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Background: Active surveillance for cervical intraepithelial neoplasia 2 (CIN2) would allow time for most cases to regress naturally and in turn avoid potentially unnecessary and harmful treatment. Aim: To determine reasons for choosing active surveillance over surgery among women given a hypothetical diagnosis of CIN2. Materials and Methods: Women residing in Australia aged 25–40 years with no prior diagnosis of cervical cancer, cervical abnormality CIN2 or above, and/or previous hysterectomy, were randomised to one of four identical hypothetical scenarios of testing human papillomavirus (HPV)‐positive: high‐grade cytology and a diagnosis of CIN2 that used alternate terminology to describe resolution of abnormal cells and/or inclusion of an overtreatment statement. Participants selected active surveillance or surgery after viewing the scenario and free‐text reason/s for their choice were thematically analysed. Results: Of the 1638 women randomised, 79% (n = 1293) opted for active surveillance. The most common reasons for choosing active surveillance included concerns about surgery and associated risks, preferring to 'wait and see', trusting the doctor's recommendations and having an emotional response toward surgery. For women who chose surgery, being risk‐averse, addressing the issue straight away and perceiving surgery to be the better option for them were the most common themes identified. Conclusion: When presented with balanced information on the benefits and harms of different management options for CIN2 and given a choice, most women in this hypothetical situation chose active surveillance over surgery. Addressing women's concerns about active surveillance may open up the possibility that if deemed safe, it could be an acceptable alternative for women. [ABSTRACT FROM AUTHOR]

Background: Intrauterine hysteroscopic morcellators have been studied as an alternative method for removing submucosal leiomyomas. Aims: To assess the long‐term efficacy of hysteroscopic morcellation of submucosal leiomyomas in women with abnormal uterine bleeding (AUB). Materials and Methods: We conducted a prospective cohort study including all women with AUB who underwent a hysteroscopic resection with mechanical morcellation of a benign submucosal leiomyoma confirmed at histopathology. Need for further surgery, patient satisfaction, symptom resolution and post‐operative complications were documented by direct patient contact after a minimum of six months of follow‐up. Results: A total of 73 women were included in the study with a mean length of follow‐up of 32 ± 13 months. Mean total size of pathology at the time of index surgery was of 42 ± 20 mm. A total of 9/73 (12%) women required subsequent hysterectomy and 20/73 (27%) any subsequent related surgery (operative hysteroscopy, abdominal myomectomy or hysterectomy) with the estimated three‐year cumulative incidence being 30 ± 6%. Satisfaction rate of participants was 84%. In multivariate Cox proportional analyses, only a total size of pathology of 50 mm or more was found to be significantly associated with the risk of requiring further surgical procedures (hazard ratio = 2.9, P = 0.02). Conclusions: Hysteroscopic morcellation of submucosal leiomyomas is an effective method to manage women with AUB, although women with larger pathology have an increased risk of requiring subsequent surgical procedures. [ABSTRACT FROM AUTHOR]

The article offers information on robotic-assisted surgical procedures and their use in gynaecology in Australasia. Topics discussed include the da Vinci system for robotic surgery from Intuitive Surgical; the evidence of robot-assisted surgery in myomectomy, hysterectomy and endometriosis; and the use of robotic surgery for cancer.

There has been a significant increase in minimally invasive surgery in gynaecology over the last 15 years, with approximately only one-third of hysterectomies for benign disease now performed via laparotomy. While robotic surgery offers considerable technical advantages over conventional laparoscopy and is associated with only a modest learning curve, the improvement in clinical outcomes is marginal and there are several disadvantages. There are increased set-up and operating times, the need to accommodate and maintain large sophisticated equipment, and the requirement for additional training. The preeminent issue regarding the place of robotic gynaecological surgery is cost. How this is addressed and contained will ultimately determine uptake in Australia. From the published literature to date, robotic surgery compared with conventional laparoscopic surgery is associated with marginal improvements in clinical outcomes for benign hysterectomy and endometrial cancer surgery, but little improvement for other benign gynaecological surgery or for cervical cancer surgery. Robotic surgery probably does improve clinical outcomes in obese and morbidly obese patients and is associated with improved ergonomics for the surgeon. It is likely that there will be continued substantial improvements in robotic surgical platforms into the foreseeable future and that robotic surgery will play an increasingly important role in gynaecological surgery in Australia. [ABSTRACT FROM AUTHOR]

Background: Recent evidence supports the fallopian tube as the site of origin for many pelvic serous cancers (PSC) including epithelial ovarian cancers (EOC). As a result, a change in practice with opportunistic bilateral salpingectomy (OBS) at the time of hysterectomy has been advocated as a preventative strategy for PSC in a low-risk population. Aims: The aim of this study was to assess current clinical practice in Australia with respect to OBS during gynaecological surgery for benign indications. Materials and Methods: An anonymous online survey was sent to all active Royal Australian and New Zealand College of Obstetrics and Gynaecology (RANZCOG) Fellows in Australia. Data regarding clinician demographics and the proportion of clinicians offering OBS were collected. Reasons for and against offering or discussing OBS were sought. A descriptive analysis was performed. Results: The response rate was 26% (280/1490) with 70% of respondents offering or discussing OBS to women undergoing gynaecological surgery for benign indications, usually at the time of abdominal (96%) or laparoscopic (76%) hysterectomy. The main reason for offering or discussing OBS was current evidence to suggest the fallopian tubes as the site of origin for most EOC. Main reasons for not offering OBS were insufficient evidence to benefit the woman (36%) or being unaware of recent evidence (33%). Conclusions: The survey responses indicate that OBS is frequently discussed or offered in Australia, usually at the time of hysterectomy. Given the lack of robust evidence to suggest a benefit at a population-based level, a national registry is recommended to monitor outcomes. [ABSTRACT FROM AUTHOR]

Robotic surgery has become an integral part of gynaecological surgery in the USA. In Australia, however, robotic surgery has only been established in urologic and cardiac surgery. In 2008, the Royal Adelaide Hospital (RAH) was the first public hospital to initiate a robotic surgery program in gynaecology and gynaecological oncology in Australia. To evaluate the feasibility and outcome of the robotic surgery program in gynaecology and gynaecological oncology at the RAH. A prospective case series analysis of the first 71 patients operated by robotic surgery from August 2008 to May 2010 was performed. All patients underwent a total or radical robotic hysterectomy with or without staging for gynaecological cancer, benign disease or genetic risk. No conversions to laparotomy were required. Sixty-seven patients (95%) were discharged the morning after surgery. Four patients (5%) required hospital stays of up to 3 days because of pre-existing medical conditions or logistical reasons. The only major postoperative complication was one vault dehiscence. Minor short-term problems in four patients were vaginal cuff cellulitis, vaginal vault granulation tissue and infected port sites. The RAH experience is that robotic surgery in gynaecology and gynaecological oncology is safe and feasible. Patient recovery is excellent, and the hospital stay is reduced. Robotic surgery has the potential to significantly expand the minimally invasive surgical options for women undergoing surgery for benign and malignant gynaecological disease in Australia. [ABSTRACT FROM AUTHOR]