Antonella Iannaccone

Definition of compartment-based radical surgery in uterine cancer: radical hysterectomy in cervical cancer as 'total mesometrial resection (TMMR)' by M Höckel translated to robotic surgery (rTMMR).

BackgroundRadical hysterectomy has been developed as a standard treatment in Stage I and II cervical cancers with and without adjuvant therapy. However, there have been several attempts to standardize the technique of radical hysterectomy required for different tumor extension with variable success. Total mesometrial resection as ontogenetic compartment-based oncologic surgery - developed by open surgery - can be standardized identically for all patients with locally defined tumors. It appears to be promising for patients in terms of radicalness as well as complication rates. Robotic surgery may additionally reduce morbidity compared to open surgery. We describe robotically assisted total mesometrial resection (rTMMR) step by step in cervical cancer and present feasibility data from 26 patients.MethodsPatients (n = 26) with the diagnosis of cervical cancer were included. Patients were treated by robotic total mesometrial resection (rTMMR) and pelvic or pelvic/periaortic robotic therapeutic lymphadenectomy (rtLNE) for FIGO stage IA-IIB cervical cancer.ResultsNo transition to open surgery was necessary. No intraoperative complications were noted. The postoperative complication rate was 23%. Within follow-up time (mean: 18 months) we noted one distant but no locoregional recurrence of cervical cancer. There were no deaths from cervical cancer during the observation period.ConclusionsWe conclude that rTMMR and rtLNE is a feasible and safe technique for the treatment of compartment-defined cervical cancer.

Definition of Compartment Based Radical Surgery in Uterine Cancer—Part I: Therapeutic Pelvic and Periaortic Lymphadenectomy by Michael Höckel Translated to Robotic Surgery

Objective. To define compartment based therapeutic pelvic and periaortic lymphadenectomy in cervical and endometrial cancer. Compartment based oncologic surgery appears to be favorable for patients in terms of radicality as well as complication rates, and the same appears to be true for robotic surgery. We describe a method of robotically assisted compartment based lymphadenectomy step by step in uterine cancer and demonstrate feasibility data from 35 patients. Methods. Patients with the diagnosis of endometrial (n = 16) or cervical (n = 19) cancer were included. Patients were treated by rTMMR (robotic total mesometrial resection) or rPMMR (robotic peritoneal mesometrial resection) and pelvic or pelvic/periaortic rtLNE (robotic therapeutic lymphadenectomy) with cervical cancer FIGO IB-IIA or endometrial cancer FIGO I-III. Results. No transition to open surgery was necessary. Complication rates were 13% for endometrial cancer and 21% for cervical cancer. Within follow-up time median (22/20) month we noted 1 recurrence of cervical cancer and 2 endometrial cancer recurrences. Conclusions. We conclude that compartment based rtLNE is a feasible and safe technique for the treatment of uterine cancers and is favorable in aspects of radicality and complication rates. It should be analyzed in multicenter studies with extended followup on the basis of the described technique.

The Use of Plasma Exchange in a Very Early-onset and Life Threatening, Hemolysis, Elevated Liver Enzymes, and Low Platelet (HELLP) Syndrome: A Case Report

Background: HELLP syndrome is a life threatening pregnancy and early postpartum complication. Very early presentation (before the 21st pregnancy week) is rare and represents an extremely difficult situation for patients and physicians. Supportive therapy (magnesium sulfate, antihypertensive drugs and corticosteroids) may be useful to prolong pregnancy; till now the removing of placenta is the only effective therapeutic option. Plasmapheresis may represent a new and efficacious therapeutic option. Case description: The article reports on a case of very-early onset HELLP Syndrome at the 18th (17+5) week of gestation. It was a challenging clinical and therapeutic case. Since the fetus did not show any signs of growth retardation or pathological Doppler findings, indicating a good fetal prognosis, we used plasmapheresis as an ultima ratio to prolong pregnancy. With plasmapheresis, the pregnancy was prolonged for 20 days. Unfortunately the deterioration of the clinical situation required delivery in the 21st (20+4) gestational week. Conclusion: Plasmapheresis allows prolongation of pregnancy with early onset, life threatening HELLPSyndrome.

Soluble B7-H4 blood serum levels are elevated in women at high risk for preeclampsia in the first trimester, as well as in patients with confirmed preeclampsia

B7‐H4 negatively regulates T‐cell‐mediated immunity and might play an important role in preeclampsia (PE). Here, we have investigated the association between PE and maternal soluble B7‐H4 (sB7‐H4) serum levels and B7‐H4 mRNA expression in the placenta.

Geburtseinleitung: „anything new?“

ZusammenfassungDie Geburtseinleitung ist eine häufige geburtshilfliche Maßnahme, die bei angemessener Indikationsstellung Vorteile für Mutter und Kind erbringen kann. Zur Verfügung stehen sowohl medikamentöse als auch mechanische Methoden: PGE1/PGE2 in unterschiedlicher Verabreichungsform und Oxytocin sowie mechanische Instrumente wie der Zervixreifungsballon (CRB Cook®) und Foley-Katheter (Off-label-Use). Ein kombiniertes Einleitungsschema, das mechanische Methoden wie den Zervixreifungsballon impliziert, erscheint effektiv, sicher und für die Patientinnen sehr zufriedenstellend.AbstractInduction of labor is a common obstetric procedure, which, when based on appropriate indications, can be advantageous for mother and child. Drug-based and mechanical methods are available: prostaglandins (PGE1/PGE2) in various administration forms and oxytocin; as well as mechanical instruments such as the Foley catheter (off-label use) and the cervical ripening balloon (CRB Cook®; Cook Group, Bloomington, Indiana, USA) can be used. Combined induction implicating mechanical methods such as the CRB seems to be effective, safe, and comfortable for patients.