Chiara Facchini

Controversies in Surgical Staging of Endometrial Cancer

Endometrial cancer is the most common gynaecological malignancy and its incidence is increasing. In 1998, international federation of gynaecologists and obstetricians (FIGO) required a change from clinical to surgical staging in endometrial cancer, introducing pelvic and paraaortic lymphadenectomy. This staging requirement raised controversies around the importance of determining nodal status and impact of lymphadenectomy on outcomes. There is agreement about the prognostic value of lymphadenectomy, but its extent, therapeutic value, and benefits in terms of survival are still matter of debate, especially in early stages. Accurate preoperative risk stratification can guide to the appropriate type of surgery by selecting patients who benefit of lymphadenectomy. However, available preoperative and intraoperative investigations are not highly accurate methods to detect lymph nodes and a complete surgical staging remains the most precise method to evaluate extrauterine spread of the disease. Laparotomy has always been considered the standard approach for endometrial cancer surgical staging. Traditional and robotic-assisted laparoscopic techniques seem to provide equivalent results in terms of disease-free survival and overall survival compared to laparotomy. These minimally invasive approaches demonstrated additional benefits as shorter hospital stay, less use of pain killers, lower rate of complications and improved quality of life.

Sexual function in women undergoing surgery for deep infiltrating endometriosis: a comparison with healthy women

Background Endometriosis is a chronic and progressive condition of women of reproductive age. It is strongly associated with significant impairment of sexual function. Aim To objectively evaluate the impact of laparoscopic excision of endometriosis on sexual function in patients with deep infiltrating endometriosis (DIE) compared to healthy women. Setting and design Prospective study, including 250 patients with a diagnosis of DIE scheduled for laparoscopic surgery and 250 healthy women. Methods A sexual activity questionnaire, SHOW-Q (Sexual Health Outcomes in Women Questionnaire), was used to collect data pertaining to womens satisfaction, orgasm, desire and pelvic problem interference with sexual function. Women with DIE underwent complete excision of endometriotic lesions. All participants were asked to complete the SHOW-Q questionnaire before and after surgery. Results SHOW-Q scores in the endometriosis group before and 6 months after surgery were compared with the healthy group scores. A significant improvement was found between pre- and post-treatment in the scores of the satisfaction scale, desire scale and pelvic problem interference scale of SHOW-Q. The distribution of post-surgery SHOW-Q scores was comparable to healthy womens scores apart from the orgasm scale score, which was unchanged in the post-surgery group. Conclusions The surgical approach to treatment has a positive impact not only on organ impairment but also on sexual function in women affected by DIE.

A case report of nasal endometriosis in a patient affected by Behcet's disease.

We present a case of nasal endometriosis, an uncommon extrapelvic implantation of endometriotic tissue. A woman with a history of pelvic endometriosis and Behcets syndrome was diagnosed with nasal endometriosis after episodes of perimenstrual epistaxis and nasal pain. Despite being rare, the presence of catamenial symptoms and the possibility of performing endoscopic biopsy allowed us to make the diagnosis of nasal endometriosis. The simultaneous presence of Behcets syndrome focused our attention on the pathogenesis and the therapeutic management of endometriosis.

One-Step Laparoscopic Management of a Female Adnexal Tumor of Wolffian Origin

We report a case of female adnexal tumor of Wolffian origin (FATWO), a rare neoplasm arising from the mesonephric ducts. A 48-year-old woman came first to our center for a recent discovery of a pelvic mass. Transvaginal ultrasonographic findings suggested a solid right para-ovarian mass suspected to be malignant. After thorough counseling, the patient underwent operative laparoscopy for excision of the para-ovarian mass with frozen section (FS) examination resulting in the diagnosis of a poorly differentiated adenocarcinoma. In this case, FS results allowed performing a comprehensive oncological staging, through a totally laparoscopic extrafascial hysterectomy, bilateral adnexectomy, total omentectomy, pelvic wall peritonectomy, and pelvic, parasacral and para-aortic lymphadenectomy. Final pathological and immunohistochemical results confirmed the diagnosis of FATWO. To our knowledge, this is the first case of FATWO managed entirely by a minimally invasive laparoscopic approach in a single surgical session.

Diagnosis and laparoscopic management of a rare endometriosis-related peritoneal mass with rapid growth in early pregnancy

Herein is described the diagnosis, clinical management and laparoscopic removal of a rapid growing retro‐uterine mass in a pregnant woman. After laparoscopic removal of the pelvic mass, diagnosis of peritoneal endometriotic cyst was made on histology. The patient was asymptomatic and no history of endometriosis was reported. The laparoscopic management of the peritoneal mass was safe and effective and to our knowledge this is the first case report describing a decidualized endometriotic lesion in the absence of a pre‐pregnancy endometriosis diagnosis.

Uterine Suspension: A New Laparoscopic Technique

Laparoscopic surgery is a frequently performed surgical technique in a gynecological field. Total Laparoscopic Hysterectomy (TLH) for large uteri is a difficult procedure technically. In this study, We report our experience with large uteri and present a case of TLH performed on a uterus weighting 3550g. From 2012 to 2013, We performed TLH procedures for 962 cases, TLH in case of uteri weighing over one kilogram was 60 cases. The median uteri weight was 1050g (1000-4545g) The median operative time and blood loss were 119 minutes(62-315 minutes) and 334ml (10-1380ml). The convention to abdominal hysterectomy was only one case (1.7%). The experience and specialized techniques are necessary to performe TLH for large uteri safely and fast.