New Keystone flap application in vulvo-perineal reconstructive surgery: A case series

Objective: This study aimed to evaluate the application of the Keystone flap technique and the long-term results of vulvovaginal reconstruction after vulvar surgery. Methods: This is the first case series describing the application of the Keystone perforator island flaps (KPIF) technique to close a wide defect after radical vulvectomy. We prospectively collected patient demographics, operative times, complications, pathologic results, and length of stay on all patients. The benefits, cosmetic results and satisfaction of patients were analyzed in the follow up. Results: Five patients were selected for the study: four underwent radical vulvectomy for squamous cell vulvar cancer, and one underwent vulvar wide excision for Paget disease followed by reconstruction with the Keystone flap technique. The defects were successfully covered by the Keystone flap technique in all patients. Conclusions: Keystone flaps seem to be easy to design and elevate, and it offers rapid fasciocutaneous closure in wide vulvo-perineal defects with excellent long-term results

Chapter 13 Is There a Role for Laparoscopy in Ovarian Cancer?

During 1960s and 1970s, the first laparoscopic procedures concerned treatment of benign diseases. Today, indications have significantly increased even in ovarian borderline tumours and in ovarian cancer. Furthermore, the role of diagnostic laparoscopy remains apparent in the overall therapeutic setting of advanced ovarian cancer as well. The present chapter aims to summarize current evidence regarding potential role of laparoscopy in ovarian cancer treatment as well as indicate potential difficulties that should be raised during its usage

Effect of dual wavelengths laser system (DWLS) on ovarian endometrioma: an histopathological study

Background Surgical management of ovarian endometriosis is still debated and controversial. The removal of the cystic capsule with the stripping technique (cystectomy) seems to be most recommended for the lowest recurrence rate, but has harmful consequences on the ovarian reserve due to excision of healthy ovarian parenchyma. Some authors proposed plasma laser and CO2laser for the ablation of the cystic capsule instead of the stripping technique, in order to preserve healthy ovarian tissue. Nevertheless few data exist on thermal effect and possible ovarian damage. Moreover, no data are available on the risk of recurrence. The aim of the study was to evaluate the effect of dual wavelengths laser system (DWLS) on cystic capsule ablation by histologically analysing the depth of necrosis induced by vaporization and the thermal damage to the underlying healthy ovarian tissue Methods We analysed ovarian endometrioma tissues after diode laser ablation. DWLS, with flat fibres of 400 or 1000 micron (Biolitec® Leonardo®, wavelength of 980 nm and 1470 nm) was used using a set mode at 20 and 30 W, at a distance averaging 2 mm from the tip of the piece, and with an exposure time limited to 1 second on each site. Histopathological analysis of the depth of cyst wall ablated and the characteristics of the underlying ovarian tissue were performed after surgery. Results No complications occurred during surgery with good haemostasis control. Following histological analysis, the depth of necrosis induced by vaporization was medially 915 μm (range 600-1400 μm) depending on the power used. No endometriosis cells were found in the treated tissue and no thermal damages were found on the ovarian parenchyma below the necrotic tissue. Conclusions The DWLS ablation technique seems to be a good alternative to the stripping technique and other ablation techniques, as it produces an adequate depth of necrosis with a complete destruction of the endometriosis cyst wall and this could be associated with a more likely low risk of recurrence. In our results, it does not seem to cause a severe thermal damage to healthy ovarian tissue with a consequent higher probability of preservation of the ovarian reserve. The results in term of efficacy and pregnancy outcomes need further larger randomized studie