Grigoris Grimbizis

Background: Adenomyosis is a prevalent gynaecological disorder whose pathogenesis remains incompletely understood. Congenital Müllerian anomalies provide an informative in vivo model, since obstructive and non‐obstructive variants impose spatially defined alterations of intrauterine pressure, myometrial architecture, and contractility. Objectives: To characterise adenomyosis localisation across Müllerian anomaly subtypes, assess concomitant endometriosis prevalence, and examine their topographic concordance with sites of uterine obstruction. Search Strategy: PubMed/MEDLINE, Embase and Scopus were searched from inception to October 2025 using MeSH/Emtree and free‐text terms for adenomyosis and congenital Müllerian anomalies, without date restrictions. Selection Criteria: Original case reports, case series, and observational studies in English explicitly describing the diagnostic modalities used for both conditions. Data Collection and Analysis: Two reviewers independently screened and extracted data; methodological quality was assessed with the Joanna Briggs Institute tools. Data were synthesised descriptively by malformation subtype, with case‐by‐case laterality analysis where individual patient‐level data were available. Main Results: Forty‐two studies (135 patients) were included. Unicornuate uterus predominated (102/135, 75.6%). Among patients with directly reported localisation and a non‐communicating functional rudimentary horn, adenomyosis involved the rudimentary horn in 10/12 cases (83.3%). In Robert's uterus, adenomyosis was ipsilateral to the blind hemicavity in 3/3 evaluable cases (100%). In Mayer–Rokitansky–Küster–Hauser (MRKH) syndrome, adenomyosis occurred in remnants lacking functional endometrium in 10/15 patients (66.7%). Concomitant endometriosis (43/134 evaluable patients, 32.1%) was most frequent in obstructive anomalies (Herlyn‐Werner‐Wunderlich syndrome (HWW) 3/5, 60.0%; Robert's uterus 2/4, 50.0%) and least frequent in septate uterus (0/2, 0%) and MRKH (2/15, 13.3%), localising ipsilateral to the obstruction in 9/10 (90.0%) reported obstructive cases. Conclusions: Adenomyosis preferentially involved structurally abnormal or obstructed uterine compartments. The endometriosis gradient was compatible with impaired menstrual efflux as a shared mechanical determinant. These findings derive from a low‐quality evidence base and should therefore be regarded as hypothesis‐generating. Prospective confirmation is required, although these findings may support increased clinical awareness in women with Müllerian anomalies, particularly obstructive variants.

Background/Objectives: Pelvic lymphadenectomy has long been considered the gold standard for surgical staging in early-stage endometrial cancer. However, sentinel lymph node biopsy (SLNB) with ultrastaging has emerged as a less invasive alternative. The aim of the study is to assess the detection rate, learning curve and diagnostic accuracy of SLNB in a cohort of patients with a high prevalence of obesity and early-stage endometrial cancer. Methods: This relatively small prospective single-center study included patients with presumed early-stage endometrial carcinoma who underwent laparoscopic hysterectomy, SLNB and bilateral pelvic lymphadenectomy at the 1st Department of Obstetrics & Gynecology between 1 April 2023 and 31 May 2025. Results: Forty-one patients were recruited. The mean age was 64.3 years, and the mean BMI was 32.4 kg/m². Bilateral and overall sentinel lymph node (SLN) detection was achieved in 27 of 41 patients (65.9%) and 85.4%, respectively. Concerning the learning curve, after the first 20 cases the bilateral detection rate was as high as 90.5% (p-value < 0.001). The median number of SLN for the left and right side were 1 (IQR: 1–2) and 2 (IQR: 1–3), respectively. The median number of lymph nodes dissected by lymphadenectomy was 7 (IQR: 5–8) for both sides. There were three patients with lymph node metastases, all of which were detected by SLNB. Conclusions: Bilateral detection of SLNs is technically feasible and requires a relatively short learning curve, under expert supervision in a high-volume, standardized training environment, even in patients with a high prevalence of obesity. The adoption of a standardized detection protocol is key to avoiding mapping failure.

Background: Ovarian cancer is the eighth most common cancer in women worldwide. Prognosis in ovarian cancer patients is mainly affected by the complete resectability of the tumor at the time of surgery. Among the methods used to determine resectability are laparotomy, laparoscopy, and imaging techniques. In ovarian cancer patients, the Fagotti Score (FS) and Peritoneal Cancer Index (PCI) can be used during upfront diagnostic laparoscopy to quantify disease burden, resectability, and prognosis. Methods: The aim of this retrospective study was to assess the FS and PCI as tools for predicting optimal cytoreduction (R = 0, <1) and correctly assigning patients for primary debulking surgery (PDS) or interval debulking surgery (IDS). An ROC was used to compare the accuracy of both FS and PCI scores for assessing resectability. Diagnostic measures for both were calculated. Results: A total of 45 patients were ultimately included in this study. The area under the curve was 0.801 for the FS and 0.705 for the laparoscopic PCI, with an optimal cut-off score of 24.5. In our cohort, the FS demonstrated a sensitivity of 90%, a specificity of 64%, a PPV of 66.7%, and an NPV of 88.9%. Similarly, using a cut-off of 24.5, the PCI demonstrated a sensitivity of 80%, a PPV of 59.3%, and an NPV of 56%. Conclusions: Laparoscopic PCI is a useful tool for predicting resectability in ovarian cancer patients. However, when compared with the PCI, it seems that the FS performs better as a predictive score for resectability.

Introduction: Surgical treatment for patients with complex female genital anomalies (FGA) depends on the specific type of anomaly, its level of complexity, the symptoms experienced by the patient, and a thorough understanding of the embryological origins of the anomaly. The aim of this study is to analyze the results of the surgical treatment of young female patients with complex FGA presented with primary amenorrhea and/or cyclic pelvic pain and present their treatment algorithm. Material and Methods: This retrospective cohort study analyzed prospectively collected data of adolescents and young women with FGA presented with primary amenorrhea and/or cyclic pelvic pain. Forty‐eight patients of 11 different types of FGA, evaluated and treated in our Department between January 2007 and June 2025, were included. Results: All patients were treated surgically. The design of the surgical treatment was based on the existing uterine body, cervical, and vaginal anatomy. Immediate surgery was performed in patients with obstructive pain, whereas nonobstructive cases were treated near anticipated sexual activity. Neovagina creation was performed in 26 cases of vaginal aplasia; isthmo‐neovagina anastomosis was performed in one patient with cervical aplasia and a normal uterus and in two patients with a rudimentary cavity, while excision of the rudimentary cavity was performed in a third one. Two patients developed rectovaginal fistula, which was managed successfully. Surgical treatment of a patient with an obstructed bicorporeal complete uterus combined with cervical and vaginal aplasia was unsuccessful, leading to hysterectomy. All transverse vaginal septae were excised, one through posterior colpotomy. One patient with a complete bicorporeal uterus and unilateral cervical aplasia underwent successful anastomosis and another one underwent excision of the obstructed uterine body. Rudimentary cavities of unicorporeal uteri were removed. Conclusions: Surgical treatment of FGA presenting with primary amenorrhea and/or cyclic pelvic pain should be anatomy‐driven, with priority given to symptom relief and preservation of reproductive potential by restoring genital tract continuity, when feasible, or removing obstructed parts.

Background/Objectives: This study investigates the predictive role of pre-operative sonographic assessment of ovarian mobility in determining intra-operative ovarian resectability among patients undergoing vaginal hysterectomy for pelvic organ prolapse. Methods: This prospective study was conducted in a tertiary academic urogynecology center. Women with pelvic organ prolapse scheduled for vaginal hysterectomy were consecutively recruited after providing informed consent. Pre-operatively, all patients had a detailed history, pelvic examination (POP-Q), and pelvic floor ultrasound (including assessment of the mobility of both ovaries and sonographic determination of ovarian descent in relation to the pelvic ischial spines). Patients were planned for vaginal hysterectomy, anterior and posterior colporrhaphy, McCall culdoplasty, and bilateral salpingo-oophorectomy (SO), where feasible. During surgery, the location and mobility of the ovaries, as well as the presence of peri-ovarian adhesions, were recorded. Pair-to-pair comparisons between sonographic and clinical findings were performed. Results: From February 2023 to January 2024, 50 Caucasian adult women underwent reconstructive vaginal surgery for prolapse. Thirty-five patients underwent concomitant bilateral SO via vaginal route, seven underwent unilateral SO, and three under went salpingectomy only. ROC analysis indicated that pre-operative ultrasound assessment of ovarian mobility predicts: (1) intra-operative ovarian mobility (sensitivity 95.6%, specificity 77.8%); (2) the presence of peri-ovarian adhesions (sensitivity 46.1%, specificity 94.2%); and (3) resectability, i.e., the ability to perform SO via the vaginal route (sensitivity 96.4%, specificity 50.0%). The absence of ovarian mobility was not associated with an increased risk of intra-operative and post-operative complications. Conclusions: Pre-operative sonographic assessment of ovarian location and mobility can predict ovarian location and resectability during vaginal surgery with high diagnostic accuracy.

Background/Objectives: Patients with advanced ovarian cancer with a high tumor burden typically undergo neoadjuvant chemotherapy (NACT) followed by interval debulking surgery. The optimal number of NACT cycles remains undefined: although three to four cycles are considered gold-standard, in real-world practice, five or more cycles are frequently administrated. This study aims to evaluate the impact of delayed interval debulking surgery (DIDS) after ≥5 cycles of NACT on the survival rates. Methods: We conducted a retrospective analysis of women with advanced ovarian cancer that underwent surgery in the 1st Department of Obstetrics–Gynecology Clinic from 2012 to 2022. Patient characteristics, oncological, and follow-up information were collected. Results: A total of 125 patients met the inclusion criteria and were divided into two groups: Group A (77 patients) received 3–4 of NACT cycles, and Group B (48 patients) ≥5 cycles. No statistically significant difference was observed between the groups concerning age, BMI, comorbidities, Aletti score, FIGO stage, pre-operative CA-125 values, surgery duration, rate of postoperative complications, hospital stay, ICU admittance, and complete gross resection (RD = 0). However, patients undergoing DIDS experienced significantly greater intraoperative blood loss. Progression-free survival did not differ between groups (IDS: 17 vs. DIDS: 18 months, p = 0.561), whereas overall survival was significantly lower in the DIDS group (IDS: 52 vs. DIDS: 36 months, p = 0.00873). This statistical significance persisted after controlling for residual disease, but was lost after adjusting for FIGO stage. Conclusions: DIDS may be considered for advanced ovarian cancer patients with a high tumor burden, when complete gross resection (RD = 0) cannot be achieved during IDS. Further prospective randomized trials are necessary to evaluate its oncological safety and morbidity.

Background: Patients with ovarian cancer often require intensive care unit (ICU) admission after surgery due to the complexity of the operation and the higher risk of complications. However, not all patients require a prolonged stay in the ICU. To identify factors that may predict extended stay in the ICU following surgery for ovarian cancer. Methods: A retrospective review was conducted of patients who underwent surgery for ovarian cancer and were admitted to the ICU at a single tertiary hospital center between January 2004 and December 2023. Patient demographics, clinical characteristics, and perioperative variables were analyzed. Results: Of the 74 patients included, 36.5% had an ICU stay of at least 48 h. Factors associated with prolonged ICU stay included higher Body Mass Index (BMI) and time of surgery duration. In contrast, a greater body temperature at the end of the operation was linked to a decrease in the length of ICU stay. Conclusions: These findings provide valuable insights for preoperative counseling and resource allocation, enhancing postoperative care for ovarian cancer patients. Additional research is required to confirm these data and investigate any other factors that may predict extended stay in the ICU.

Background/Objectives: Cytoreductive surgery for women with advanced ovarian cancer is a demanding process with high morbidity. The present analysis aims to identify whether using the Ligasure^® Maryland jaw open sealer/divider (LMJsd) with a nanocoating (Covidien^®, Medtronic^®, 710 Medtronic Parkway, Minneapolis, MN, USA), could lead to better outcomes during cytoreduction surgery by reducing intraoperative bleeding and other hospitalization-related parameters. Methods: Patients with ovarian cancer (FIGO III/IV) who were subjected to primary or interval cytoreductive surgery at the Gynecologic-Oncology Unit, 1st Department of Obstetrics and Gynecology, Papageorgiou General Hospital, Thessaloniki, Greece, were included in the analysis. Patients were retrospectively allocated into two groups: women operated on with or without using the LMJsd. Differences between the two groups (intraoperative blood loss and blood transfusion, duration of surgery, postoperative blood transfusion, admission to intensive care unit (ICU), and overall hospital length of stay) were investigated. Results: From 2012 to 2020, 284 women with ovarian cancer were surgically treated; 208 were stage III/IV. In the LMJsd group of women (n = 34), the duration of surgery and blood loss during surgery were significantly decreased (p < 0.0005) compared to the non-LMJsd group (n = 174). The intraoperative blood transfusion rate and the number of packed red blood cell units transfused were significantly decreased in the first group (p = 0.0025); the postoperative blood transfusion rate was not different (p = 0.065). Moreover, ICU admission and overall hospital length of stay were significantly decreased in the LMJsd group (p < 0.0005 and p = 0.015). Conclusions: Using the LMJsd is associated with decreased intraoperative bleeding and transfusion rates, duration of surgery, admission to ICU, and overall hospital length of stay in women treated with surgical cytoreduction for advanced ovarian cancer. Some limitations of this study are as follows: its limited impact because it is an observational retrospective analysis and bias because the cumulative experience of the surgeons may have an impact on the surgical outcomes.

Patients with ovarian cancer often require intensive care unit (ICU) admission after surgery due to the complexity of the operation and the higher risk of complications. However, not all patients require a prolonged stay in the ICU. Aim of this study is to identify factors that may predict extended stay in the ICU following surgery for ovarian cancer. A retrospective review was conducted of patients who underwent surgery for ovarian cancer and were admitted to the ICU at a single tertiary hospital center between January 2004 and December 2023. Patient demographics, clinical characteristics, and perioperative variables were analyzed. Of the 74 patients included, 36.5% had an ICU stay of at least 48 hours. Factors associated with prolonged ICU stay included higher Body Mass Index (BMI) and time of surgery duration. In contrast, a greater body temperature at the end of the operation was linked to a decrease in the length of ICU stay. These findings provide valuable insights for preoperative counseling and resource allocation, enhancing postoperative care for ovarian cancer patients. Additional research is required to confirm these data and investigate any other factors that may predict extended stay in the ICU.