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We conducted a literature review to evaluate the minimally invasive fertility-sparing procedures, namely robotic radical trachelectomy (RRT) and laparoscopic radical trachelectomy (LRT), in patients with early-stage cervical cancer. We searched PubMed, MEDLINE, Ovid, Google Scholar, and Scopus up to July 2015 using the following key words and their combinations: cervical cancer, early stage, fertility-sparing surgery, radical trachelectomy, robotic trachelectomy, and laparoscopic trachelectomy. Papers providing details of RRT and LRT separately were included. Extracted papers and their bibliographies were reviewed according to the purpose of the study, and demographic, surgical, and clinical parameters were analyzed. Our review comprised 45 cases of RRT and 216 cases (including our case) of LRT. The median (range) patient age was 29 (9) years in the RRT group and 32 (10) years in the LRT group (p < .001). Histological types and stages were significantly different in the 2 groups (p < .001 for both). The median length of excised parametrial tissue was significantly higher in the RRT group (p < .001). The hysterectomy conversion rate on the results of frozen section examination was significantly higher in the RRT group (37% vs 6.5%; p < .001). There was a significant difference in median lymph node count based on the surgical approach (RRT: 22 [range, 21] vs LRT: 32 [range, 14]; p = .02). Estimated blood loss and length of hospital stay were significantly higher in the LRT group (both p < .001). The mean (range) operative time was 308 (188) minutes in the RRT group and 296 (143) minutes in the LRT group (p < .001). Pregnancy, preterm, and term birth rates were similar in the 2 groups (RRT: 18.5%, 7.4%, and 0, respectively; LRT: 29%, 8%, and 8%, respectively). Thirteen women experienced recurrent cervical cancer in the LRT group, and no recurrence was seen in the RRT group. The median (range) duration of follow-up was 8 (7.5) months in the RRT group and 34 (20) months in the LRT group (p < .001). Based on the reported data, LRT seems comparable to RRT for treating patients with early-stage cervical cancer who wish to preserve fertility. [ABSTRACT FROM AUTHOR]

Several obstetric complications due to inappropriately healed cesarean scar such as placenta accreta, scar dehiscence, and ectopic scar pregnancy are increasingly reported along with rising cesarean rates. Furthermore, many gynecologic conditions, including abnormal uterine bleeding, pelvic pain and infertility, are imputed to deficient cesarean scar healing. Hysteroscopy is the most commonly reported approach for the revision of cesarean scar defects (CSDs). Nevertheless, existing evidence is inadequate to conclude that either hysteroscopy or laparoscopy is effective or superior to each other. Although several management options have been suggested recently, the laparoscopic approach has not been thoroughly scrutinized. We present a case and reviewed the data related to the laparoscopic repair of CSDs and compared the hysteroscopic and laparoscopic management options based on the data from previously published articles. As a result of our analyses, the laparoscopic approach increases uterine wall thickness when compared with the hysteroscopic approach, and both surgical techniques seem to be effective for the resolution of gynecologic symptoms. Hysteroscopic treatment most likely corrects the scar defect but does not strengthen the uterine wall; thus, the potential risk of dehiscence or rupture in subsequent pregnancies does not seem to be improved. Because large uterine defects are known risk factors for scar dehiscence, the repair of the defect to reinforce the myometrial endurance seems to be an appropriate method of treatment. [ABSTRACT FROM AUTHOR]

Study Objective To compare adhesion formation and histological features of peritoneal closure and nonclosure over an intra-abdominally placed barbed suture. Design Single-blind randomized controlled trial (Canadian Task Force Classification I). Setting Certified animal research facility. Subjects Eight nonpregnant rats. Interventions Abdominal cavities were entered via midline incision. Left and right parietal peritoneal surfaces were incised 1.5 cm long separately and stitched with unidirectional barbed suture material (3/0 V-Loc). The parietal peritoneum was approximated over the barbed suture using polypropylene suture material (7/0 Prolene) to embed the barbed suture (peritonization) on one side, and left open on the other side. The side of the barbed suture to be peritonized was allocated at random. On the postoperative day 32, all rats were sacrificed, adhesion formations on each side were macroscopically scored, and histological features were evaluated microscopically. Measurement and Main Results The median adhesion score was 2.00 (range, 1–4) on operative fields. There was no statistically significant difference in median adhesion score between the peritonized and nonperitonized sides (1.5 vs 2, respectively; p = .13). Microscopically, there were no statistically significant differences in median acute and chronic inflammation scores between the peritonized and nonperitonized sides (p = .58 and p = .45, respectively), but a significantly higher median fibrosis score on the peritonized side (3 vs 1.5, respectively; p = .02). Conclusion Based on the results of the present study in a rat model, barbed suture material might be associated with adhesion formation when used intra-abdominally, and these adhesions could not be prevented by peritonization. [ABSTRACT FROM AUTHOR]