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Background and objectives Near-infrared fluorescence (NIRF) of the Firefly® system has become a useful and widespread technique for the visualization and detection of tumors, sentinel lymphnodes, and vascular/anatomical structures. Methods Between February 1, 2017 to September 30, 2019, a total of 25 patients affected by benign and malignant pathologies underwent robotic surgery by the use of organ transillumination with the concomitant Firefly®. We analyzed the pre-operative patients' characteristics (age and body mass index [BMI], previous abdominal surgeries and systemic disease); pre-operative diagnosis, surgical procedure and approach (multiport or single site), transilluminated organ, surgical outcomes (operating time, incidence of intraoperative complications, and incidence of conversion to other surgery); and postoperative outcome. The surgical procedures included: four bladder endometriosis nodules resections, one pelvic lymphadenectomy with ureterolysis, and 23 hysterectomies. Results The average operating time was 283.3 (+/- 76.9) minutes, there were no intra-operative complications or laparotomic conversions. The average recovery days were 5.9. There have been three grade 2 post-surgical complications, following the Memorial Sloan Kettering Cancer Center Surgical Secondary Events System classification. The combination of NIRF and transillumination allows a clear view of the anatomical landmarks and the resection margins. Conclusions It's likely that improvement in the anatomical detail could confer a greater surgical safety with lower percentage of intra and post-surgical complications and sparing of safe tissue. To evaluate the validity of these techniques in a larger number of patients and compare these new surgical procedures with standard ones, further studies are needed.

Background and objectives Operative laparoscopy is generally performed under general anesthesia. Local anesthesia and conscious sedation may be useful in select short procedures. In the present study, we evaluated safety and efficacy of operative laparoscopy under conscious sedation. Methods Retrospective observational study evaluating patients undergoing gynecologic laparoscopy. Laparoscopy under conscious sedation was performed for each patient with umbilical direct insertion of a 12-mm port, followed by 2 ancillary ports at 1 cm medially to the anterior superior iliac spine. Conversion to conventional laparoscopy or laparotomy was recorded. Conscious sedation was obtained using Remifentanil and Propofol, administered by an infusion system based on pharmacokinetic and pharmacodynamic models. Local anesthesia was administered at port insertion sites and for paracervical block. Pain intensity was evaluated with the Visual Analog Scale (VAS). Adverse events and drug concentrations throughout the procedure were retrieved. Results Our study population included 166 patients. They underwent laparoscopic unilateral versus bilateral salpingo-oophorectomy, ovarian cystectomy, bilateral salpingo-oophorectomy and omentectomy for a borderline ovarian tumor, myomectomy; or underwent surgery for unexplained infertility evaluation, pelvic pain, staging of ovarian cancer. Mean duration of pneumoperitoneum was 22.3 ± 7.2 min. Rate of conversion to laparoscopy under general anesthesia was 17/166 (10.2%) and there were only 3 cases of patients with low tolerability to the procedure. No severe adverse events occurred. Hospital discharge occurred in all unconverted cases after 6 to 18 h. Conclusions Operative laparoscopy under conscious sedation and local anesthesia appears to be a feasible technique in gynecologic surgery with no adverse patient outcomes.

To provide an update on the outcomes and complications of laparoscopic (or robot-assisted) sacrocervicopexy with and without supracervical hysterectomy, and highlight the differences with sacrocolpopexy technique based on the most recent evidence.Laparoscopic and robot-assisted sacrocervicopexy with supracervical hysterectomy and sacrohysteropexy have good success rates, with a mean objective success rate of 96% (range 90-100%), subjective success rates of 80-95% and mean reoperation rate of 3%. Also, pelvic symptoms and quality of life improved after laparoscopic sacrocervicopexy. These results are similar to laparoscopic and abdominal sacrocolpopexy, and are confirmed by the results of two comparative studies. Mesh erosion risk is very low in patients treated with laparoscopic sacrocervicopexy. Studies that compare laparoscopic sacrocolpopexy with concomitant total hysterectomy and sacrocervicopexy with subtotal hysterectomy show that total hysterectomy is associated with a greater prevalence of vaginal mesh exposure when compared with a subtotal hysterectomy. In case of sacralpexy, if it is decided to proceed with a hysterectomy, it is recommended to limit this to a subtotal.The benefits of laparoscopic sacrocervicopexy with or without supracervical hysterectomy in terms of outcomes and reduced risk of mesh erosion in comparison with sacrocolpopexy and concomitant total hysterectomy have to be confirmed by randomized controlled trials. Moreover, standardization of surgical technique is mandatory.

Laparoscopic sacrocervicopexy appears to be an effective option for sexually active women with pelvic organ prolapse., Background and Objectives: To evaluate the efficacy of laparoscopic sacrocervicopexy for apical support in sexually active patients with pelvic organ prolapse. Methods: One-hundred thirty-five women with symptomatic prolapse of the central compartment (Pelvic Organ Prolapse Quantitative [POP-Q] stage 2) underwent laparoscopic sacrocervicopexy. The operating physicians used synthetic mesh to attach the anterior endopelvic fascia to the anterior longitudinal ligament of the sacral promontory with subtotal hysterectomy. Anterior and posterior colporrhaphy was performed when necessary. The patients returned for follow-up examinations 1 month after surgery and then over subsequent years. On follow-up a physician evaluated each patient for the recurrence of genital prolapse and for recurrent or de novo development of urinary or bowel symptoms. We define “surgical failure” as any grade of recurrent prolapse of stage II or more of the POP-Q test. Patients also gave feedback about their satisfaction with the procedure. Results: The mean follow-up period was 33 months. The success rate was 98.4% for the central compartment, 94.2% for the anterior compartment, and 99.2% for the posterior compartment. Postoperatively, the percentage of asymptomatic patients (51.6%) increased significantly (P < .01), and we observed a statistically significant reduction (P < .05) of urinary urge incontinence, recurrent cystitis, pelvic pain, dyspareunia, and discomfort. The present study showed 70.5% of patients stated they were very satisfied with the operation and 18.8% stated high satisfaction. Conclusion: Laparoscopic sacrocervicopexy is an effective option for sexually active women with pelvic organ prolapse.

Introduction: Conscious sedation has traditionally been used for laparoscopic tubal ligation. General anesthesia with endotracheal intubation may be associated with side effects, such as nausea, vomiting, cough, and dizziness, whereas sedation offers the advantage of having the patient awake and breathing spontaneously. Until now, only diagnostic laparoscopy and minor surgical procedures have been performed in patients under conscious sedation. Case Description: Our report describes 5 cases of laparoscopic salpingo-oophorectomy successfully performed with the aid of conventional-diameter multifunctional instruments in patients under local anesthesia. Totally intravenous sedation was provided by the continuous infusion of propofol and remifentanil, administered through a workstation that uses pharmacokinetic–pharmacodynamic models to titrate each drug, as well as monitoring tools for levels of conscious sedation and local anesthesia. We have labelled our current procedure with the acronym OLICS (Operative Laparoscopy in Conscious Sedation). Four of the patients had mono- or bilateral ovarian cysts and 1 patient, with the BRCA1 gene mutation and a family history of ovarian cancer, had normal ovaries. Insufflation time ranged from 19 to 25 minutes. All patients maintained spontaneous breathing throughout the surgical procedure, and no episodes of hypotension or bradycardia occurred. Optimal pain control was obtained in all cases. During the hospital stay, the patients did not need further analgesic drugs. All the women reported high or very high satisfaction and were discharged within 18 hours of the procedure. Discussion and Conclusion: Salpingo-oophorectomy in conscious sedation is safe and feasible and avoids the complications of general anesthesia. It can be offered to well-motivated patients without a history of pelvic surgery and low to normal body mass index.

Objective To assess the efficacy of autocrosslinked hyaluronic gel in postsurgical adhesion prevention after laparoscopic myomectomy. Design Prospective, randomized, controlled study. Setting University of Naples "Federico II". Patient(s) Thirty-six infertile women with symptomatic myomas were randomly divided into two groups of 18 patients each. Intervention(s) Laparoscopic myomectomy with subserous sutures or interrupted figure 8 sutures, with (group A) or without (group B) application of autocrosslinked hyaluronic acid (HA) gel. Main outcome measure(s) Rate of postsurgical adhesions at 60–90 days of follow-up. Result(s) The rate of subjects who developed postoperative adhesions was significantly lower in group A in comparison with group B (27.8% vs. 77.8%). In both groups, the rate of adhesions was significantly higher in patients treated with interrupted figure 8 sutures than with subserous sutures. Conclusion(s) Autocrosslinked HA gel is a promising resorbable agent barrier for the reduction of postoperative adhesions after laparoscopic myomectomy. Moreover, the type of suture is a factor influencing the postsurgical adhesion formation.