Alan Farthing

Virtual reality simulation training can improve technical skills during laparoscopic salpingectomy for ectopic pregnancy

Objectives  To assess the first commercially available virtual reality (VR) simulator to incorporate procedural modules for training of inexperienced gynaecological surgeons to perform laparoscopic salpingectomy for ectopic pregnancy.

Human papillomavirus detection by hybrid capture and its possible clinical use.

AIMS--To determine the sensitivity of the hybrid capture method for human papillomavirus (HPV) detection and potential clinical uses as a screening method for the identification of cervical intraepithelial neoplasia. METHODS--The presence of oncogenic types of HPV was tested for in samples taken from the cervix at colposcopy, and compared with detection by polymerase chain reaction (PCR) in 60 patients. Both sets of results were corrected with the pathology determined by biopsy and smear cytology. RESULTS--Hybrid capture detection showed 86% agreement with PCR. Eighty three percent of CIN 3 lesions, 62% of CIN 2, 59% of CIN 1 and 21% of normal controls were positive for oncogenic HPV types. CONCLUSION--The hybrid capture detection method is reliable, sensitive, and easy to use. The addition of HPV testing to cytological screening would detect a greater proportion of cervical dysplasia with a higher false positive rate.

Functions of human papillomavirus E6 and E7 oncoproteins

The identification of certain human papillomaviruses as human tumour viruses has been paralleled by our understanding of how the viral oncoproteins function. The virally encoded E6 and E7 proteins act, in part, to abrogate the activities of the tumour suppressor proteins p53 and pRB. The interaction between these viral proteins and regulators of cell growth offers targets for future therapeutic developments.

Posttransplant skin cancer: A possible role for p53 gene mutation but not for oncogenic human papillomaviruses*

BACKGROUND Loss of p53 tumor suppressor function is a critical step in the development of diverse malignancies, including skin cancers in nonimmunosuppressed patients where UV-specific p53 gene mutations have been identified. In tumors associated with human papillomavirus (HPV), such as cervical carcinoma, p53 may be inactivated instead by binding to a viral oncoprotein. OBJECTIVE Our purpose was to examine the hypothesis that HPV may play an analogous role in the development of posttransplant skin cancer. METHODS p53 Immunoreactivity, suggestive of p53 gene mutation, was examined by immunocytochemistry. Oncogenic HPV DNA was detected by polymerase chain reaction. RESULTS Comparable p53 immunoreactivity was seen in skin tumors from both transplant and nontransplant patients. HPV DNA was not demonstrated in any tumor specimen. CONCLUSION Our data do not implicate oncogenic HPV in posttransplant skin cancer. p53 Gene mutation, rather than HPV-induced p53 degradation, may be more significant in the development of these tumors.

Abdominal radical trachelectomy in West London

Please cite this paper as: Saso S, Ghaem‐Maghami S, Chatterjee J, Naji O, Farthing A, Mason P, McIndoe A, Hird V, Ungar L, Del Priore G, Smith J. Abdominal radical trachelectomy in West London. BJOG 2012;119:187–193.

Total laparoscopic hysterectomy for early stage endometrial cancer in obese and morbidly obese women.

This is a retrospective observational study, where we have evaluated the role of total laparoscopic hysterectomy (TLH) in obese and morbidly obese patients with early stage endometrial cancer. Our study illustrates that low conversion rates are achievable when appropriately trained surgeons undertake this procedure. All the women with high BMI were operated on laparoscopically in preference to laparotomy, unless there was an obvious contraindication such as a very large uterus or disseminated disease. We have also shown low conversation and complication rates for our patients, in particular a low rate of wound infection. This is in contrast to the high rate of wound infection and prolonged hospital stay reported for obese patients in the literature. Our study shows that TLH for endometrial cancer in obese women is feasible, safe and is likely to be cost-effective and adds to the weight of evidence for its use in this condition.

Radiological predictors of cytoreductive outcomes in patients with advanced ovarian cancer.

To assess site of disease on preoperative computed tomography (CT) to predict surgical debulking in patients with ovarian cancer.

Gestational surrogacy after intra‐operative oocyte collection in a hysterectomised woman diagnosed with endometrial cancer

Please cite this paper as: Lavery S, Ng C, Kyrgiou M, Farthing A. Gestational surrogacy after intra‐operative oocyte collection in a hysterectomised woman diagnosed with endometrial cancer. BJOG 2011;118:1669–1671.

Laparoscopic radical abdominal trachelectomy for the management of stage IB1 cervical cancer at 14 weeks' gestation: case report and review of the literature.

for the management of stage IB1 cervical cancer at 14 weeks’ gestation: case report and review of the literature M Kyrgiou, DH Horwell, A Farthing a Department of Surgery & Cancer, Faculty of Medicine, Imperial College, London, UK b West London Gynaecological Cancer Centre, Queen Charlotte’s & Chelsea – Hammersmith Hospital, Imperial Healthcare NHS Trust, London, UK c Spire Harpenden Hospital, Harpenden, UK Correspondence: Dr M Kyrgiou, West London Gynaecological Cancer Centre, 2nd Floor, Hamm House, Queen Charlotte’s & Chelsea – Hammersmith Hospital, Imperial Healthcare NHS Trust – Imperial College, Du Cane Road, London W12 0HS, UK. Email m.kyrgiou@imperial.ac.uk

Fertility‐sparing surgery for young women with early‐stage cervical cancer

Sir, Robert Fraser finds our effort to conduct a randomised controlled trial on acupuncture for the induction of labour a waste of energy. His argument is based only on a quotation from 2002 by Dr Renckens. We therefore find another quotation from the same issue of BJOG appropriate, this one by Dr Zeisler and Dr Husslein. It states that, ‘acupuncture in obstetrics is drug-free, clinically effective and cost-effective’. Furthermore, the recent conclusion by Dr Smith and Dr Cochrane justifies further studies on acupuncture. It states that, ‘evidence is beginning to consolidate that acupuncture may assist with the management of some complaints during pregnancy. However, definitive conclusions about its effectiveness cannot be reached and further research is therefore justified.’ j