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Background: The rate of concurrent endometrial cancer (EC) in atypical endometrial hyperplasia (AEH) can be as high as 40%. Some patient characteristics showed associations with this occurrence. However, their real predictive power with related validation has yet to be discovered. The present study aimed to assess the performance of various models based on patient characteristics in predicting EC in women with AEH., Methods: This is a retrospective multi-institutional study including women with AEH undergoing definitive surgery. The women were divided according to the final histology (EC vs. no-EC). The available cases were divided into a training and validation set. Using k-fold cross-validation, we built many predictive models, including regressions and artificial neural networks (ANN)., Results: A total of 193/629 women (30.7%) showed EC at hysterectomy. A total of 26/193 (13.4%) women showed high-risk EC. Regression and ANN models showed a prediction performance with a mean area under the curve of 0.65 and 0.75 on the validation set, respectively. Among the best prediction models, the most recurrent patient characteristics were age, body mass index, Lynch syndrome, diabetes, and previous breast cancer. None of these independent variables showed associations with high-risk diseases in women with EC., Conclusions: Patient characteristics did not show satisfactory performance in predicting EC in AEH. Risk stratification in AEH based mainly on patient characteristics may be clinically unsuitable.

Background: Nowadays hysteroscopic surgery offers the opportunity of treating in Day Hospital even patients who cannot undergo a traditional surgery because of high anesthesiological risk. The aim of this study is to prove that minimal invasive hysteroscopic procedures in loco-regional anesthesia can replace laparotomic gynecological surgery in many intrauterine lesions with the same effectiveness on pain and outcome., Methods: From September 1999 to December 2000 at the Obstetric and Gynecological Department in Asti 200 hysteroscopic procedures have been performed. The patients (all i.v. line inserted, ECG and pulsometer monitored, and sublingual BDZ sedated) were divided into two groups: a group of 50 patients who underwent operation on paracervical block alone, and the other one of 150 women on paracervical block plus periorificial infiltration of local anesthetic., Results: Only one woman in the first group paracervical block was totally insufficient and she needed a general anesthesia. In the same group, 44% of paracervical blocks required an additional conscious sedation with Propofol and Fentanyl. In the second group only 16 % of cases required an additional sedation. In all cases outcome was very good with complete recovery of the patients dismissed the same afternoon., Conclusions: In our experience operative hysteroscopies under loco-regional anesthesia with paracervical block and periorificial infiltration is a very satisfactory alternative to general anesthesia. Moreover the type of intrauterine lesion did not influence the tolerability of the operation.

Background: New techniques of laparoscopy: gasless, open Hasson, optic trocars allow to avoid the risks of vessel and bowel injuries. The objective of this study was to evaluate the capability of a retractor system as an alternative to conventional technique without pneumoperitoneum and to assess if the system facilitates the use of conventional surgical instruments during gynaecological surgery., Design: Prospective evaluation., Setting: University-affiliated county hospital., Patients: Gasless laparoscopy surgery was performed on 49 patients between December 1995 and July 1996 with a retractor system without pneumoperitoneum consisting of an intrabdominal retractor using conventional surgical and laparoscopic instruments and to enable a simultaneous vaginal approach., Results: Gasless laparoscopy was successful in 44 (90%) of cases. A simultaneous vaginal approach was used in one third of indications including vaginal myomectomy and laparoscopic assisted hysterectomy. Conversion to laparotomy was required in 5% of cases. Mean procedure duration was 90 minutes and mean hospitalisation time was 5.7 days., Conclusions: The introduction of new techniques of laparoscopy: gasless, open Hasson, optic trocars has broadened the application of operative laparoscopy. Gasless technique in lieu of conventional laparoscopy can be performed reliably and safely for most gynaecological indications. The most outstanding benefit of this method is that it can be combined with a vaginal approach which is not possible using a pneumoperitoneum due to gas leakage. The place of gasless laparoscopy will depend on continuing development by instrument manufacturers, in order to achieve an instrument providing vision as good as that seen with the pneumoperitoneum.

Background: Remarkable progress has been made in laparoscopic surgery over the past few years. The evolution of laparoscopic techniques has enabled surgeons to undertake celio-assisted vaginal operations. In particular, the possibility of using mechanical retractors to lift the abdominal wall as an alternative to pneumoperitoneum now enables surgeons to operate simultaneously using a transvaginal and laparoscopic approach. Gas-free laparoscopy has introduced a new and very interesting concept of laparovaginal surgery. The uterus is in fact both an abdominal and pelvic organ and can therefore be reached more easily and with greater safety using a combined vaginal and laparoscopic technique., Methods: A group of 17 patients underwent celio-assisted vaginal surgery. A prospective study was performed in patients with indications for vaginal operations who had given their informed consent to the use of this new surgical technique. Their mean age was 49.4 years. Mean parity was 1., Results: Vaginal myomectomy was performed in 58.8% of cases, whereas 41.2% underwent vaginal hysterectomy. Laparoconversion was necessary in 17.6% of cases. Postoperative complications were rare (11.7%). The mean duration of surgery was 122.7 minutes. Mean hospital stay was 3.7 days., Conclusions: The considerable advantages of celio-assisted vaginal surgery using gas-free laparoscopy may be summed up as reduced operating time and reduced intra-abdominal pressure which significantly diminish the risk of thromboembolism. The disadvantages that were noted compared to pneumoperitoneum include: diminished lateral exposure of the abdominal cavity and paracholic grooves, reduced lifting of the rib margin and a greater presence of the intestinal ansae in the laparoscopic visual field in obese patients.

The authors review the literature on the different combinations of radiotherapy with chemotherapy and surgery with the aim of giving a state of art on the role of combined multimodality treatment of invasive vulvar carcinoma. From the data of the recent literature it appears that radiation integrated with surgery and chemotherapy can play an important role in reducing the risk of postoperative locoregional failure in patients with advanced primary or nodal disease and avoiding exenteration in patients with disease involving the anus or proximal urethra. This integrated multimodality therapy is a promising approach in the treatment of invasive vulvar carcinoma but further exploration in a larger number of patients is needed before giving consolidated data applicable in routine oncological clinical practice.