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Laparoscopic uterosacral ligament suspension (LUSLS) of the vaginal apex for the treatment of pelvic organ prolapse (POP) has gained popularity. The aim of this systematic review is to investigate perioperative outcomes and complications, subjective and objective success rates and recurrence rates in women undergoing this surgical procedure.A systematic literature search was performed in December 2021. The critical appraisal skills program (CASP) was used to assess the methodological quality of the selected studies. The Clavien-Dindo (CD) scale and the Satava scale were used to classify periprocedural complications. Continuous variables were described as means and standard deviations while categorical were expressed as percentages of the whole group. Statistical significance was set at p 0.05.26 articles were selected and analysed, with a total population of 1401 patients. Anatomical and subjective success rates after LUSLS ranged from 79% and 100% and from 76.2% to 100% respectively. The re-operation rate varied from 2% to 4.5% in the largest cohorts. The overall complication rate was 13.6%, however grade III CD complications occurred only in 1% of patients. Ureteral complications were described in only 2 cases.LUSLS represent a safe and effective technique for vaginal apex resuspension in women with POP. Further larger prospective randomized studies are required to confirm these data.

Background Abdominal lateral suspension with mesh represents an alternative treatment to suspend the vaginal apex. Objectives The aim of this study was to summarize literature data regarding the anatomical and functional outcomes, and intra- and postoperative complications of this technique with minimally invasive approach (laparoscopic/robotic). Search strategy Systematic literature search using MEDLINE/PubMed, SCOPUS, Web of Science. Data collection and analysis Two authors extracted data on baseline characteristics (age, BMI, prior pelvic reconstructive surgery, preoperative POP stage), perioperative outcomes (operative time, estimated blood loss, intraoperative and postoperative complications, admission time), objective and subjective success rate, surgical failure, time of follow-up. Data were presented descriptively. Main Results Thirteen studies were included in the review. The overall number of patients for our analysis was 1066. Patients referred for laparoscopic/robotic lateral suspension were most frequently postmenopausal, aged 50 to 65 years, BMI ≥ 25 kg/m2; 22.2% were already hysterectomized, while 17% had already a previous POP surgery. Operative time ranged from 78.4 ± 29.7 to 254 ± 45 min. The overall anatomic success was more than 90% in the apical compartment and more than 88% in the anterior compartment. Subjective cure rate varies from 78.4% to 100% in medium-term follow-up. Post-operative complication grade >= 3 according to Claiven-Dindo Scale was 1.03%. Mesh erosion rate varied between 0% and 13%. Conclusions Results coming from our systematic review suggest safety, efficacy and feasibility of minimally invasive lateral suspension with optimal anatomical and functional outcomes. Well‐designed, randomized, controlled trials are required to confirm this data.

The choice of whether or not to preserve the uterus in the case of patients with urogenital prolapse who undergo sacral colpopexy is still debated. We compared objective and subjective outcomes of laparoscopic sacral hysteropexy (LSHP) and laparoscopic sacral colpopexy with concomitant supracervical hysterectomy (LSCP/SCH) in patients with symptomatic pelvic organ prolapse. This is a multicenter retrospective cohort study conducted at the Urogynecology Department of the Fondazione Policlinico Universitario A. Gemelli IRCCS of Rome and at the Diaconesses Croix Saint Simon Hospital of Paris. We collected data of 136 patients; 78 underwent LSHP and 58 underwent LSCP/SCH for pelvic organ prolapse between January 2016 and December 2017. Patients of the two groups had similar preoperative characteristics. All patients completed 24-month follow-up evaluation. Overall, anatomical cure rate was 84.6% and 87.9% in the LSHP group and LSCP/SCH group, respectively, without statistically significant differences. In particular, in the LSHP group the anatomical success rate was 94.9%, 92.3% and 92.3% for the apical, anterior and posterior vaginal compartment whereas in the LSHP group LSCP/SCH was 100%, 91.4% and 94.8%, respectively. Subjective success rate was 89.7% among patients who underwent LSHP and 93.1% among women who underwent LSCP/SCH (p = 0.494). The median operative time (OT) was significantly shorter in LSHP. There were no significant differences between the groups in terms of estimated blood loss, conversion to laparotomy and intra- and postoperative complications. Patients’ satisfaction was high in both groups without statistical differences. Both laparoscopic procedures are safe and effective in the treatment of pelvic organ prolapse. LSHP can be offered as an alternative in women who are strongly motivated to preserve the uterus in the absence of abnormal uterine findings.

Paget disease is a rare neoplasm of the skin that mainly involves the vulvar region. Vulvar Paget's disease (VPD) can spread beyond the apparent edges of the lesion resulting in a high risk of involved surgical margins. Our aim is to verify the efficacy of a preoperative vulvo-vaginal intensive clock mapping in the prediction of the invasiveness and the extension of VPD.All consecutive patients with primary VPD referred to our institution from July 2005 to December 2018 were subjected to a preoperative intensive biopsy mapping (clock mapping) of the vulvo-vaginal area: inside and outside the vulvar skin visible lesion, according to o'clock positions, and in the vagina. Patients with positive biopsies "only inside" or "also beyond" the visible lesion were included, respectively, in Group A and B. Surgical excision was drawn passing by the points with negative histology. Pathological findings of mapping biopsies were compared with those from radical surgery.A total of 28 women were enrolled. After clock mapping definitive histology: 17 (60.7%) and 11 (39.3%) patients were included in Group A and B. Definitive histology showed non-invasive, micro-invasive and invasive VPD, respectively, in 13 (46.4%), 11 (39.3%) and 4 (14.3%) patients, with 4 patients further upstaged. Overall, negative margins were found in 14 (50%) patients: 9 (32.1%) from Group A and 5 (17.9%) from Group B. In 23 cases (82.1%), clock mapping identified free surgical margins along the vulvo-perineal skin excision front.Preoperative clock mapping emerged as potentially useful workup tool to predict invasiveness and extension of VPD, to tailor surgical excision.

Objective Laparoscopic high uterosacral ligament suspension ( l -HUSLS) is a laparoscopic-transposed vaginal technique for the treatment of pelvic organ prolapse. Nowadays data regarding quality of life and sexual functions in patients who underwent l -HUSLS for pelvic organ prolapse are few and generic with most of the study investigating the anatomical outcome. For these reasons, the aim of our study is to evaluate these subjective outcomes in women undergoing this surgical procedure with the support of validated questionnaires. Study design This is a retrospective study with the primary aim of analysing the quality of life, sexual function, patient satisfaction rates and anatomical outcome among patients who underwent l -HUSLS in our institution. The SPSS Version 26.0 for Windows (Statistical package for the social studies, Chicago, IL, USA) was used for the statistical analysis. Results A total of 60 patients underwent l -HUSLS between 2016 and 2018. All patients had a high grade of apical prolapse. No intraoperative and major postoperative complications were registered. The median follow-up was 24 months (24−48). PGI-I score was 1–2 in 55 (91.6 %) women. We observed a significant improvement of EQ-5D index and VAS scores from the baseline to the 2 years follow-up: from 0.72 (0.67−1) to 0.91 (0.79−1) and from 50 (30−90) to 70 (50−100) respectively (p = 0.000). All women showed a statistically significant amelioration of FSDS and ICIQ-SF scores. Anatomical success rate after 24 months was 83.7 %. Conclusions l -HUSLS appears to be a safe, feasible and effective treatment for advanced pelvic organ prolapse with high rates of patient self-reported cure.

The purpose of this study was to evaluate the clinical evolution, structural anomalies associated and neonatal outcomes of fetal neck hyperextension in two cases with prenatal ultrasound diagnosis in two different gestational ages.In 2019, two cases of fetal hyperextension came to our attention. Follow-up information was obtained from hospital medical records and obstetrical care providers.Two woman were investigated in our institution for the presence of fetal abnormalities in the II and III trimester, respectively. In both cases, fetal attitude presented persistent fetal neck hyperextension. One of the two fetuses had a mild ventriculomegaly and suspected for micrognathia. Both had an amniotic fluid increase. One of two had no movement in the lower and upper limbs in ultrasound scans associated with club foot and suspected scoliosis. Both were born by cesarean section with pretty different prognosis: one healthy baby had a retarded psychomotor development and the other one died after 6 months. A precise diagnosis was possible only in one case.The early identification of a fetus with persistent hyperextension of the fetal head should require a detailed ultrasound exam for structural abnormalities and a careful prenatal counseling due to possible postnatal outcome.

Background: Recently, it was reported that minimally invasive surgery (MIS) has a negative impact on early-stage cervical cancer (ECC) patient survival. At the same time, advantages of MIS regarding quality of life and low rate of intra- and postoperative complications are well known. Therefore, it is essential to select patients who may benefit from MIS without worsening their oncologic outcomes. The aim of this study is to investigate which pathological factors could guide surgeons’ choice about the best approach in ECC. Patients and Methods: Patients with 2009 FIGO stage from IA1 with lymphovascular space invasion (LVSI) to IB1/IIA1 treated by open or laparoscopic surgery were judged eligible for the study. Disease-free survivals (DFS) of both approaches were tested in subgroups, defined according to histology, tumor size, grading, LVSI, parametrial involvement, and nodal status. Results: A total of 423 patients were enrolled (217 in the open and 206 in the laparoscopic group). No difference between open surgery and laparoscopy was found among subgroups defined according to histology, grading, LVSI, parametrial involvement, or nodal status. Among patients with tumor > 20mm, laparoscopy showed a significantly higher relapse risk [hazard ratio (HR): 2.103, p = 0.030]. Among patients with tumor < 20mm, laparoscopy showed DFS superimposable to open surgery (HR: 0.560, p = 0.128). Conclusions: Tumor size of 20mm appeared as the only independent discrimination criterion in patients whose prognosis is affected by surgical approaches.

Introduction/Background The benefit of surgical staging with laparoscopy remains controversial and the prognostic significance of peritoneal involvement in locally advanced cervical cancer (LACC) patients has still to be demonstrated. Peritoneal involvement upstages cervical cancer to FIGO stage IVB, which can benefit from addition of bevacizumab to standard chemotherapy, after FDA approval. The aim of this study is to determine the rate of peritoneal involvement in a large series of LACC. Methodology Retrospective cohort study approved by the Institutional Review Board. Patients with newly diagnosed LACC (FIGO stage IB2-IVA) and metastatic cervical cancer (FIGO stage IVB), were included. All women underwent diagnostic laparoscopy with peritoneal biopsy at the time of examination under anesthetic (EUA) and cystoscopy between March 2015 and December 2018, during staging of cervical cancer. Clinical and surgical characteristics were extracted from electronic records. Results 201 patients underwent EUA in the study period.Of these 9 (4.4%) did not undergo diagnostic laparoscopy. 192 women underwent diagnostic laparoscopy: 171 (89.1%) LACC, 21 (10.9%) IVB (distant/parenchymal metastases). No intra- or post-operative complication was recorded. Peritoneal involvement was present in 30/192 (15.6%) women and it was histologically confirmed in all cases. 18/30 (60%) cases had only pelvic peritoneal involvement, 9/30 (30%) had both pelvic and upper-abdominal involvement, while 3/30 (10%) had only upper-abdominal involvement. PET/CT-scan and MRI-scan detected peritoneal carcinomatosis in 3/30 (10.0%) and 2/30 (6.7%) patients, respectively. In 21/30 (70%) cases, laparoscopy upstaged the tumour to FIGO stage IVB and changed the treatment plan. 9/30 (30%) were staged as IVB for distant/parenchymal metastases (independently from laparoscopic findings). 15/30 (50%) cases underwent chemotherapy+bevacizumab. Conclusion Diagnostic laparoscopy as part of cervical cancer staging is an important tool to detect unexpected peritoneal disease and change therapeutic management of LACC patients. Disclosure Nothing to disclose.

Introduction/Background To compare survival outcomes of laparoscopic and open surgery for radical hysterectomy (RH) among patients with early-stage cervical cancer (CC) and to identify which subgroups may benefit from one approach rather than the other. Methodology 237 and 303 consecutive patients, with clinical FIGO stage from IA1 with lymph vascular space involvement to IB1/IIA1 CC underwent open and laparoscopic RH respectively in 3 Italian Institutions. Differences in terms of progression-free survival (PFS) between the two surgical approaches were tested in the entire population and in different patient‘s subgroups. Results Median follow up was 34 months. Open and laparoscopy procedures had similar 3-yr PFS rate in the entire series (86.4% vs 85.6%, p=0.987). PFS of the two approaches were compared among subgroups stratified by tumor histology, tumor grading, tumor diameter, lymph vascular space status, parametrial invasion, lymph node status and adjuvant treatment.Open and laparoscopic approaches revealed a significantly different 3-yr PFS rate only among patients with >20 mm tumor (85.2% vs 69.2% respectively, p=0.026). On the contrary 3-yr PFS in ≤2 cm tumor did not differ between open and laparoscopic surgery (87.5% vs 93.4% respectively, p=0.151). Conclusion Tumor diameter could be considered the most important determinant to choosing to guide the choice of surgical approach in early stage CC. Women with >20 mm disease should undergo open RH. In case of tumor ≤20 mm, both of the approaches appear to be safe. Therefore, laparoscopic surgery could still be considered an option in this subgroup of patients. Disclosure Nothing to disclose.