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Article: Robotic surgery for deep-infiltrating endometriosis: is it time to take a step forward?

Ferrari, Filippo Alberto / Youssef, Youssef / Naem, Antoine / Ferrari, Federico / Odicino, Franco / Krentel, Harald / Moawad, Gaby

Frontiers in medicine

2024 Volume 11, Page(s) 1387036

Abstract: Endometriosis is a chronic debilitating disease that affects nearly 10% of women of the reproductive age. Although the treatment modalities of endometriosis are numerous, surgical excision of the endometriotic implants and nodules remains the sole ... ...

Abstract	Endometriosis is a chronic debilitating disease that affects nearly 10% of women of the reproductive age. Although the treatment modalities of endometriosis are numerous, surgical excision of the endometriotic implants and nodules remains the sole cytoreductive approach. Laparoscopic excision of endometriosis was proven to be beneficial in improving the postoperative pain and fertility. Moreover, it was also proved to be safe and efficient in treating the visceral localization of deep endometriosis, such as urinary and colorectal endometriosis. More recently, robotic-assisted surgery gained attention in the field of endometriosis surgery. Although the robotic technology provides a 3D vision of the surgical field and 7-degree of freedom motion, the safety, efficacy, and cost-effectiveness of this approach are yet to be determined. With this paper, we aim to review the available evidence regarding the role of robotic surgery in the management of endometriosis along with the current practices in the field.
Language	English
Publishing date	2024-03-05
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2775999-4
ISSN	2296-858X
ISSN	2296-858X
DOI	10.3389/fmed.2024.1387036
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Article ; Online: Health-related quality of life after hysterectomy for endometrial cancer: the impact of enhanced recovery after surgery (ERAS) shifting paradigm.

Ferrari, Federico / Soleymani Majd, Hooman / Giannini, Andrea / Favilli, Alessandro / Laganà, Antonio Simone / Gozzini, Elisa / Odicino, Franco

Gynecologic and obstetric investigation

2024

Abstract: Objectives: Enhanced recovery after surgery (ERAS) protocols provide well-known benefits in the immediate recovery with a shorter length of stay (LOS) also in gynecological surgery. However, the impact of ERAS has not been clearly showed yet regarding ... ...

Abstract	Objectives: Enhanced recovery after surgery (ERAS) protocols provide well-known benefits in the immediate recovery with a shorter length of stay (LOS) also in gynecological surgery. However, the impact of ERAS has not been clearly showed yet regarding long-term consequences and health-related quality of life (HRQL). The aim of this study is to investigate the impact of ERAS on HRQL after hysterectomy for endometrial cancer. Design: Observational retrospective study with propensity score matching (PSM). Participants We administered the SF-36 validated questionnaire to women underwent hysterectomy and lymph nodal staging before and after introducing ERAS protocol, getting, respectively, a standard practice (SP) and ERAS group Settings Academic hospital Methods We collected demographic, clinical, surgical and postoperative data and performed a PSM of the baseline coufouders. We administered the questionnaire four weeks after the surgery. The SF-36 measures HRQL using eight scales: physical functioning (PF), role physical (RLP), bodily pain (BP), general health (GH), vitality (Vt), social functioning (SF), role emotional (RLE) and mental health (MH). Results After PSM, we enrolled a total of 154 patients, 77 in each group (SP and ERA). The two groups were similar in terms of age, BMI, anaesthesiologic risk, Charlson comorbidity index (CCI) and surgical technique (minimally invasive versus open access). Median LOS was shorter for ERAS group (5 versus 3 days; p = 0.02), while no significant differences were registered in the rates of postoperative complications (16.9% versus 17.4%; p = 0.66). Response rates to SF-36 questionnaire were 89% and 92%, respectively, in SP and ERAS group. At multivariate analyzes, the mean scores of SF-36 questionnaire, registered at 28 days weeks after surgery (range 26-32 days), were significantly higher in ERAS group for PF (73.3 vs 91.6; p < 0.00), RLP (median 58.3 vs 81.2; p = 0.02) and SF (37.5 versus 58.3; p = 0.01) domains, when compared to SP patients. Limitations Further follow-up was not possible due to the anonymized data derived from clinical audit. Conclusions ERAS significantly increases HRQL of women underwent surgery for endometrial cancer. HRQL assessment should be routinary implemented in the ERAS protocol.
Language	English
Publishing date	2024-03-12
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	800003-7
ISSN	1423-002X ; 0378-7346
ISSN (online)	1423-002X
ISSN	0378-7346
DOI	10.1159/000538024
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Article ; Online: Clinical and prognostic value of

Albano, D / Zizioli, V / Odicino, F / Giubbini, R / Bertagna, F

Revista espanola de medicina nuclear e imagen molecular

2018 Volume 38, Issue 2, Page(s) 87–93

Abstract: Purpose: Endometrial carcinoma (EC) is a cancer with a good overall prognosis, except in cases of recurrent or advanced EC. The aim of this study was to assess the diagnostic performance, the prognostic value and the impact on therapeutic management of ! ...

Title translation	Valor clínico y pronóstico de la PET/TC con
Abstract	Purpose: Endometrial carcinoma (EC) is a cancer with a good overall prognosis, except in cases of recurrent or advanced EC. The aim of this study was to assess the diagnostic performance, the prognostic value and the impact on therapeutic management of Materials and methods: We retrospectively evaluated 157 patients with histologically proven EC and restaging Results: Seventy-nine patients had positive Conclusions: 18
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Endometrial Neoplasms/diagnostic imaging ; Endometrial Neoplasms/therapy ; Female ; Fluorodeoxyglucose F18 ; Humans ; Middle Aged ; Neoplasm Recurrence, Local/diagnostic imaging ; Neoplasm Recurrence, Local/therapy ; Positron Emission Tomography Computed Tomography ; Prognosis ; Radiopharmaceuticals ; Retrospective Studies
Chemical Substances	Radiopharmaceuticals ; Fluorodeoxyglucose F18 (0Z5B2CJX4D)
Language	Spanish
Publishing date	2018-12-17
Publishing country	Spain
Document type	Journal Article
ISSN	2253-8089
ISSN (online)	2253-8089
DOI	10.1016/j.remn.2018.09.005
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Article ; Online: Validation of an enhanced recovery after surgery protocol in gynecologic surgery: an Italian randomized study, a response.

Ferrari, Federico / Forte, Sara / Odicino, Franco

American journal of obstetrics and gynecology

2020 Volume 224, Issue 3, Page(s) 336–337

MeSH term(s)	Enhanced Recovery After Surgery ; Female ; Gynecologic Surgical Procedures ; Humans ; Italy ; Perioperative Care
Language	English
Publishing date	2020-11-15
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	80016-8
ISSN	1097-6868 ; 0002-9378
ISSN (online)	1097-6868
ISSN	0002-9378
DOI	10.1016/j.ajog.2020.11.009
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Article ; Online: Role of

Albano, D / Zizioli, V / Treglia, G / Odicino, F / Giubbini, R / Bertagna, F

Revista espanola de medicina nuclear e imagen molecular

2018 Volume 38, Issue 1, Page(s) 10–16

Abstract: Purpose: Uterine sarcomas are rare tumors with poor prognosis due to the high recurrence rates. The current role of : Materials and methods: Forty-one women with uterine sarcoma underwent 73 : Results: Thirty-three : Conclusions: ... ...

Title translation	18
Abstract	Purpose: Uterine sarcomas are rare tumors with poor prognosis due to the high recurrence rates. The current role of Materials and methods: Forty-one women with uterine sarcoma underwent 73 Results: Thirty-three Conclusions: 18
MeSH term(s)	Adult ; Aged ; Female ; Fluorodeoxyglucose F18 ; Follow-Up Studies ; Humans ; Middle Aged ; Neoplasm Staging ; Positron Emission Tomography Computed Tomography/methods ; Radiopharmaceuticals ; Retrospective Studies ; Sarcoma/diagnostic imaging ; Sarcoma/pathology ; Sensitivity and Specificity ; Uterine Neoplasms/diagnostic imaging ; Uterine Neoplasms/pathology
Chemical Substances	Radiopharmaceuticals ; Fluorodeoxyglucose F18 (0Z5B2CJX4D)
Language	Spanish
Publishing date	2018-11-03
Publishing country	Spain
Document type	Journal Article
ISSN	2253-8089
ISSN (online)	2253-8089
DOI	10.1016/j.remn.2018.04.006
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Article ; Online: Impact of endometrial sampling technique and biopsy volume on the diagnostic accuracy of endometrial cancer.

Ferrari, Federico / Forte, Sara / Arrigoni, Giulia / Ardighieri, Laura / Coppola, Maria Consuelo / Salinaro, Federica / Barra, Fabio / Sartori, Enrico / Odicino, Franco

Translational cancer research

2022 Volume 9, Issue 12, Page(s) 7697–7705

Abstract: Background: Histotype and tumor grading of endometrial cancer are the most important factors that have to be assessed by preoperative endometrial sampling, and their concordance with the final surgical and definitive histological findings is of ... ...

Abstract	Background: Histotype and tumor grading of endometrial cancer are the most important factors that have to be assessed by preoperative endometrial sampling, and their concordance with the final surgical and definitive histological findings is of paramount importance. We aim to compare histotype and tumor grading concordance of various endometrial sampling techniques (ESTs) and to investigate the role of endometrial volume biopsy. Methods: We performed a retrospective analysis of patients with apparent early stage endometrial cancer collecting demographic, clinical data, type of EST, pathological characteristics of endometrial biopsies and final specimens. We classified ESTs as dilation and curettage (D&C), diagnostic hysteroscopy with D&C, outpatient hysteroscopy and operative hysteroscopy with or without D&C. Diagnostic and operative hysteroscopy were performed with Bettocchi's 5 mm hysteroscope. We evaluated concordance for histotype, and tumor grading, and we performed subgroup analysis based on the technique and final tumor grading. Concordance was classified from good, moderate, sufficient, fair, poor and none using Cohen k-statistic. Finally, we investigated the existence of independent risk factors for discordant tumor grading using multivariate binary logistic regression. Results: We collected 148 patients and of these 131 (88.5%) were diagnosed with endometrioid histotype and 65 (44%), 46 (31%) and 37 (25%) respectively with well, moderate and poor differentiated tumors. Atypical hyperplasia (AH) was detected preoperatively in 28 patients (19%). Histotype concordance was fair (k=0.35) and tumor grading concordance was moderate (k=0.45); particularly, concordance was fair in well-differentiated cases (k=0.38); concordance was moderate in moderate- and poor-differentiated cases (k=0.52) and good (k=0.71). Operative hysteroscopy showed moderate concordance for histotype (k=0.41), while grading concordance was fair for G1 (k=0.41), moderate for G2 (k=0.58) and good for G3 (k=0.72), regardless the use of D&C. Preoperative volume biopsy did not impact the concordance of tumor grading, while the adoption of operative hysteroscopy (with or without D&C) decreased the risk of grading discordance in G3 tumors (HR 0.17; 95% CI: 0.03-0.94; P=0.04). Conversely, time elapsed from diagnosis to treatment in well-differentiated tumors increased the risk of discordant results (HR 1.06; 95% CI: 1.02-1.52; P=0.04). Conclusions: Operative hysteroscopy demonstrated the best tumor grading concordance, especially in poor-differentiated tumors. The volume of biopsy did not affect the tumor grading concordance.
Language	English
Publishing date	2022-01-20
Publishing country	China
Document type	Journal Article
ZDB-ID	2901601-0
ISSN	2219-6803 ; 2218-676X
ISSN (online)	2219-6803
ISSN	2218-676X
DOI	10.21037/tcr-20-2074
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Article ; Online: Moderate and severe fetal pyelectasis: Correlation between prenatal aspects and postnatal outcome.

Loardi, C / Signorelli, M / Gregorini, M / Marella, D / Torri, F / Zambelloni, C Mario / Omodei, U / Odicino, F

Journal of neonatal-perinatal medicine

2019 Volume 13, Issue 1, Page(s) 91–96

Abstract: Background: Renal pelvic dilatation (RPD) is a frequent finding in fetal ultrasound. The aim of the study is to correlate the prenatally detected moderate and severe pyelectasis with the postnatal outcome.: Methods: A retrospective analysis involving ...

Abstract	Background: Renal pelvic dilatation (RPD) is a frequent finding in fetal ultrasound. The aim of the study is to correlate the prenatally detected moderate and severe pyelectasis with the postnatal outcome. Methods: A retrospective analysis involving 90 cases of prenatally detected moderate and severe RPD referred to our prenatal diagnosis centre with 18 months of urological follow-up. Prenatal ultrasound was correlated with postnatal renal function, assessed by plasmatic creatinine and/or renal scintigraphy performed before surgery. Results: Cases were divided between two groups according to postnatal management: group A including 35 newborns (38.9%) that needed surgical treatment and group B with 55 patients (61.1%) who were managed conservatively. The group A presented higher median RPD (18 mm, IQR 12-25 mm) compared to the group B (11 mm, IQR 10-14 mm). The most common anomaly detected within group A was pelvi-ureteric junction (PUI) obstruction (43%). Within group B 32 cases (58%) showed spontaneous resolution of hydronephrosis during postnatal follow up. In case of moderate pyelectasis the risk of postnatal surgery was 25% and raised to 60% for severe RPD. In our study, 29 newborns showed pathologic scintigraphies: 25 required surgery while 4 did not find indication for surgery due to ipsilateral renal function irreversible damage. 6 patients had high creatinine level (>0.6 mg/dl). 35 cases out of 90 (39%) developed monolateral irreversible renal function impairment. Conclusion: Moderate and severe RPD are often correlated with postnatal renal damage, therefore a close multidisciplinary follow-up is required. Prenatal scanning is highly predictive of postnatal outcome and can address properly the prenatal counseling.
MeSH term(s)	Conservative Treatment ; Creatinine/metabolism ; Female ; Humans ; Hydronephrosis/complications ; Hydronephrosis/congenital ; Hydronephrosis/diagnostic imaging ; Hydronephrosis/therapy ; Infant, Newborn ; Kidney Pelvis/surgery ; Male ; Pregnancy ; Pyelectasis/diagnostic imaging ; Pyelectasis/metabolism ; Pyelectasis/therapy ; Radionuclide Imaging ; Remission, Spontaneous ; Renal Insufficiency/congenital ; Renal Insufficiency/etiology ; Renal Insufficiency/metabolism ; Retrospective Studies ; Severity of Illness Index ; Solitary Kidney ; Ultrasonography, Prenatal ; Ureter/surgery ; Ureteral Obstruction/congenital ; Ureteral Obstruction/diagnostic imaging ; Ureteral Obstruction/surgery ; Urethral Stricture/diagnostic imaging ; Urethral Stricture/metabolism ; Urethral Stricture/therapy ; Urogenital Abnormalities/diagnostic imaging ; Urogenital Abnormalities/metabolism ; Urogenital Abnormalities/therapy ; Urologic Surgical Procedures ; Vesico-Ureteral Reflux/diagnostic imaging ; Vesico-Ureteral Reflux/metabolism ; Vesico-Ureteral Reflux/therapy
Chemical Substances	Creatinine (AYI8EX34EU)
Language	English
Publishing date	2019-09-25
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2435387-5
ISSN	1878-4429 ; 1934-5798
ISSN (online)	1878-4429
ISSN	1934-5798
DOI	10.3233/NPM-180071
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Article ; Online: Opportunistic salpingectomy during postpartum contraception procedures at elective and unscheduled cesarean delivery.

Ferrari, Federico / Forte, Sara / Prefumo, Federico / Sartori, Enrico / Odicino, Franco

Contraception

2019 Volume 99, Issue 6, Page(s) 373–376

Abstract: Objective: To compare intra- and postoperative surgical complications of opportunistic bilateral total salpingectomy during postpartum permanent contraception procedures in elective and unscheduled cesarean delivery.: Study design: We conducted a ... ...

Abstract	Objective: To compare intra- and postoperative surgical complications of opportunistic bilateral total salpingectomy during postpartum permanent contraception procedures in elective and unscheduled cesarean delivery. Study design: We conducted a retrospective cohort study (2010-2017) of women who had postpartum permanent contraception procedures during cesarean delivery, and we collected baseline characteristics, scheduling of delivery (elective versus unscheduled), operative time, estimated blood loss (EBL) and surgical complications (bleeding, iatrogenic injury, infection, anemia and relaparotomy). We classified patients according to contraceptive technique: bilateral total salpingectomy, bilateral partial salpingectomy with or without fimbriae, and other methods. Results: Five hundred twenty-eight women underwent postpartum permanent contraception procedures, 245 (46.4%) had bilateral total salpingectomy, 239 (45.3%) had bilateral partial salpingectomy, and 48 (8.3%) underwent other methods. We did not find differences in baseline characteristics, operative time and EBL among postpartum permanent contraception groups. Unscheduled cesarean delivery did not influence the choice of postpartum permanent contraception technique (p=.22). Postpartum permanent contraception-related intraoperative bleeding occurred in 1 (0.4%) and 2 (0.9%) patients, respectively, in bilateral total and partial salpingectomy group (p=.23). Postoperative complications were 13 (5.3%) and 6 (2.5%), respectively, in bilateral total and partial salpingectomy groups (p=.11). Subgroup analysis confirmed no differences for intra- and postoperative complications during unscheduled cesarean delivery. We noted a 4.3-min increase in operative time for total salpingectomy after multivariate analysis (p<.01). Conclusion: At maternal request for postpartum permanent contraception during cesarean delivery, bilateral total salpingectomy can be a safe and feasible method even in case of unscheduled cesarean delivery. Implications statement: Our results suggest that bilateral total salpingectomy during any cesarean delivery may be an acceptable choice for its higher contraceptive efficacy and risk-reduction effect for ovarian cancer, at the price of a small increase in operative time.
MeSH term(s)	Adult ; Cesarean Section/methods ; Combined Modality Therapy ; Female ; Humans ; Italy ; Linear Models ; Middle Aged ; Multivariate Analysis ; Operative Time ; Ovarian Neoplasms/prevention & control ; Postoperative Complications/etiology ; Pregnancy ; Retrospective Studies ; Salpingectomy/methods ; Sterilization, Tubal/methods
Language	English
Publishing date	2019-03-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	80106-9
ISSN	1879-0518 ; 0010-7824
ISSN (online)	1879-0518
ISSN	0010-7824
DOI	10.1016/j.contraception.2019.03.041
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Article ; Online: Laparoscopic Access with Optical Gasless Trocar: A Single-center Experience of 7431 Procedures.

Ciravolo, Giuseppe / Donarini, Paolo / Rampinelli, Fabio / Visenzi, Chiara / Odicino, Franco

Journal of minimally invasive gynecology

2019 Volume 27, Issue 2, Page(s) 535–540

Abstract: Study objective: To analyze the complications experienced and describe laparoscopic surgery using a gasless optical trocar.: Design: A retrospective study.: Setting: A department of obstetrics and gynecology in a tertiary center in Italy.: ... ...

Abstract	Study objective: To analyze the complications experienced and describe laparoscopic surgery using a gasless optical trocar. Design: A retrospective study. Setting: A department of obstetrics and gynecology in a tertiary center in Italy. Patients: Seven thousand four hundred thirty-one surgical procedures were performed. Interventions: From the hospital database, data were evaluated regarding major complications of laparoscopy with the ENDOPATH XCEL Bladeless Trocar (Ethicon, Johnson & Johnson, Somerville, NJ) performed between 2000 and 2017 by different laparoscopic surgeons. Measurements and main results: The mean age of the patients was 40.66 ± 12.06 years (range, 13-91 years). The mean body mass index was 22.12 ± 3.64 kg/m Conclusions: The optical gasless trocar is a feasible laparoscopic entry technique. The complication rate is lower than those reported previously.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Feasibility Studies ; Female ; Gases ; Gynecologic Surgical Procedures/adverse effects ; Gynecologic Surgical Procedures/instrumentation ; Gynecologic Surgical Procedures/methods ; Humans ; Insufflation ; Intestinal Perforation/epidemiology ; Intestinal Perforation/etiology ; Italy/epidemiology ; Laparoscopy/adverse effects ; Laparoscopy/instrumentation ; Laparoscopy/methods ; Middle Aged ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Retrospective Studies ; Surgical Instruments/adverse effects ; Young Adult
Chemical Substances	Gases
Language	English
Publishing date	2019-07-10
Publishing country	United States
Document type	Evaluation Study ; Journal Article
ZDB-ID	2186934-0
ISSN	1553-4669 ; 1553-4650
ISSN (online)	1553-4669
ISSN	1553-4650
DOI	10.1016/j.jmig.2019.03.025
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Article: Endometrial Carcinomas with Intestinal-Type Metaplasia/Differentiation: Does Mismatch Repair System Defects Matter? Case Report and Systematic Review of the Literature.

Ardighieri, Laura / Palicelli, Andrea / Ferrari, Federico / Bugatti, Mattia / Drera, Emma / Sartori, Enrico / Odicino, Franco

Journal of clinical medicine

2020 Volume 9, Issue 8

Abstract: Background: Intestinal metaplasia/differentiation in primary endometrial carcinomas is an uncommon phenomenon, with only few cases described.: Material and methods: We performed a systematic review of endometrial carcinomas with intestinal metaplasia/ ...

Abstract	Background: Intestinal metaplasia/differentiation in primary endometrial carcinomas is an uncommon phenomenon, with only few cases described. Material and methods: We performed a systematic review of endometrial carcinomas with intestinal metaplasia/differentiation interrogating the electronic databases Pubmed, Web of Science, and Scopus, and we reported an additional case arising in a 49-year-old woman. Results: We identified only eight patients diagnosed with endometrial carcinomas exhibiting intestinal metaplasia/differentiation, and additionally our case. Endometrial carcinomas with intestinal-type features can present in pure or mixed forms in association with usual-type endometrioid carcinomas; in mixed forms, the two neoplastic components may derive from a common neoplastic progenitor, as evidenced by the concomitant loss of MSH2 and MSH6 protein expression in our case. Disease recurrences occur in a significant fraction of the cases, including patients diagnosed in low-stage disease. Conclusions: Endometrial carcinomas with intestinal metaplasia/differentiation are rare and they may represent a more aggressive tumor variant, thus requiring a proper treatment despite the low-tumor stage. The ProMise classification should be performed also in these unusual tumors, since they can be associated with mismatch repair system defects.
Language	English
Publishing date	2020-08-06
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm9082552
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