Laurentiu Pirtea

Background: Restoration of apical support is a primary objective in pelvic organ prolapse surgery; however, postoperative pelvic floor biomechanics and vaginal axis orientation are increasingly recognized as relevant determinants of clinical outcome. Laparoscopic pectopexy may be performed using synthetic mesh or non-absorbable sutures (wire), yet the influence of fixation material on postoperative vaginal axis remains insufficiently explored. This study aimed to evaluate vaginal axis orientation after mesh versus wire pectopexy using magnetic resonance imaging (MRI). Methods: A prospective non-randomized comparative cohort study included 100 women with symptomatic apical pelvic organ prolapse (POP-Q stage ≥ II). Fifty patients underwent mesh pectopexy and fifty wire pectopexy. All patients underwent standardized postoperative pelvic MRI at one-year follow-up using a 1.5 Tesla scanner with dynamic Valsalva sequences. MRI measurements included vaginal PS3L axis angle, H-line, and M-line. Clinical outcomes were assessed by gynecological examination. Statistical analysis included ANOVA, logistic regression, and ROC curve evaluation. Results: No cases of apical prolapse recurrence were observed. Vaginal axis orientation was significantly associated with postoperative clinical findings (F = 3.867, p = 0.019). Logistic regression identified vaginal axis angle as an independent predictor of normal clinical outcome (β = −0.257, p = 0.008; AUC = 0.819). A more physiological vaginal axis was more frequently observed following wire pectopexy Conclusions: Postoperative vaginal axis orientation assessed by MRI represents a relevant parameter after apical prolapse repair. Wire pectopexy was associated with a more physiological vaginal axis alignment, suggesting potential biomechanical advantages that may influence postoperative pelvic floor stability.

Background/Objectives: Sentinel lymph node (SLN) mapping has become a standard approach in the surgical staging of early-stage endometrial cancer, aiming to reduce the morbidity associated with full lymphadenectomy while preserving diagnostic accuracy. Vaginal Natural Orifice Transluminal Endoscopic Surgery (V-NOTES) represents a novel, minimally invasive approach for SLN mapping that may offer specific benefits in terms of access, cosmetics, and recovery, particularly in select patient populations. Methods: A comprehensive literature search was conducted in the main databases for studies evaluating the use of V-NOTES for sentinel lymph node mapping in patients with endometrial cancer. Results: Of the 12 included studies, three were observational cohort studies, while the remaining were case reports and series. The mean patient age was 59.6 years, with a majority being overweight or obese. V-NOTES was performed using both transperitoneal and retroperitoneal approaches, with indocyanine green (ICG) being the most used tracer. The overall mean SLN detection rate was 98.19%, with a bilateral detection rate of 93.7%. The average operative time was 155 min, the mean blood loss was 72.03 mL, and the average hospital stay was 2.4 days. The complication rate was low (3.9%), with no conversions to laparotomy reported. Conclusions: V-NOTES appears to be a feasible and safe alternative for SLN mapping in early-stage endometrial cancer, with high detection rates and favourable perioperative outcomes. However, due to the limited number of comparative studies and small sample sizes, further prospective research is needed to establish its efficacy relative to traditional minimally invasive techniques and to determine the optimal patient selection criteria.

Due to possible congenital infections, cytomegalovirus (CMV) remains a significant public health concern in childbearing-aged and pregnant women. We analyzed the spatial, temporal, and age-related trends in CMV seroepidemiology in Croatia over 10 years. A total of 2838 childbearing-aged and pregnant women, aged 16–45 years, tested between 2015 and 2024 were included in the study. CMV IgM/IgG antibodies were detected using a commercial ELISA. IgM/IgG-positive samples were tested for IgG avidity. CMV IgG antibodies were detected in 2006 (70.6%) of participants. No significant differences were observed between 2015–2019 and 2020–2024 (72.0% vs. 69.8%), while yearly differences were of borderline significance, ranging from 62.4 to 77.3%. The overall seropositivity increased progressively with age from 49.6% in the 16–20 age group to 77.5% in the 36–40 age group. Significant regional differences in IgG seroprevalence were observed: 68.6% in the City of Zagreb/Northern Croatia, 78.5% in Pannonian Croatia, and 71.9% in Adriatic Croatia, while differences between settlement types were not significant. IgG seroprevalence was higher in women with an unfavorable obstetric history (85.3%) than in non-pregnant women and those with a normal pregnancy (70.6% and 66.5%, respectively). IgM antibodies were detected in 278 (9.8%) of participants. Acute infections were more common in younger participants, with rates decreasing from 13.6% in the youngest age group to 6.7% in the oldest. Logistic regression showed that age was a significant predictor of both IgG and IgM positivity. Region and obstetric history were significant predictors of IgG seropositivity, while settlement was a significant predictor of IgM seropositivity.

Background/Objectives: Sentinel lymph node (SLN) mapping has become a standard approach in the surgical staging of early-stage endometrial cancer, aiming to reduce the morbidity associated with full lymphadenectomy while preserving diagnostic accuracy. Vaginal Natural Orifice Transluminal Endoscopic Surgery (V-NOTES) represents a novel, minimally invasive approach for SLN mapping that may offer specific benefits in terms of access, cosmetics, and recovery, particularly in select patient populations. Methods: A comprehensive literature search in the main databases was conducted for studies evaluating the use of v-notes for sentinel lymph node mapping in endometrial cancer patients. Results: Of the 12 included studies, three were observational cohort studies, while the remaining were case reports and series. The mean patient age was 59.6 years, with a majority being overweight or obese. V-NOTES was performed using both transperitoneal and retroperitoneal approaches, with indocyanine green (ICG) being the most commonly used tracer. The overall mean SLN detection rate was 98.19%, with a bilateral detection rate of 93.7%. The average operative time was 155 minutes, mean blood loss was 72.03 mL, and average hospital stay was 2.4 days. The complication rate was low (3.9%), with no conversions to laparotomy reported. Conclusions: V-NOTES appears to be a feasible and safe alternative for SLN mapping in early-stage endometrial cancer, with high detection rates and favorable perioperative outcomes. However, due to the limited number of comparative studies and small sample sizes, further prospective research is needed to establish its efficacy relative to traditional minimally invasive techniques and to determine optimal patient selection.

Background and Objectives: This study aimed to evaluate the efficacy and safety of modified laparoscopic Burch intervention over a 24-month follow-up period. Materials and Methods: We performed a retrospective cohort evaluation including all eligible patients, 83 patients, who underwent modified laparoscopic Burch colposuspension for stress urinary incontinence (SUI). Primary outcomes included the presence or absence of SUI on follow-up and the success of index surgery based on responses to validated questionnaires of patient-reported outcomes. Results: Patient-reported outcomes indicated a progressive improvement in perceived well-being over time. At the 6-month follow-up, 50.6% of participants reported their condition as “greatly improved”, increasing cumulatively to 66.7% by 24 months. The severity of urinary incontinence symptoms was markedly reduced following the intervention. The incidence of severe incontinence was notably low, with only 4.8% of patients affected at 6 months, remaining consistent at 5.1% at 24 months. This finding aligns with a high procedural success rate, as the vast majority of patients (≥94.9%) reported no severe symptoms across all follow-up intervals. Dryness, defined as the absence of urinary leakage, demonstrated an upward trend over time. At 6 months, 45.8% of patients reported complete dryness, with this figure rising to 55.1% at 12 months and 62.8% at 24 months. The Urogenital Distress Inventory-6 (UDI-6) served as a critical metric for evaluating the subjective burden of urinary symptoms. Across all follow-up intervals, over 97% of patients achieved scores below the clinically significant threshold (Conclusions: The modified laparoscopic Burch colposuspension demonstrated consistent efficacy, with significant improvements in urinary continence, symptom severity, and quality of life over the 24-month follow-up period.

Objectives: Pelvic organ prolapse (POP) is a common condition affecting women, often requiring surgical intervention. Laparoscopic pectopexy has gained popularity, but there is ongoing debate about the efficacy and safety of mesh versus thread as fixation materials. This study aims to compare the outcomes of these two techniques, focusing on cure, recurrence and postoperative complication rates. Methods: A prospective analysis was conducted on patients undergoing laparoscopic pectopexy for POP. This prospective study included 78 patients diagnosed with pelvic organ prolapse stage II–IV according to the POP-Q system. Thirty-six (46.15%) underwent laparoscopic pectopexy with mesh and forty-two patients (53.84%) underwent the laparoscopic pectopexy procedure with thread. Data on cure rates, recurrence, mild asymptomatic cystocele and chronic pain were analyzed. Statistical significance was assessed using chi-squared and Fisher’s exact tests. Results: The cure rate was high in both group: 94.4% in the Mesh group and 100% in the thread group. Recurrence of vaginal apex prolapse occurred in 5.56% of the Mesh group, while no recurrence was observed in the thread group. Chronic pain was reported in 11.11% of the Mesh group but was absent in the thread group (p < 0.05). The overall rate for cystocele across all participants was 44.87% (40.48% of patients in the thread group experienced mild asymptomatic cystocele, compared to 50% in the Mesh group). No intraoperative complications were reported in either group. Conclusions: Thread-based laparoscopic pectopexy demonstrates equivalent or superior outcomes compared to mesh, with a high cure rate, no recurrence rate and no chronic pain. These findings support the use of thread as a safer alternative, aligning with FDA guidelines on mesh usage.

Background: Pelvic organ prolapse (POP) is a public health problem that influences millions of women around the globe, and it has a significant impact on the quality of life. From the FDA statement regarding the complications of using mesh implants in POP surgery to studies that have shown the benefits and side effects, we conducted a systematic review investigating the complications associated with surgical mesh implantation for POP repair. Methods: Relevant studies were identified through a comprehensive search of scientific databases. Studies evaluating the use of mesh in POP surgery and reporting on associated complications were included. Results: Among 2816 studies, 28 studies met the research criteria, with a total number of 8958 patients, revealing that in laparoscopic mesh surgery, the rate of mesh exposure was lower compared to vaginal mesh surgery, among other complications. Conclusions: Laparoscopic mesh surgery is superior as a long-term approach for POP repair compared to vaginal mesh surgery, offering lower complication rates and potentially better anatomical success. However, vaginal mesh surgery remains a valuable option for patients who are unsuitable for laparoscopy due to specific factors. Future research should explore alternative techniques, like pectopexy with or without mesh, to further improve surgical outcomes and patient experience.

Background and Objectives: Our aim was to perform a retrospective analysis of the volume of cervical screening tests, the number of patients treated with an excision method, and the incidence of invasive and non-invasive cervical during a pandemic and pre-pandemic period of 24 months. Materials and Methods: The study compared 404 patients who underwent cervical cone biopsy for cervical cancer. The study examined patients’ specimens based on histopathological characteristics and categorized cervical lesions based on pap smear. Results: There was a statistically significant age difference between the two study periods. The mean difference was 32 years before the pandemic and 35 years during the pandemic (p-value > 0.05). The biggest patient loss ratio identified by age group was in the 50–59-year group, with a 14.53% loss in the pre-pandemic period and a 9.1% loss in the pandemic period. In the pandemic period, patients from rural areas presented in the clinical trial with a lower rate of 39.52% (83 patients) vs. 60.47% (127 patients) in urban areas. A higher percentage of patients experiencing cervicorrhagia as a clinical manifestation in the pandemic period vs. the pre-pandemic period, with an increase in more severe lesions in the pandemic period, had a statistical significance of 8% more newly diagnosed compared to the pre-pandemic period. Conclusions: The addressability of the patients during the COVID period was not affected in a drastic way in our study. We encountered a decrease in appointments in the age group of 50–59 years and a decrease in patients with rural residence. In our study, we found an increase in cervical bleeding as a reason for consultation in the pandemic period with a higher lesion degree, both on a pap smear and on a cervical biopsy.

This systematic review evaluates the clinical outcomes and molecular predictors of response to pembrolizumab in patients with advanced and metastatic cervical cancer. We adhered to the PRISMA guidelines for systematic reviews, conducting a database search in PubMed, Scopus, and Embase. The eligibility criteria centered on clinical outcomes, including the overall survival (OS), progression-free survival (PFS), and immune-related biomarkers post-pembrolizumab therapy. We included both prospective and retrospective studies that detailed clinical outcomes and molecular characteristics predictive of therapeutic response. Our search yielded six studies involving 846 patients treated with pembrolizumab from 2017 to 2022. The meta-analysis of these studies showed that pembrolizumab, used as monotherapy or in combination with chemotherapy, extended the OS by a weighted median of 10.35 months and the PFS by 8.50 months. The treatment demonstrated a pooled objective response rate (ORR) of 22.39%, although the I² test result of 67.49% showed a high heterogeneity among the studies. Notably, patients with high PD-L1 expression (CPS ≥ 10) experienced improved outcomes in terms of the PFS and OS. The most common complications were fatigue, diarrhea, and immune-related adverse events. Pembrolizumab significantly enhances clinical outcomes in metastatic cervical cancer, particularly among patients with high PD-L1 expression. The drug maintains a good safety profile, reinforcing its treatment potential for patients with advanced and metastatic cervical cancer. Future studies should explore long-term effects and strategies to integrate pembrolizumab optimally into current treatment regimens, aiming to maximize patient benefits and effectively manage side effects.

A cesarean scar ectopic pregnancy (CSP) represents an uncommon yet potentially life-threatening condition requiring immediate and efficient management. We present a case of a 32-year-old woman diagnosed with a scar pregnancy at 8 weeks of gestation. Laparoscopic surgical management was chosen due to its minimally invasive nature and potential for preserving fertility. During the procedure, temporary clipping of uterine arteries was employed to control intraoperative bleeding. The patient recovered well postoperatively with no complications. This case highlights the feasibility and effectiveness of laparoscopic intervention combined with temporary uterine artery clipping in the management of scar pregnancies, offering a valuable approach for clinicians faced with similar cases. Through this report, we aim to contribute to the existing literature on the optimal management of CSP and highlight the efficacy of laparoscopic surgery in this context.