery. It has been rapidly adopted and it has already assumed an important position at various centers where this is available. It comprises of three components: A surgeon's console, a patient-side cart with four robotic arms and a high-definition three-dimensional (3D) vision system. In this review we have discussed various robotic-assisted laparoscopic benign gynecological procedures like myomectomy, hysterectomy, endometriosis, tubal anastomosis and sacrocolpopexy. A PubMed search was done and relevant published studies were reviewed. Surgeries that can have future applications are also mentioned. At present most studies do not give significant advantage over conventional laparoscopic surgery in benign gynecological disease. However robotics do give an edge in more complex surgeries. The conversion rate to open surgery is lesser with robotic assistance when compared to laparoscopy. For myomectomy surgery, Endo wrist movement of robotic instrument allows better and precise suturing than conventional straight stick laparoscopy. The robotic platform is a logical step forward to laparoscopy and if cost considerations are addressed may become popular among gynecological surgeons world over.
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Affiliation(s)
- Rooma Sinha
- Department of Obstetrics and Gynecology, Apollo Health City, Hyderabad, Telangana, India
| | - Madhumati Sanjay
- Department of Obstetrics and Gynecology, Apollo Health City, Hyderabad, Telangana, India
| | - B Rupa
- Department of Obstetrics and Gynecology, Apollo Health City, Hyderabad, Telangana, India
| | - Samita Kumari
- Department of Obstetrics and Gynecology, Apollo Health City, Hyderabad, Telangana, India
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Robotic-Assisted Laparoscopy vs Conventional Laparoscopy for the Treatment of Advanced Stage Endometriosis. J Minim Invasive Gynecol 2015; 22:40-4. [DOI: 10.1016/j.jmig.2014.06.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 06/03/2014] [Accepted: 06/04/2014] [Indexed: 11/21/2022]
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