Angelos Daniilidis

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: Endometrial cancer (EC) is one of the most prevalent cancers in women globally, which has recently gained attention as an increase has been noted among premenopausal women. Improving fertility-sparing treatments is crucial to assist women in completing their family planning. Methods: This study aims to explore the current evidence on the mechanisms of action and correlation between Glucagon-like Peptide-1 (GLP-1) and its agonists with EC, as well as the potential application in the conservative therapy for early-stage EC. A narrative review of the worldwide literature was conducted according to Scale for the Assessment of Narrative Review Articles (SANRA) principles, intending to analyze the correlation of GLP-1 receptor agonists (GLP-1RAs) with EC and their precise effect in the fertility-sparing treatment in women with atypical endometrial hyperplasia (AEH) or early-stage EC. Results: Preclinical studies indicate that GLP-1 receptor (GLP-1R) expression on healthy and malignant endometrial tissues of models regulates apoptosis via the AMPK-mTOR pathway. Observational and early clinical studies conclude that their role in the improvement of metabolic and hormonal imbalance increases the risk for the development of EC, as well as anti-tumour and anti-inflammatory effects. Conclusions: GLP-1RAs represent a potentially promising addition to the conservative management of AEH and early-stage EC in premenopausal women; however, further extensive clinical trials are required to ensure their safety and efficacy in future treatment algorithms and preconception exposure.

Background/Objectives: The clinical management of uterine fibroids in the context of infertility is characterized by significant heterogeneity. The aim of our study was to record the participants’ views and clinical practices regarding minimally invasive, fertility-sparing management of fibroids, focusing on fertility outcomes. Methods: An online survey was distributed to members of the European Society of Gynecology (ESG), using a questionnaire comprising 27 questions. Questions 1 to 5 related to the participants’ background, while questions 6 to 27 related to the clinical management of fibroids. Results: A total of 98 participants completed the survey, of whom 83% (n = 82) practiced in European countries and 43% (n = 42) had completed specialist training in minimally invasive gynecological surgery. For FIGO 0–II fibroids, hysteroscopic removal was recommended by 94% (n = 92) of participants, although only 27% (n = 26) would do so in all cases, irrespective of the size and submucosal proportion. Anti-adhesion agents were used at least occasionally after the hysteroscopic removal of FIGO 0–II fibroids by 51% (n = 50) of participants. A clinically significant fibroid size was recognized by 57% (n = 56) of participants for FIGO III fibroids and by 51% (n = 50) for FIGO IV fibroids. The opinion was almost evenly divided on whether the distance between an intramural, non-cavity-distorting fibroid and the junctional zone affected the decision for removal: 49% (n = 48) considered that it did not, whereas 51% (n = 50) considered that it did, citing variable cut-off values. Most participants favored minimal-access approaches over laparotomy, whereas the use of robot-assisted laparoscopy was limited. Conclusions: Our results confirm the significant variation in clinical practice associated with fibroid management and underline the need for standardized care, based on high-quality evidence.

Background/Objectives: Clinical management of uterine fibroids in the context of infertility is characterised by significant heterogeneity. The aim of our study was to record the participants’ views and clinical practices regarding minimally invasive, fertility-sparing management of fibroids, focusing on fertility outcomes. Methods: Online survey distributed to members of the European Society of Gynecology (ESG), using a questionnaire comprising 27 questions. Questions 1 to 5 related to the participants’ background, while questions 6 to 27 related to the clinical management of fibroids. Results: 98 participants completed the survey, 83% (n=82) of which practice in European countries. 43% (n=42) had completed specialist training in minimally invasive gynecological surgery. For FIGO 0–II fibroids, 94% of participants recommended hysteroscopic removal in infertile patients. 50% may use anti-adhesion agents after hysteroscopic removal of FIGO 0–II fibroids. For FIGO III fibroids, 57% of participants (n=56) believe they have a detrimental impact on fertility while, for FIGO IV fibroids, 51% (n=50) believe the same. 48% of participants (n=49) stated that the distance between the inner portion of an intramural, non-cavity distorting fibroid and the junctional zone does not affect their decision for removal in infertile patients, and 51% (n=50) stated that it does, with variable cut-off values given. The majority of participants favour minimal access approaches over traditional laparotomy; however, the use of robot-assisted laparoscopy was limited. Conclusions: Our results confirm the significant variation in clinical practice associated with fibroid management and underline the need for standardised care, based on high-quality evidence.

Obstetric patients represent a unique and high-risk population in the Intensive Care Unit (ICU), where clinical management must account for the complex physiological changes of pregnancy and the safety of both mother and fetus. Human error in this setting is multifactorial, often stemming from diagnostic delays, communication failures, and systemic inefficiencies. This review synthesizes current evidence on the types, causes, and prevention strategies for human error in obstetric critical care, highlighting the critical role of multidisciplinary teams and standardized protocols in reducing maternal morbidity and mortality.

Background: Pelvic organ prolapse (POP) significantly impairs patients’ quality of life, especially in urinary, bowel, and sexual domains. While laparoscopic sacrocolpopexy (LS) is the current gold standard for apical prolapse repair, it is associated with certain complications. Laparoscopic pectopexy (LP), a newer technique utilizing the iliopectineal ligament for apical suspension, may offer improved outcomes with fewer adverse effects. This scoping review aimed to evaluate patient-reported outcomes (PROs) and quality of life (QoL) following LP and compare its effectiveness to other established surgical approaches. Methods: A scoping review was conducted in accordance with PRISMA-ScR guidelines. Searches of PubMed, Scopus, and Web of Science databases were performed through June 2025. Eligible studies included randomized controlled trials, prospective and retrospective cohorts, and case series that reported PROs following LP. Data on validated QoL tools (e.g., P-QOL, PFDI-20, PFIQ-7, FSFI, PISQ-12), surgical technique, and follow-up duration were extracted. Due to heterogeneity in the study design and outcomes, findings were synthesized qualitatively. Results: Thirteen studies including a total of 742 patients met the inclusion criteria. Across all included studies, LP was associated with significant improvements in QoL metrics, including urinary and sexual function, and overall patient satisfaction. Tools such as PFDI-20, FSFI, PISQ-12, and PGI-I consistently showed postoperative improvement (p < 0.05). Comparative studies demonstrated that the outcomes for LP were similar or superior to those of sacrocolpopexy, sacrospinous fixation, or sacrohysteropexy, particularly regarding sexual function. Conclusions: LP is an effective surgical alternative for apical POP repair, offering significant improvements in patient-reported quality of life and functional outcomes. Its favorable safety profile and comparable efficacy to traditional methods make it a compelling option, particularly for patients with contraindications to sacral dissection. Findings are limited by small and heterogeneous studies, short follow-up, and potential publication and language biases. Further prospective studies with long-term follow-up periods are necessary to confirm these findings and refine patient selection criteria.

Background and Objectives: The use of Artificial Intelligence (AI) in the medical field is rapidly expanding. This review aims to explore and summarize all published research on the development and validation of deep learning (DL) models in gynecologic laparoscopic surgeries. Materials and Methods: MEDLINE, IEEE Xplore, and Google scholar were searched for eligible studies published between January 2000 and May 2025. Selected studies developed a DL model using datasets derived from gynecologic laparoscopic procedures. The exclusion criteria included non-gynecologic datasets, non-laparoscopic datasets, non-Convolutional Neural Network (CNN) models, and non-English publications. Results: A total of 16 out of 621 studies met our inclusion criteria. The findings were categorized into four main application areas: (i) anatomy classification (n = 6), (ii) anatomy segmentation (n = 5), (iii) surgical instrument classification and segmentation (n = 5), and (iv) surgical action recognition (n = 5). Conclusions: This review emphasizes the growing role of AI in gynecologic laparoscopy, improving anatomy recognition, instrument tracking, and surgical action analysis. As datasets grow and computational capabilities advance, these technologies are poised to improve intraoperative guidance and standardize surgical training.

10-step approach for laparoscopic pectopexy combined with supracervical hysterectomy - Facts, Views and Vision in ObGyn

The assessment of the ovarian reserve is important in patients with fertility intent. The anti-Müllerian hormone (AMH) serum level is a useful ovarian reserve marker. Endometriosis is a benign disease with three phenotypes: superficial peritoneal endometriosis (SUP), ovarian endometrioma (OMA), and deep endometriosis (DE). Endometriosis is linked with infertility; however, the exact impact of endometriosis and endometriosis surgery on AMH levels is less clear. This narrative review examines how different endometriosis phenotypes and related surgeries affect AMH levels as well as explores whether pre- and post-surgical AMH can predict the reproductive outcomes in women seeking pregnancy. The evidence suggests that OMA is linked to reduced AMH values and a higher AMH decline rate over time. OMA cystectomy causes further a reduction in AMH, which, however, tends to recover postoperatively. Non-excisional surgery for OMA spares the ovarian parenchyma; however, an at least temporary decline in AMH is observed. The effect is likely smaller than that of cystectomy. Non-thermal methods of hemostasis following cystectomy are likely superior in terms of AMH. The AMH levels before OMA cystectomy appear to be positively correlated with the postoperative probability of pregnancy, particularly spontaneous conception, but not livebirth rates. Preoperative AMH levels are also predictive of the risk of diminished ovarian reserve (DOR). Similarly, postoperative AMH levels and the rate of AMH decline at 1 year after OMA cystectomy appear to be predictive of fertility outcomes. SUP likely has little (if any) impact on AMH levels. DE reduces AMH levels, and a further reduction following surgery is anticipated. However, a reduction in AMH values should not be interpreted as a decline in the patient’s reproductive potential. Further research should focus on the extra-ovarian locations of endometriosis and their impact on AMH values.