Background Vulvar cancer is a rare gynecological malignancy that primarily affects women of postmenopausal age. Treatment is mainly surgical, particularly for vulvar squamous cell carcinoma, the most prevalent histotype. In patients with unifocal tumors with a maximum diameter of <4 cm, in the absence of suspected inguinal lymph nodes, sentinel lymph node (SLN) biopsy is recommended. The use of a radioactive tracer is mandatory; the use of the vital blue dye is optional. Results Two patients diagnosed with vulvar squamous cell carcinoma (FIGO IB stage) underwent bilateral radical vulvectomy, SLN search and removal, and bilateral inguinal lymphadenectomy at the Cannizzaro Hospital Operative Unit of Obstetrics and Gynecology Department (Catania, Italy). Three milliliters of indocyanine green (ICG) 0.5 mg/mL was administered in 3 peritumoral injections under general anesthesia to screen the SLN. The images were acquired using an intraoperative infrared camera system, which allowed intraoperative visualization of the SLN. An SLN was identified for each patient. The lymph nodes examined by the pathologist were negative for metastatic localization of the disease. However, patients underwent bilateral inguinofemoral lymphadenectomy, as this procedure is not currently codified as a gold standard for the detection of SLN in vulvar cancer. All the lymph nodes removed were negative for the localization of vulvar carcinoma metastases. Conclusions The potential of the administration of indocyanine green (ICG) allows the execution of SLN biopsy, avoiding the multiple administrations of radiocolloid in the pre-operative phase, painful for the patient, elimination, and exposure to radioactivity. Therefore, while requiring standardization of the methodology and a large-scale application, this procedure could open a new surgical management perspective in patients with early-stage vulvar cancer.
Background Septate uterus is a common Mullerian ducts anomaly. The aim of our pilot study was the evaluation of diode laser hysteroscopic metroplasty efficacy to increase endometrial volume in women with septate uterus. Results We prospectively enrolled 10 consecutive patients with septate uterus undergoing office hysteroscopic metroplasty with diode laser between February and November 2019. Endometrial volume was evaluated before and 3 months after surgery using 3D transvaginal ultrasound. The surgical procedure was uncomplicated in all patients, the endometrial volume increased at 3 months follow-up (the median increase was 1.9 cm 3 (range 1.7–2.1), and there was a complete removal of septum with no intrauterine synechiae at follow-up hysteroscopy. Conclusions Office hysteroscopic metroplasty with diode laser is a safe procedure and has preliminary showed to increase endometrial volume. The increase in endometrial volume by 3D-TV US could be used as a prognostic factor for the reproductive outcomes.
Background Medical education has recognised the importance of anatomy teaching. Limitations in applied anatomy knowledge exist among obstetrics and gynaecology (O&G) trainees. This study aims to evaluate the knowledge of O&G trainees in applied anatomy and study-associated factors. Materials and methods The questionnaire-based study involved O&G trainees between 1/8/2019 and 1/12/2019. Data collected included age, gender, evaluation of medical school anatomy course, attendance at applied anatomy workshops, operating theatre workload, and senior colleagues' demonstration of anatomy during operating sessions. Results There were 271 trainees recruited with a mean age of 29.3 years, and 80.1% rated the value of medical school anatomy courses as average or above average. Furthermore, 90.8% never attended applied anatomy workshops. In addition, 9.6% and 62% of first- and fifth-year trainees rated their knowledge as either good or very good, and 41.7% reported that anatomy demonstrations by senior doctors happened sometimes. The overall score of applied anatomy knowledge was significantly higher in higher training years, with attendance at applied anatomy lectures, with more operating workloads, and when senior doctors demonstrate anatomy more often during operating sessions. Conclusions Deficiencies in knowledge existed. Factors which may improve knowledge include more applied undergraduate anatomy courses, more frequent operating sessions, attending anatomy workshops, and more senior colleagues' demonstration of anatomy during surgeries.
Background Hysteroscopy training requires the development of specific psychomotor skills. Few validated low-cost models exist in hysteroscopy. The main objective of this study is to determine face, content, and construct validity of a simulator designed for training basic hysteroscopy skills applied to office-based hysteroscopy. Methods Twenty-five hysteroscopy experts and 30 gynecology residents participated in this prospective observational study. The simulator consisted of three color-textured, silicone-coated anthropomorphic 3-dimensional (3-D) printout uterine models inside a box. Each uterine model in the simulator was designed to develop one of the following basic hysteroscopic skills: hysteroscopic navigation, direct biopsy, and foreign body removal. Participants performed five video-recorded simulation attempts on each model. Procedure-specific checklists were used to rate performance. Results Median scores (25th–75th percentiles; p-value) 4 (3–4; p < 0.001) and surgical experience associated to the simulated procedures 4 (3–4; p < 0.001) indicated positive perceptions as to the realism of the internal cavity of the simulator. Median scores of 4 (3–4; p < 0.001) were assigned to the realism and utility of the tasks performed in the simulator for enhancing novice training in hysteroscopy. Expert performance scores were significantly higher and task completion times were significantly lower than those of novices in the navigation exercise ( F (1,53) = 56.66; p < 0.001), the directed biopsy exercise ( F (1,53) = 22.45; p < 0.001), and the foreign body removal exercise ( F (1,53) = 58.51; p < 0.001). Novices’ performance improved on all three exercises: navigation exercise ( F (1,53) = 182.44; p < 0.001), directed endometrial biopsy ( F (1,53) = 110.53; p < 0.001), and foreign body removal ( F (1,53) = 58.62; p < 0.001). Experts’ task completion times were significantly lower when compared to that of novices in the five attempts ( p < 0,001) of the exercises: navigation ( F (1,48) = 25.46; p < 0.001), directed biopsy ( F (1,46 ) = 31.20; p < 0.001), and foreign body removal ( F (1,50) = 69.8; p < 0.001). Novices’ task completion times diminished significantly throughout the sequence of exercises. Conclusions The low-cost simulator designed for the acquisition of basic skills in hysteroscopy demonstrated face, content, and construct validity.
Background One of the major drawbacks of gynecologic laparoscopy is post-laparoscopic shoulder pain (PLSP) that is believed to result from intra-abdominal CO 2 retention leading to peritoneal and diaphragmatic stretching and causing referred pain in C4 dermatome. Several interventions have been applied to prevent and reduce its incidence and severity, with contradictory results. Only pulmonary recruitment maneuver, extended assisted ventilation, and active intra-abdominal gas aspiration have been mentioned to be effective interventions for CO 2 evacuation. However, in our experience, an alternative technique of delayed suprapubic port removal (DSPR) was found to be an effective method in CO 2 expulsion. Therefore, we conducted this randomized trial to determine the effectiveness of the DSPR technique in reducing the incidence and severity of PLSP. The trial was conducted at a single, tertiary hospital between May 2015 and May 2016. Having complied with the criteria, 220 patients scheduled for elective gynecological laparoscopy were randomly allocated into 2 groups after giving informed consent. Laparoscopic procedures were performed through 10-mm umbilical port and at least 2 ancillary, including suprapubic, ports. In conventional group, ancillary ports were removed at the end of surgery leaving only opened umbilical cannula for pneumoperitoneum deflation. Abdominal compression from periphery towards umbilicus was performed to further expel CO 2 before removing the umbilical cannula. In DSPR group, both umbilical and suprapubic cannulas were retained. Two-step abdominal compression was undertaken, primarily towards umbilicus and secondarily towards pelvic cavity, before sequentially removing the umbilical and the suprapubic cannulas. Postoperatively, each patient was asked to rate PLSP level on 100-mm VAS during 0–6, 6–12, 12–24, and 24–48 h, respectively. Statistical analysis was performed to determine both incidence and severity of PLSP during 24- and 48-h post-laparoscopy. Results Patients in DSPR group demonstrated significantly lower incidence of PLSP within 24 h (43.8% vs 59.0%; p = 0.027) and 48 h (43.8% vs 60.0%; p = 0.019), and expressed apparently lower pain scores (0 (0–0) vs 0 (0–8); p = 0.020) during 24–48 h post-surgery. Conclusion DSPR is an effective CO 2 expulsion technique, resulting in significant reduction of both incidence and severity of PLSP within 24–48 h post-laparoscopy. Trial registration Thai Clinical Trials Registry, TCTR20160208003 . Registered 8 February 2016 — retrospectively registered; http://www.thaiclinicaltrials.org/
