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Centini G, Labanca L, Giorgi M, Martire FG, Catania F, Zupi E, Lazzeri L. The implications of the anatomy of the nerves and vessels in the treatment of rectosigmoid endometriosis. Clin Anat 2024; 37:270-277. [PMID: 37165994 DOI: 10.1002/ca.24059] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 04/30/2023] [Accepted: 05/02/2023] [Indexed: 05/12/2023]
Abstract
Endometriosis is a common benign gynecological disease characterized by the presence of endometrial glands and stroma outside the uterus. It can be defined as endometrioma, superficial peritoneal endometriosis or deep infiltrating endometriosis (DIE) depending on the location and the depth of infiltration of the organs. In 5%-12% of cases, DIE affects the digestive tract, frequently involving the distal part of the sigmoid colon and rectum. Surgery is generally recommended in cases of obstructive symptoms and in cases with pain that is non-responsive to medical treatment. Selection of the most optimal surgical technique for the treatment of bowel endometriosis must consider different variables, including the number of lesions, eventual multifocal lesions, as well as length, width and grade of infiltration into the bowel wall. Except for some major and widely accepted indications regarding bowel resection, established international guidelines are not clear on when to employ a more conservative approach like rectal shaving or discoid resection, and when, instead, to opt for bowel resection. Damage to the pelvic autonomic nervous system may be avoided by detection of the middle rectal artery, where its relationship with female pelvic nerve fibers allows its use as an anatomical landmark. To reduce the risk of potential vascular and nervous complications related to bowel resection, a less invasive approach such as shaving or discoid resection can be considered as potential treatment options. Additionally, the middle rectal artery can be used as a reference point in cases of upper bowel resection, where a trans mesorectal technique should be preferred to prevent devascularization and denervation of the bowel segments not affected by the disease.
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Affiliation(s)
- Gabriele Centini
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy
| | - Luca Labanca
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy
| | - Matteo Giorgi
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy
| | - Francesco Giuseppe Martire
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy
| | - Francesco Catania
- Department of Surgical Sciences, Gynecological Unit, Valdarno Hospital, Montevarchi, Italy
| | - Errico Zupi
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy
| | - Lucia Lazzeri
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy
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Martire FG, Labanca L, Giorgi M, Selntigia A, Russo C, Centini G, Ginetti A, D’Abate C, Capriglione S, Exacoustos C, Catania F, Zupi E, Lazzeri L. The role of hysteroscopy with morcellator without anesthesia in the management of abnormal uterine bleeding. J Turk Ger Gynecol Assoc 2024; 25:1-6. [PMID: 38444293 PMCID: PMC10921079 DOI: 10.4274/jtgga.galenos.2023.2023-7-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/03/2023] [Indexed: 03/07/2024] Open
Abstract
Objective To evaluate the feasibility of hysteroscopy with morcellator without anesthesia and the diagnostic accuracy of 2D, 3D and power Doppler transvaginal sonography (TVS) in patients with abnormal uterine bleeding (AUB). Material and Methods This was a retrospective study including women with AUB. All patients underwent 2D, 3D and power Doppler TVS evaluation of the uterine cavity, and patients with suspicion on ultrasound (US) of endometrial pathology (EP) underwent hysteroscopy with morcellator without anesthesia. The painful symptomatology was assessed during the procedure using a visual analogue scale (VAS). Additionally, histological evaluation was performed. Results A total of 182 women underwent US imaging, of whom 131 (72%) had hysteroscopy. 130/131 patients completed the hysteroscopic examination with good compliance (VAS <4). One patient (0.8%) was unable to complete the procedure due to nulliparity and cervical stenosis. Of the 130 patients the US diagnosis was confirmed in 120 (92.3%), while in 10 patients (7.7%) the hysteroscopic diagnosis was different from the US diagnosis. Histological examination confirmed benign endometrial polyps in 115/130 patients (88.5%), while premalignant conditions were diagnosed in 3/130 patients (2.3%) and malignant conditions in 2/130 (1.5%). Of the 10 patients with endometrial thickening, two were diagnosed with a malignant condition. Conclusion This study confirmed the feasibility of managing patients with AUB and suspicion of EP using "see-and-treat" hysteroscopy with morcellator without anesthesia. This procedure has the potential to yield desired outcomes while minimizing pain and discomfort, presenting a feasible outpatient approach for both treating and preventing endometrial carcinoma without requiring anesthesia.
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Affiliation(s)
- Francesco Giuseppe Martire
- Department of Surgical Sciences, Obstetrics and Gynecology of Unit, University of Rome Tor Vergata, Rome, Italy
- Department of Surgical Sciences, Gynecological Unit, Valdarno Hospital, Montevarchi, Italy
| | - Luca Labanca
- Department of Surgical Sciences, Gynecological Unit, Valdarno Hospital, Montevarchi, Italy
| | - Matteo Giorgi
- Department of Molecular and Developmental Medicine, Division of Obstetrics and Gynecology, University of Siena, Siena, Italy
| | - Aikaterini Selntigia
- Department of Surgical Sciences, Obstetrics and Gynecology of Unit, University of Rome Tor Vergata, Rome, Italy
| | - Consuelo Russo
- Department of Surgical Sciences, Obstetrics and Gynecology of Unit, University of Rome Tor Vergata, Rome, Italy
| | - Gabriele Centini
- Department of Molecular and Developmental Medicine, Division of Obstetrics and Gynecology, University of Siena, Siena, Italy
| | - Alessandro Ginetti
- Department of Molecular and Developmental Medicine, Division of Obstetrics and Gynecology, University of Siena, Siena, Italy
| | - Claudia D’Abate
- Department of Molecular and Developmental Medicine, Division of Obstetrics and Gynecology, University of Siena, Siena, Italy
| | - Stella Capriglione
- Department of Surgical Sciences, Gynecological Unit, Valdarno Hospital, Montevarchi, Italy
| | - Caterina Exacoustos
- Department of Surgical Sciences, Obstetrics and Gynecology of Unit, University of Rome Tor Vergata, Rome, Italy
| | - Francesco Catania
- Department of Surgical Sciences, Gynecological Unit, Valdarno Hospital, Montevarchi, Italy
| | - Errico Zupi
- Department of Molecular and Developmental Medicine, Division of Obstetrics and Gynecology, University of Siena, Siena, Italy
| | - Lucia Lazzeri
- Department of Molecular and Developmental Medicine, Division of Obstetrics and Gynecology, University of Siena, Siena, Italy
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Giorgi M, Labanca L, Centini G, Lazzeri L, Martire FG, Sorrentino E, Mancini V, Raimondo D, Raffone A, Neola D, Aru AC, Habib N, Casadio P, Seracchioli R, Zupi E. Extrauterine adenomyoma: A case report and systematic review of the literature. Int J Gynaecol Obstet 2024; 164:869-901. [PMID: 37688388 DOI: 10.1002/ijgo.15049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/06/2023] [Accepted: 07/29/2023] [Indexed: 09/10/2023]
Abstract
OBJECTIVE To describe a case of extrauterine adenomyoma (EA) and review all the cases of EA in the literature. METHODS Pubmed/MEDLINE, Embase, and Google Scholar from 1807 to December 2022. All studies reporting the histologic diagnosis of an EA. We collected the following data: patient's age, size and location of adenomyoma, presence of endometriosis and adenomyosis, past gynecologic treatment, symptoms, diagnostic imaging, surgical intervention, alternative/adjuvant treatment, associated malignancy, and follow up. RESULTS Sixty-seven studies with 85 patients were included. Pain was the most frequent symptom (69.5%). Among diagnostic examinations, ultrasonography was used in 60 out of 81 reported cases, with several radiologic features described. EA was located inside the pelvis in 77.6% of patients. Adnexa were the most frequent site of the disease (24, 28.2%). History of endometriosis or adenomyosis was described in 35 patients (35, 41.2%). Uterine tissue morcellation was reported in 6 of the 85 patients (7.1%). Associated malignancy was detected in 9 out of 85 patients with available data (10.6%). There were two recurrences of disease. CONCLUSION Specific imaging features of EA are yet to be described in the literature. History of endometriosis and adenomyosis or uterine tissue morcellation may be suggestive of EA. Histologic examination can give a definitive diagnosis and exclude malignant transformation.
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Affiliation(s)
- Matteo Giorgi
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy
| | - Luca Labanca
- Department of Surgical Sciences, Gynecological Unit, Valdarno Hospital, Montevarchi, Italy
| | - Gabriele Centini
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy
| | - Lucia Lazzeri
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy
| | - Francesco Giuseppe Martire
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy
| | - Ester Sorrentino
- Department of Medical Biotechnology, Section of Pathology, University of Siena, Siena, Italy
| | - Virginia Mancini
- Department of Medical Biotechnology, Section of Pathology, University of Siena, Siena, Italy
| | - Diego Raimondo
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Antonio Raffone
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Daniele Neola
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Anna Chiara Aru
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Nassir Habib
- Department of Obstetrics and Gynecology, Beaujon Hospital-University of Paris, Paris, France
| | - Paolo Casadio
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Renato Seracchioli
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Errico Zupi
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy
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Martire FG, Giorgi M, Labanca L, Centini G, Catania F, Exacoustos C, Zupi E, Lazzeri L. Unilateral hydroureteronephrosis after introduction of a levonorgestrel-releasing intrauterine system: a case report and literature review. Minerva Obstet Gynecol 2023; 75:491-497. [PMID: 36255159 DOI: 10.23736/s2724-606x.22.05112-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Insertion of a LNG-Intra-uterine System (LNG-IUS) has many gynecological indications. The approved indications worldwide are contraception, treatment of abnormal uterine bleeding depending on not organic disease, and endometrial protection in case of an estrogenic therapy. Instead adenomyosis, fibroids, and fertility-sparing management of endometrial hyperplasia or early endometrial cancer in patients with desire of pregnancy are off label indications. Hydroureteronephrosis is an uncommon complication during LNG-IUS insertion. There are few cases described in the literature. The first diagnostic approach for this complication is an abdominal-pelvic ultrasound scan to identify the abnormal position of the device. Diagnostic management includes computed tomography (CT) or magnetic resonance imaging (MRI), which are necessary to confirm hydroureteronephrosis and to assess the exact location of the LNG-IUS in the abdomen. A minimally invasive approach is the standard of care with the removal of the device, while the therapeutic management of the hydroureteronephrosis depends on ureteral and kidney involvement. We report the history of a dislocated LNG-IUS in the left paracervical space with subsequent ipsilateral hydroureteronephrosis. In our case we removed the device through hysteroscopy and later inserted a J-J stent. Follow-up at three months revealed the persistence of left hydroureteronephrosis, so we performed ureter reimplantation. We also performed a review of the literature to analyze common diagnostic and therapeutic pathways for this rare complication.
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Affiliation(s)
- Francesco G Martire
- Unit of Gynecology, Department of Surgical Sciences, Tor Vergata University, Rome, Italy
- Unit of Gynecology, Department of Surgical Sciences, Valdarno Hospital, Azienda USL Toscana Sud Est, Montevarchi, Arezzo, Italy
| | - Matteo Giorgi
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy -
| | - Luca Labanca
- Unit of Gynecology, Department of Surgical Sciences, Valdarno Hospital, Azienda USL Toscana Sud Est, Montevarchi, Arezzo, Italy
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy
| | - Gabriele Centini
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy
| | - Francesco Catania
- Unit of Gynecology, Department of Surgical Sciences, Valdarno Hospital, Azienda USL Toscana Sud Est, Montevarchi, Arezzo, Italy
| | - Caterina Exacoustos
- Unit of Gynecology, Department of Surgical Sciences, Tor Vergata University, Rome, Italy
| | - Errico Zupi
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy
| | - Lucia Lazzeri
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy
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Lazzeri L, Andersson KL, Angioni S, Arena A, Arena S, Bartiromo L, Berlanda N, Bonin C, Candiani M, Centini G, Forno SD, Donati A, Exacoustos C, Fuggetta E, Labanca L, Maiorana A, Maneschi F, Mattei A, Muzii L, Ottolina J, Perandini A, Perelli F, Pino I, Porpora MG, Remorgida V, Scaramuzzino S, Schimberni M, Seracchioli R, Solima E, Vignali M, Zupi E, Martire FG. How to Manage Endometriosis in Adolescence: The Endometriosis Treatment Italian Club Approach. J Minim Invasive Gynecol 2023; 30:616-626. [PMID: 37001691 DOI: 10.1016/j.jmig.2023.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 04/03/2023]
Abstract
The evaluation of endometriosis in an adolescent girl is a challenging topic. The initial stage of the disease and the limited diagnostic instrument appropriate for the youth age and for its typical features can reduce the ability of the gynecologist. At the same time, missing a prompt diagnosis can delay the beginning of specific and punctual management of endometriosis, which could avoid a postponed diagnosis from 6 to 12 years, typical of adolescent girls complaining of dysmenorrhea. This article aimed to answer all the potential questions around the diagnosis and management of endometriosis in adolescents starting from a clinical case looking at the possible solution that is easily reproducible in the clinical practice.
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Affiliation(s)
- Lucia Lazzeri
- Department of Molecular and Developmental Medicine (Drs. Lazzeri, Centini, Martire, and Zupi), Università di Siena, Siena, Italy
| | - Karin Louise Andersson
- Department of Territory Health (Dr. Andersson, Exacoustos), Azienda Sanitaria Toscana Centro, Florence, Italy
| | - Stefano Angioni
- Department of Surgical Sciences (Dr. Angioni), Università di Cagliari, Cittadella Universitaria, Cagliari, Italy
| | - Alessandro Arena
- Department of Medical and Surgical Sciences (Drs. A. Arena, Del Forno, and Seracchioli), DIMEC, Sant'Orsola Hospital, Università di Bologna, Bologna, Italy
| | - Saverio Arena
- Department of Obstetrics and Gynecology (Arena), Santa Maria della Misericordia hospital, Perugia, Italy
| | - Ludovica Bartiromo
- Department of Obstetrics and Gynecology (Drs. Bartiromo, Candiani, Ottolina, and Schimberni), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Berlanda
- Department of Obstetrics and Gynecology (Drs. Berlanda and Donati), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Cecilia Bonin
- Azienda Ospedaliera Universitaria Integrata (Drs. Bonin and Perandini), Università di Verona, Piazzale A. Stefani 1, Verona, Italy
| | - Massimo Candiani
- Department of Obstetrics and Gynecology (Drs. Bartiromo, Candiani, Ottolina, and Schimberni), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gabriele Centini
- Department of Molecular and Developmental Medicine (Drs. Lazzeri, Centini, Martire, and Zupi), Università di Siena, Siena, Italy
| | - Simona Del Forno
- Department of Medical and Surgical Sciences (Drs. A. Arena, Del Forno, and Seracchioli), DIMEC, Sant'Orsola Hospital, Università di Bologna, Bologna, Italy
| | - Agnese Donati
- Department of Obstetrics and Gynecology (Drs. Berlanda and Donati), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Caterina Exacoustos
- Department of Territory Health (Dr. Andersson, Exacoustos), Azienda Sanitaria Toscana Centro, Florence, Italy; Department of Surgical Sciences, Gynecologic Unit (Drs. Exacoustos, and Martire), University of Rome "Tor Vergata" Rome, Italy
| | - Eliana Fuggetta
- Department of Obstetrics and Gynecology (Drs. Fuggetta and Maneschi), San Giovanni Addolorata Hospital (Drs. Labanca and Martire), Roma, Italy
| | - Luca Labanca
- Department of Surgical Sciences (Drs. Labanca), Valdarno Hospital, Azienda Toscana Sud Est, Italy
| | - Antonio Maiorana
- Department of Obstetrics and Gynecology (Dr. Maiorana), ARNAS Ospedale Civico Piazza Nicola, Palermo, Italy
| | - Francesco Maneschi
- Department of Obstetrics and Gynecology (Drs. Fuggetta and Maneschi), San Giovanni Addolorata Hospital (Drs. Labanca and Martire), Roma, Italy
| | - Alberto Mattei
- Department of Molecular and Developmental Medicine (Drs. Lazzeri, Centini, Martire, and Zupi), Università di Siena, Siena, Italy; Department of Surgical Sciences, Gynecologic Unit (Drs. Exacoustos, and Martire), University of Rome "Tor Vergata" Rome, Italy
| | - Ludovico Muzii
- Department of Maternal and Child Health and Urology (Drs. Muzii, Porpora, and Scaramuzzino), Università di Roma La Sapienza, Policlinico Umberto I, Rome, Italy
| | - Jessica Ottolina
- Department of Obstetrics and Gynecology (Drs. Bartiromo, Candiani, Ottolina, and Schimberni), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessio Perandini
- Azienda Ospedaliera Universitaria Integrata (Drs. Bonin and Perandini), Università di Verona, Piazzale A. Stefani 1, Verona, Italy
| | - Federica Perelli
- Division of Gynecology and Obstetrics (Drs. Mattei and Perelli), Santa Maria Annunziata Hospital, USL Toscana Centro, Florence, Italy
| | - Ida Pino
- Preventive Gynecology Unit (Dr. Pino), European Institute of Oncology IRCCS, Milan, Italy
| | - Maria Grazia Porpora
- Department of Maternal and Child Health and Urology (Drs. Muzii, Porpora, and Scaramuzzino), Università di Roma La Sapienza, Policlinico Umberto I, Rome, Italy
| | - Valentino Remorgida
- Unit of Obstetrics and Gynecology (Dr. Remorgida), University of Eastern Piedmont, Novara, Italy
| | - Sara Scaramuzzino
- Department of Maternal and Child Health and Urology (Drs. Muzii, Porpora, and Scaramuzzino), Università di Roma La Sapienza, Policlinico Umberto I, Rome, Italy
| | - Matteo Schimberni
- Department of Obstetrics and Gynecology (Drs. Bartiromo, Candiani, Ottolina, and Schimberni), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Renato Seracchioli
- Department of Medical and Surgical Sciences (Drs. A. Arena, Del Forno, and Seracchioli), DIMEC, Sant'Orsola Hospital, Università di Bologna, Bologna, Italy; Division of Gynecology and Human Reproduction Phisiopatology (Dr. Seracchioli), IRCCS, Azienda Ospedaliera Universitaria di Bologna, Bologna Italy
| | - Eugenio Solima
- Department of Obstetrics and Gynecology (Drs. Solima and Vignali), Macedonio Melloni Hospital, Milan, Italy
| | - Michele Vignali
- Department of Obstetrics and Gynecology (Drs. Solima and Vignali), Macedonio Melloni Hospital, Milan, Italy
| | - Errico Zupi
- Department of Molecular and Developmental Medicine (Drs. Lazzeri, Centini, Martire, and Zupi), Università di Siena, Siena, Italy.
| | - Francesco Giuseppe Martire
- Division of Gynecology and Obstetrics (Drs. Mattei and Perelli), Santa Maria Annunziata Hospital, USL Toscana Centro, Florence, Italy
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Barbanti C, Labanca L, Gentile F, Chini T, Centini G, Habib N, Zupi E, Lazzeri L. Urinary-tract endometriosis: a multidisciplinary fight against a silent enemy. J Minim Invasive Gynecol 2022; 29:584-585. [PMID: 35247606 DOI: 10.1016/j.jmig.2022.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 02/16/2022] [Accepted: 02/25/2022] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE To demonstrate the safety and feasibility of laparoscopic robotic assisted approach to urinary tract endometriosis. DESIGN This is an educational video to explain the main steps of robotic assisted ureteroneocystostomy due to endometriosis. SETTING Tertiary care university hospital. Patient written consent was obtained on 9th March 2021. The local IRB confirmed that the video met the ethical criteria. INTERVENTIONS Laparoscopic Robotic assisted resection of uterosacral ligament endometriotic nodule, left terminal partial ureterectomy, partial cystectomy and ureteroneocystostomy. CONCLUSION This video shows a stepwise approach to laparoscopic robotic assisted urinary tract endometriosis management demonstrating its feasibility and safety. Urinary-tract endometriosis affect only the 0,3% to 6% of women affected by endometriosis, amongst which the most common localization is the bladder (84-90%) [1]. The ureteral compression is rare but can lead to obstruction up to silent loss of renal function [2], which is one of the main factors to take into account in the management of this disease [3].
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Affiliation(s)
- Chiara Barbanti
- Departement of molecular and developmental medicine, University of Siena, Siena (Drs. Chiara, Labanca, Centini, Zupi, and Lazzeri), Italy
| | - Luca Labanca
- Departement of molecular and developmental medicine, University of Siena, Siena (Drs. Chiara, Labanca, Centini, Zupi, and Lazzeri), Italy
| | - Filippo Gentile
- Azienda Ospedaliera Universitaria Senese, U.O.C. Urology, Siena (Drs. Filippo and Tommaso), Italy
| | - Tommaso Chini
- Azienda Ospedaliera Universitaria Senese, U.O.C. Urology, Siena (Drs. Filippo and Tommaso), Italy
| | - Gabriele Centini
- Departement of molecular and developmental medicine, University of Siena, Siena (Drs. Chiara, Labanca, Centini, Zupi, and Lazzeri), Italy.
| | - Nassir Habib
- Obstetrics and Gynecology Service, Beaujon Teaching Hospital, Clichy and Paris Diderot University, Clichy (Dr. Habib), France
| | - Errico Zupi
- Departement of molecular and developmental medicine, University of Siena, Siena (Drs. Chiara, Labanca, Centini, Zupi, and Lazzeri), Italy
| | - Lucia Lazzeri
- Departement of molecular and developmental medicine, University of Siena, Siena (Drs. Chiara, Labanca, Centini, Zupi, and Lazzeri), Italy
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Labanca L, Ghislieri M, Knaflitz M, Barone G, Bragonzoni L, Agostini V, Benedetti MG. Muscle synergies for the control of single-limb stance with and without visual information in young individuals. BMC Sports Sci Med Rehabil 2021; 13:163. [PMID: 34952624 PMCID: PMC8710023 DOI: 10.1186/s13102-021-00392-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 12/15/2021] [Indexed: 11/21/2022]
Abstract
Purpose Single-limb stance is a demanding postural task featuring a high number of daily living and sporting activities. Thus, it is widely used for training and rehabilitation, as well as for balance assessment. Muscle activations around single joints have been previously described, however, it is not known which are the muscle synergies used to control posture and how they change between conditions of normal and lack of visual information. Methods Twenty-two healthy young participants were asked to perform a 30 s single-limb stance task in open-eyes and closed-eyes condition while standing on a force platform with the dominant limb. Muscle synergies were extracted from the electromyographical recordings of 13 muscles of the lower limb, hip, and back. The optimal number of synergies, together with the average recruitment level and balance control strategies were analyzed and compared between the open- and the closed-eyes condition. Results Four major muscle synergies, two ankle-dominant synergies, one knee-dominant synergy, and one hip/back-dominant synergy were found. No differences between open- and closed-eyes conditions were found for the recruitment level, except for the hip/back synergy, which significantly decreased (p = 0.02) in the closed-eyes compared to the open-eyes condition. A significant increase (p = 0.03) of the ankle balance strategy was found in the closed-eyes compared to the open-eyes condition. Conclusion In healthy young individuals, single-limb stance is featured by four major synergies, both in open- and closed-eyes condition. Future studies should investigate muscle synergies in participants with other age groups, as well as pathological conditions. Supplementary Information The online version contains supplementary material available at 10.1186/s13102-021-00392-z.
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Affiliation(s)
- L Labanca
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy. .,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
| | - M Ghislieri
- Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy.,PoliToBIOMed Lab, Politecnico di Torino, Turin, Italy
| | - M Knaflitz
- Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy.,PoliToBIOMed Lab, Politecnico di Torino, Turin, Italy
| | - G Barone
- Department of Life Quality Studies, University of Bologna, Bologna, Italy
| | - L Bragonzoni
- Department of Life Quality Studies, University of Bologna, Bologna, Italy
| | - V Agostini
- Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy.,PoliToBIOMed Lab, Politecnico di Torino, Turin, Italy
| | - M G Benedetti
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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Abstract
OBJECTIVE Adenomyosis is a benign uterine disorder characterized by the invasion of the endometrium within the myometrium, starting from the junctional zone (JZ), the inner hormone dependent layer of the myometrium that plays an important role in sperm transport, implantation and placentation. The resulting histological abnormalities and functional defects may represent the pathogenic substrate for infertility and pregnancy complications. The objective of this paper is to review the literature to evaluate the correlation between inner myometrium alterations and infertility and to assess the role of JZ in the origin of adverse obstetric outcomes of both spontaneous and in vitro fertilization (IVF) pregnancies. METHODS we searched Pubmed for all original and review articles in the English language from January1962 until December 2019, using the MeSH terms of 'adenomyosis', 'junctional zone', combined with 'infertility', 'obstetrical outcomes', 'spontaneous conception', 'in vitro fertilization' and 'classification'. The review was divided into three sections to assess this pathogenic correlation, evaluating also the importance of classification of the disease. RESULTS AND CONCLUSIONS Absent or incomplete remodeling of the JZ can affect uterine peristalsis, alter vascular plasticity of the spiral arteries and activate inflammatory pathways, all related to adverse obstetric outcomes. Despite these observations, there is still limited evidence whether adenomyosis is a cause of infertility. However, it is reasonable to screen patients for adenomyosis, to consider pregnant women with diffuse adenomyosis at high risk of adverse obstetric outcomes, and to evaluate the importance of a noninvasive validated classification in the management of women with adenomyosis.
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Affiliation(s)
- Chiara Barbanti
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Gabriele Centini
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Lucia Lazzeri
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Nassir Habib
- Department of Obstetrics and Gynaecology, Beaujon Hospital-University of Paris, Paris, France
| | - Luca Labanca
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Errico Zupi
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Karolina Afors
- Department of Obstetrics and Gynaecology, Whittington Hospital, London, UK
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9
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Labanca L, Centini G, Lazzeri L, Afors K, Argay IM, Habib N, Zupi E. Sacrohysteropexy: A Way to Spare the Uterus. J Minim Invasive Gynecol 2020; 27:1254-1255. [PMID: 31838275 DOI: 10.1016/j.jmig.2019.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/02/2019] [Accepted: 12/04/2019] [Indexed: 11/27/2022]
Abstract
STUDY OBJECTIVE To show the safety and feasibility of laparoscopic sacrohysteropexy for treating uterine prolapse. DESIGN An educational video to explain the laparoscopic steps of this procedure by focusing on the main anatomic landmarks and on tips and tricks to avoid complications. SETTING A tertiary care university hospital. INTERVENTIONS Laparoscopic sacropexy with uterus preservation for grade 3 apical defect. CONCLUSION This video shows a stepwise approach to laparoscopic sacrohysteropexy demonstrating its feasibility and safety. There is a wide choice of surgical procedures and approaches focused on pelvic organ prolapse repair. Since many years, uterine prolapse has been an indication for hysterectomy, regardless of the occurrence of uterine disease and patients' desires. With the introduction of minimally invasive surgery, the uterine-sparing procedures are being increasingly taken into account, especially in young women [1]. Sacrohysteropexy is a uterus-sparing procedure that allows for a reduction in operating time, intraoperative blood loss, mesh-related complications, and surgical costs [2]. Furthermore, this technique has a high success rate with an objective cure rate of 100% for the apical compartment and 80% for all compartments and does not seem to increase the pelvic organ prolapse recurrence rate [3]. Sacropexy is not a life-threatening procedure, but its main objective is to restore functional anatomy with the primary goal of improvement in patient's quality of life. Moreove, no difference has been found with or without uterus preservation in term of postoperative recurrence rate or ent's quality of life [4]. However, high patient satisfaction has been recently reported; therefore, uterine preservation should be considered during patient's counseling.
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Affiliation(s)
- Luca Labanca
- Department of Molecular and Developmental Medicine (Drs. Labanca, Centini, Lazzeri, and Zupi), University of Siena, Siena, Tuscany, Italy
| | - Gabriele Centini
- Department of Molecular and Developmental Medicine (Drs. Labanca, Centini, Lazzeri, and Zupi), University of Siena, Siena, Tuscany, Italy.
| | - Lucia Lazzeri
- Department of Molecular and Developmental Medicine (Drs. Labanca, Centini, Lazzeri, and Zupi), University of Siena, Siena, Tuscany, Italy
| | - Karolina Afors
- Department of Obstetric and Gynaecology, The Whittington Hospital (Dr. Afors), London, United Kingdom
| | - Istvan Matè Argay
- Department of Obstetrics and Gynecology (Dr. Argay), University of Debrecen Clinical Center, Debrecen, Hungary
| | - Nassir Habib
- Obstetrics and Gynecology Service, Beaujon Teaching Hospital (Dr. Habib), Clichy and Paris Diderot University, Clichy, France
| | - Errico Zupi
- Department of Molecular and Developmental Medicine (Drs. Labanca, Centini, Lazzeri, and Zupi), University of Siena, Siena, Tuscany, Italy
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10
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Habib N, Labanca L, Fernandes R, Afors K, Solima E, Moawad G, Centini G. Pudendal Neurolysis: 6-Step Laparoscopic Approach. J Minim Invasive Gynecol 2020; 28:1280-1281. [PMID: 32730993 DOI: 10.1016/j.jmig.2020.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 06/30/2020] [Accepted: 07/22/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To demonstrate the safety and feasibility of the laparoscopic approach to perform pudendal neurolysis in a case of pudendal nerve entrapment syndrome [1-3]. DESIGN A video tutorial that highlights the laparoscopic steps to performing pudendal neurolysis, with a focus on the main anatomic landmarks [4,5]. SETTING A tertiary care regional hospital. INTERVENTIONS This video shows a 6-step approach to laparoscopic pudendal neurolysis for the treatment of pudendal nerve entrapment between the sacrospinous and sacrotuberous ligaments [2,6-8]. Step 1: Identification of the umbilical artery. Step 2: Dissection and development of the lateral paravesical space until the pelvic floor. Step 3: Identification of the arcus tendineus of the endopelvic fascia. Step 4: Identification of the ischial spine and the sacrospinous ligament covered by the coccygeus muscle. Step 5: Coagulation and section of the coccygeus muscle and the sacrospinous ligament. Step 6: Medialization of the pudendal nerve until its entrance into the Alcock canal. CONCLUSION This video demonstrates the safety, feasibility, and reproducibility of laparoscopic pudendal neurolysis in 6 steps. A minimally invasive approach is adequate to treat the pudendal compression until the Alcock canal [2].
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Affiliation(s)
- Nassir Habib
- Department of Obstetrics and Gynecology, Francois Quesnay Hospital, Mantes-la-Jolie, France (Dr. Habib).
| | - Luca Labanca
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy (Drs. Labanca and Centini)
| | - Rodrigo Fernandes
- Discipline of Gynecology, Department of Obstetrics and Gynecology, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil (Dr. Fernandes)
| | - Karolina Afors
- Department of Obstetrics and Gynecology, Whittington Hospital, London, United Kingdom (Dr. Afors)
| | - Eugenio Solima
- Department of Obstetrics and Gynecology, Macedonio Melloni Hospital, University of Milan, Milan, Italy (Dr. Solima)
| | - Gaby Moawad
- Gynecology Department, The George Washington University School of Medicine and Health Science, Washington, District of Columbia (Dr. Moawad)
| | - Gabriele Centini
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy (Drs. Labanca and Centini)
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11
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Roxo del Pino C, Roxo Weck A, Pinto de Aguiar Becerra E, Labanca L, Martins Pinto C. Braquioplastia: abordaje simple. Cir plást iberolatinoam 2009. [DOI: 10.4321/s0376-78922009000300002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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