Beyond the scalpel: unveiling the transformative landscape of robotic gynecologic procedures

This review aims to present a comprehensive assessment of the current status and impact of robotic-assisted laparoscopy (RAL) in gynecological surgery across various subspecialties, exploring its benefits, applications, and challenges. This included studies evaluating RAL in general gynecology, urogynecology, and gynecological oncology. RAL has emerged as a transformative technology, demonstrating efficacy in procedures ranging from routine gynecologic tasks to complex oncological surgeries. The adoption of RAL has facilitated improved surgical outcomes, reduced learning curves, and enhanced visualization. Superior dexterity, 3D vision, and filtered tremor contribute to its precision. The ergonomic advantages, including intuitive instrument movements and a third assisting arm, further enhance positive outcomes. Notably, RAL has shown promise in managing challenging patient demographics, such as morbidly obese individuals and those with intricate pelvic anatomy. In gynecological oncology, RAL has become integral, manifesting benefits in endometrial, cervical, and ovarian cancer surgeries. Despite challenges like cost considerations, RAL continues to shape the landscape of gynecological surgery, promising improved patient outcomes and contributing to the paradigm shift toward minimally invasive approaches. Ongoing research should focus on long-term cost-effectiveness, patient perspectives, and attitudes toward RAL, ensuring its continued integration into the evolving field of gynecological surgery

Empowering patients: integrating palliative care in gynecologic cancer treatment

Cervical cancer severely impacts women's health, especially in low- and middle-income nations. Patients experience significant symptoms at every stage of this cancer course, from diagnosis to treatment and beyond. Palliative care (PC) integration becomes crucial, even if oncological therapies have historically focused on disease-centric methods. PC is a multifaceted field that addresses end-of-life care as well as psychological, social, and spiritual issues in addition to physical illnesses. To improve patient satisfaction, treatment adherence, and overall quality of life, early PC initiation within the context of multimodality care is essential. Advanced patients require heightened PC and a smooth transfer to hospice care as they approach terminal disease. This emphasises how crucial it is for oncology and PC teams to work together to provide comprehensive cervical cancer management. Healthcare practitioners can improve results and maintain the overall health of women affected by this condition through combined efforts. This review article emphasises the importance of early PC integration and collaboration in the cervical cancer management continuum to offer comprehensive care and enhance patient outcomes

Strategies for managing postmenopausal bleeding: a clinician's perspective

Postmenopausal bleeding (PMB) poses a diagnostic challenge due to the varied presentation of endometrial pathologies ranging from benign endometrial atrophy to the possibility of endometrial carcinoma. Although the incidence varies with patient characteristics, it warrants thorough evaluation. Risk factors such as obesity and hormone use should guide assessment. Bleeding may originate from various gynecological and non-gynecological sites, demanding meticulous history-taking and examination. Transvaginal sonography (TVS) is typically the initial step, yet its accuracy in excluding carcinoma remains debated. Invasive procedures like hysteroscopy and endometrial sampling offer higher accuracy but are more intrusive. The optimal diagnostic strategy remains uncertain, necessitating focused research for enhanced accuracy. TVS-guided assessment with an endometrial thickness (ET) threshold of >4 mm prompts evaluation and endometrial sampling. Progestogen therapy mitigates endometrial cancer risk associated with estrogen use, with atypia-hyperplasia necessitating vigilant monitoring and possible hysterectomy. Patient counselling on treatment options is crucial. In summary, PMB warrants a systematic approach integrating imaging, histological assessment, and tailored therapy guided by risk factors, final diagnosis and patient preferences.

Optimizing gynecologic surgical outcomes: embracing enhanced recovery strategies

The implementation of enhanced recovery after surgery (ERAS) pathways represents a concerted effort to optimize patient outcomes in the perioperative period while minimizing postoperative complications and readmissions. ERAS achieves these objectives through the integration of various elements into a comprehensive perioperative management program, aimed at reducing surgical stress and its associated repercussions. Key principles of ERAS encompass preoperative counselling, nutritional strategies, emphasis on regional anaesthesia and nonopioid analgesics, meticulous fluid balance, maintenance of normothermia, and promotion of postoperative recovery strategies such as early mobilization and thromboprophylaxis. The benefits of ERAS are manifold, including shorter hospital stays, diminished postoperative pain and analgesic requirements, expedited return of bowel function, reduced complication and readmission rates, and heightened patient satisfaction, all achieved without elevating readmission, mortality, or reoperation rates. Effective adoption of ERAS necessitates institutions to evaluate their infrastructure and patient flow to support its implementation adequately. Furthermore, sustainable ERAS programs should be seamlessly integrated as a standard model of care within healthcare delivery systems. The success of ERAS hinges upon the simultaneous implementation of its multiple components, underscoring its holistic approach. Institutions are urged to endorse the adoption of ERAS pathways emphatically as a means to enhance patient care and improve perioperative outcomes

From diagnosis to treatment: a holistic approach to intraepithelial cervical disease

Cervical cancer remains a significant cause of mortality among women worldwide. Screening methods play a crucial role in identifying individuals with cervical pre-cancerous lesions, allowing for timely intervention to prevent progression to invasive disease. Treatment modalities for cervical intraepithelial neoplasia (CIN) are effective, straightforward, and safe. The choice between ablative techniques (such as cryotherapy or thermal ablation) and excisional techniques (like large loop excision or cold knife conization) depends on lesion characteristics and transformation zone type. Ablative techniques are particularly suitable for low-resource settings due to their simplicity, low complication rates, and cost-effectiveness. In areas where access to colposcopy and histopathology services is limited, strategies such as visual inspection with acetic acid (VIA) followed by immediate ablative treatment for VIA-positive individuals are recommended by the World Health Organization. This approach not only prevents the progression of high-grade CIN but also ensures high compliance among screen-positive individuals. Overall, effective screening and treatment strategies are essential in reducing the burden of cervical preinvasive lesions and preventing the development of cervical cancer.

Exploring neuroendocrine carcinoma of the cervix: a case report and literature review

Neuroendocrine neoplasms (NENs) are rare, comprising less than 1% of cervical malignancies. Diagnosis and management of cervical neuroendocrine carcinoma (NEC) pose challenges due to its rarity and aggressive nature. Aim of the study was to highlight the importance of considering NEC in the differential diagnosis of cervical malignancies and underscore the potential benefits of comprehensive treatment approaches. We report a case of a 35-year-old woman presenting with post-coital bleeding, subsequently evaluated and diagnosed with NEC T1b1N0Mx following radical hysterectomy. Adjuvant chemoradiotherapy and chemotherapy led to one year of remission. Cervical NEC poses diagnostic and therapeutic challenges due to its rarity and aggressive nature. Despite multimodal treatment, prognosis remains poor, warranting further research and targeted therapies. The rarity of cervical NEC emphasizes the need for increased awareness among clinicians to facilitate early detection and appropriate management. Further studies are warranted to explore novel treatment modalities and improve outcomes for patients with this challenging malignancy

A comprehensive review of mucinous ovarian cancer: insights into epidemiology, risk factors, histological characteristics, and clinical outcomes

Mucinous ovarian cancer (MOC) represents a rare subtype within the spectrum of epithelial ovarian carcinoma (EOC). In contrast to a uniform approach applied to all EOC subtypes, MOC stands out as a distinctive entity. A nuanced understanding of the pathological features and genomic profile of MOC holds the potential for enhancing management strategies and, consequently, prognostic outcomes. The differentiation between primary MOC and metastatic mucinous carcinoma poses a challenge but is imperative for accurate clinical decision-making. Notably, early-stage MOC exhibits a favourable prognosis, while advanced disease is characterized by a less favourable outcome. Surgical intervention assumes a pivotal role both in the early stages and metastatic scenarios. Chemotherapy is typically initiated from stage II MOC onwards, with the conventional gynaecological protocol commonly employed; however, there is also precedent for the application of gastrointestinal (GI) regimens. Given the association of MOC with diverse molecular alterations, the consideration of targeted therapy emerges as a potential therapeutic avenue for this unique disease entity. The main tool used for this literature review was PubMed. MOC stands as a distinct entity within EOC subtypes, distinguished from GI mucinous carcinoma by its unique clinical behavior, pathological features, molecular profile, prognosis, and response to standard treatment. The challenges lie in both the diagnosis and treatment of MOC, emphasizing the complexity and specialized considerations required for managing this particular subtype of OC

The evolving landscape of immunohistochemistry in cervical and uterine carcinoma in gynecologic oncology: current status and future directions

Immunohistochemistry (IHC) has become an indispensable tool in routine gynecological pathology, particularly with the advancements in molecular understanding and histological classification of gynecological cancers. This evolution has led to new immunostainings for diagnostic and classification purposes. This review describes the diagnostic utility of IHC in gynecological neoplasms, drawing insights from literature reviews, personal experiences, and research findings. It delves into the application of IHC in resolving morphologically equivocal cases, emphasizing its role in achieving an accurate diagnosis. The selection of appropriate immunomarkers for common scenarios encountered in gynecological pathology aids pathologists in navigating complex cases. Specifically, we focus on cervical and endometrial malignancies, elucidating the molecular rationale behind the use of specific immunohistochemical markers. An updated overview of essential immunohistochemical markers provides knowledge for precise diagnosis and classification of gynecological cancers. This review serves as a valuable resource for clinicians and researchers involved in the management and study of gynecological malignancies, facilitating improved patient care and outcomes

Mechanochemical Ablation: Current Status in the Management of Varicose Veins: A Comprehensive Review

Varicose veins, a common venous disorder, often lead to significant discomfort and a reduced quality of life. Over the years, numerous treatment approaches have been explored to alleviate the associated symptoms. Surgical interventions such as saphenofemoral junction ligation and Great Saphenous Vein (GSV) stripping were transformative in their time, but the emergence of endovenous techniques like Endovenous Laser Therapy (EVLT) and Radiofrequency Ablation (RFA) marked a significant shift. While these endovenous techniques have shown exceptional clinical outcomes and cost-effectiveness, they do come with the drawback of pain due to the application of heat for ablation and the necessity of infiltrating tumescent anaesthesia around the vein. In recent years, non thermal, non tumescent methods have arisen as effective alternatives that reduce patient discomfort. These methods encompass procedures such as Mechanochemical Ablation (MOCA) and endovenous cyanoacrylate glue, which minimise heat generation and eliminate the need for tumescent anaesthesia. This article provides a comprehensive overview of the current status of MOCA. It covers its mechanism of action, clinical outcomes, cost-effectiveness, and safety profiles in managing varicose veins

Vulval premalignant lesions: a review article

Vulvar intraepithelial neoplasia (VIN) is a noninvasive squamous lesion that is a precursor of vulvar squamous cell cancer. Currently, no screening tests are available for detecting VIN, and a biopsy is performed to confirm the clinical diagnosis. Despite sharing many risk factors with cervical intraepithelial neoplasia, the diagnosis of VIN is poses challenges, contributing to its increasing prevalence. This study aimed to analyze the underlying risk factors that contribute to the development of VIN, identify specific populations at risk, and define appropriate treatment approaches. Differentiated VIN (dVIN) and usual VIN (uVIN) are the classifications of VIN. While dVIN is associated with other vulvar inflammatory disorders, such as lichen sclerosis, the more prevalent uVIN is associated with an underlying human papillomavirus infection. Patients with differentiated VIN have an increased risk of developing invasive malignancies. Few effective surveillance or management techniques exist for vulvar intraepithelial neoplasia, a preinvasive neoplasm of the vulva. For suspicious lesions, a thorough examination and focused biopsy are necessary. Depending on the specific needs of each patient, a combination of surgical and medical approaches can be used