Hannes Endres

Purpose: To evaluate the safety, feasibility, and short-term reliability of transvaginal sonography-guided ovarian cyst aspiration in women with benign-appearing ovarian cysts and to explore its potential economic and environmental implications compared with minimally invasive surgical management. Methods: This retrospective cohort study included women with sonographically benign ovarian cysts treated with transvaginal sonography-guided aspiration at a tertiary-care hospital between January 2024 and October 2025. Patient characteristics, cyst morphology according to International Ovarian Tumor Analysis (IOTA) Simple Rules, procedural feasibility, complications, and recurrence rates were analyzed. In addition, targeted literature reviews were performed to contextualize reported health care costs and carbon footprints of laparoscopic gynecologic procedures. Results: Twenty-two women were included. The median age was 58 years (range 31–87), the median cyst diameter was 5.9 cm (range 2.8–10.0), and the median aspirated volume was 55 mL (range 9–600). All cysts fulfilled benign sonographic criteria, most commonly IOTA pattern B1 (77.3%), and were predominantly located in the Douglas space (77.3%). The procedure was technically feasible in 95% of cases and was performed under local anesthesia in all but one patient. No major intra or post-interventional complications occurred. One cyst recurrence (4.5%) was documented during follow-up, noting that most patients were assessed only via self-presentation. Literature data indicate substantially higher health care costs for laparoscopic and robotic gynecologic procedures compared with sonography-guided interventions. Published studies report a mean carbon footprint of approximately 42 kg CO ² e per laparoscopic procedure, while no data are currently available for sonography-guided cyst aspiration. Conclusion: Transvaginal sonography-guided ovarian cyst aspiration appears to be a safe and feasible treatment option for carefully selected benign ovarian cysts, with low short-term recurrence and minimal morbidity. Available evidence suggests potential economic advantages and a likely lower environmental impact compared with minimally invasive surgery. Given the small sample size, this approach should be considered a complementary or alternative option in selected patients rather than a first-line treatment and warrants further evaluation in larger prospective studies.

Objectives: Due to the rarity of primary vaginal carcinoma, standardized treatment approaches are limited. Radical surgery is rare, especially in advanced stages. This report evaluates the feasibility, technical aspects and outcomes of laparoscopic en bloc resection in advanced vaginal carcinoma. Case presentation: A 67-year-old woman presented with pain and vaginal bleeding. Clinical examination revealed a stenosing vaginal tumour up to 2 cm above the introitus, extending to the urethra and right vulva. Biopsies confirmed invasive squamous cell carcinoma with VAIN/VIN III. Imaging revealed enlarged pelvic lymph nodes, but no distant metastases. Methods: The surgical procedure comprised laparoscopic en bloc resection, including bilateral pelvic lymphadenectomy, radical hysterectomy with bilateral salpingo-oophorectomy, and total vaginal excision down to the pelvic floor. Additionally, inguinal bilateral ICG-guided sentinel lymph node dissection, vulvectomy with clitoral preservation, and partial urethral resection were performed, followed by transvaginal specimen removal. Vaginal closure was achieved via combined transvaginal and laparoscopic pelvic floor reconstruction. The postoperative course was uneventful, with early recovery of urinary and bowel function. Final histology confirmed complete tumor resection with clear margins (pT3, pN0, L0, V0, Pn0, R0). Functional outcomes remained excellent, with no recurrence or functional impairment at one-year follow-up. Conclusions: Laparoscopic en bloc resection appears to be a feasible option for selected patients with locally advanced vaginal carcinoma, enabling complete tumour removal with preservation of pelvic floor function and resulting in favourable postoperative and oncological outcomes.

Objective: To investigate the clinical utility of diagnostic laparoscopy in guiding treatment strategy and surgical outcomes for patients with advanced-stage ovarian cancer, specifically regarding operability assessment and the likelihood of complete cytoreduction. Methods: This retrospective cohort study analyzed 183 patients with histologically confirmed International Federation of Gynecology and Obstetrics (FIGO) stage III–IV ovarian cancer treated with curative intent between January 2018 and December 2023 at a tertiary referral center. Patients were divided into two groups: those who underwent diagnostic laparoscopy prior to primary treatment ( n = 80) and those managed without laparoscopy ( n = 103). Laparoscopy was selectively employed when operability was uncertain. The primary outcome was the rate of complete macroscopic tumor resection. Secondary endpoints included intraoperative inoperability, neoadjuvant chemotherapy (NACT) rates, and surgical complexity. Statistical analyses included chi-square tests and predictive value calculations. Results: Complete macroscopic resection was achieved in 57.5% of patients in the laparoscopy group compared to 68.0% in the control group. Among FIGO III cases, complete resection was lower in the laparoscopy group (63.0% vs. 77.0%), while rates were similar for FIGO IV (53.8% vs. 54.8%). Diagnostic laparoscopy had a positive predictive value of 59% and was a statistically significant, albeit weak, predictor of operability ( p = 0.003, phi = 0.13). Patients in the laparoscopy group were more frequently triaged to NACT (78.8% vs. 50.5%). Intraoperative inoperability was also higher (29% vs. 14%). Conclusion: Diagnostic laparoscopy influenced treatment strategy by increasing NACT use and reducing non-beneficial surgeries. Though it did not improve overall cytoreduction rates, it enabled personalized treatment planning, especially in patients with ambiguous resectability, thereby potentially lowering surgical morbidity.

Background: Diagnosis and management of ovarian cancer remain complex due to the overlap of symptoms with other malignancies and the variability in preoperative diagnostic approaches. While histological confirmation is crucial, the role of preoperative colonoscopy in improving surgical planning and patient outcomes remains unclear. Objective: This study aims to evaluate the impact of preoperative colonoscopy on surgical outcomes, peri-operative complications and interdisciplinary coordination in ovarian cancer patients. Methods: A retrospective, single-center study was conducted at the University Medical Center Freiburg, including 306 patients diagnosed with malignant ovarian tumors between 2016 and 2023. Patients were stratified into two groups: those who underwent preoperative colonoscopy (n=104) and those who did not (n=202). Tumor characteristics, diagnostic findings, and surgical outcomes were compared. Primary endpoints included the detection of abnormal colonoscopic findings and their correlation with intraoperative interventions. Secondary endpoints assessed the impact of colonoscopy on macroscopic complete resection rates and peri-operative complications. Results: Patients undergoing preoperative colonoscopy exhibited higher rates of advanced tumor stages (FIGO III/IV: 84.5% vs. 47.5%). Abnormal colonoscopic findings were observed in 38.8% of cases, yet colorectal resections were performed in only 53% of these patients. Despite a higher frequency of neoadjuvant chemotherapy in the colonoscopy group (57.3 vs. 33.7%), macroscopic complete resection rates were lower (67.0 vs. 79.2%). Sensitivity and specificity analyses indicated moderate predictive accuracy of colonoscopy for colorectal involvement (67 and 74%, respectively). In advanced ovarian cancer, preoperative colonoscopy influenced colorectal surgery decisions, with higher resection rates but minimal impact on neoadjuvant chemotherapy rates, despite moderate sensitivity and specificity. Conclusion: While preoperative colonoscopy identified colorectal involvement in a subset of ovarian cancer patients, particularly in advanced tumor stages, its impact on surgical decision-making, oncological outcomes, and physicians' choice for neoadjuvant chemotherapy was limited. The findings suggest that intraoperative assessments remain the primary determinant for colorectal interventions. Future prospective studies are warranted to clarify the clinical utility of colonoscopy in preoperative evaluation and its potential influence on interdisciplinary surgical strategies. Retrospectively registered study: 24-1364-S1-retro