INTRODUCTION

The conventional teaching of laparoscopic surgery in academic centers in the apprentice/mentor model is highly subjective. The Gynecological Endoscopic Surgical Education and Assessment is a well-structured education program proposed by the European Society for Gynaecological Endoscopy (ESGE). This program uses the Laparoscopic Skills Training and Testing (LASTT) kit, an objective, validated, and measurable test to evaluate an individual’s competence level in basic laparoscopic psychomotor skills. The LASTT kit may be used to assess the basic laparoscopic psychomotor skills of Filipino doctors, guide surgical training recruitment, and improve the local minimally invasive surgery curriculum.

The study will describe the implementation of the LASTT kit in evaluating the psychomotor skills of Filipino physicians in training and assess the feasibility and user acceptance of the kit.

A descriptive cross-sectional research design was used. A total of 34 trainees (19 medical interns and 15 surgical residents) were included. All trainees underwent the LASTT test to have the baseline data for comparison of each cohort. A posttest questionnaire for the feasibility and user acceptance of the kit was accomplished.

A majority of participants were right-handed, and female, with 0–30 laparoscopic assists. The mean age of surgical residents was higher than medical interns. Surgical residents showed a significantly shorter time to accomplish the exercises than medical interns. Finally, it showed that the kit was clear and understandable, easy to use, and represented a realistic model of the actual laparoscopic surgery.

The surgical residents were superior to medical interns in laparoscopic psychomotor skills, which supports that hands-on training and exposure to procedures improve skill proficiency. Furthermore, the LASTT kit was well accepted and would greatly aid in recruitment and skills training in the Philippines.

With the alarmingly increasing prevalence of obesity in the Western world, it has become necessary to provide more acceptable treatment options for patients with obesity. Minimally invasive endoscopic techniques are continuously evolving. Currently, metabolic and bariatric endoscopies encompass several different techniques that can offer significant weight loss and improvement in comorbidities with a favorable safety profile. Restrictive bariatric procedures include the use of intragastric balloons and gastric remodeling techniques with different suturing devices. Several studies have demonstrated the efficacy and safety of these techniques that are widely used in clinical practice. Small intestine-targeted metabolic endoscopy is an intriguing and rapidly evolving field of research, although it is not widespread in routine practice. These techniques include duodenal-jejunal bypass liners, duodenal mucosal resurfacing, and incisionless anastomoses. The aim of this review article is to provide a detailed update on the currently available bariatric endoscopy techniques in Western countries.

Objective: To evaluate pre-operative predictors of early (<30 days) severe complications (grade Dindo 3+) in patients with gynecological malignancy submitted to pelvic exenteration (PE). Methods: We retrospectively analyzed 129 patients submitted to surgery at Fondazione Policlinico Gemelli between 2010 and 2019. We included patients affected by primary or recurrent/persistent cervical, endometrial, or vulvar/vaginal cancers. Post-operative complications were graded according to the Dindo classification. Logistic regression was used to analyze potential predictors of complications. Results: We performed 63 anterior PE, 10 posterior PE, and 56 total PE. The incidence of early severe post-operative complications was 27.9% (n=36), and the early mortality rate was 2.3% (n=3). More frequent complications were related to the urinary diversion and intestinal surgery. In univariable analysis, hemoglobin ≤10 g/dL (odds ratio [OR]=4.2; 95% confidence interval [CI]=1.65–10.7; p=0.003), low albumin levels (OR=3.9; 95% CI=1.27–12.11; p=0.025), diabetes (OR=4.15; 95% CI=1.22–14.1; p=0.022), 2+ comorbidities at presentation (OR=5.18;95% CI=1.49–17.93; p=0.012) were predictors of early severe complications. In multivariable analysis, only low hemoglobin and comorbidities at presentation were independent predictors of complications. Conclusion Pelvic exenteration is an aggressive surgery characterized by a high rate of postoperative complications. Pre-operative assessment of comorbidities and patient health status are crucial to better select the right candidate for this type of surgery.

With the alarmingly increasing prevalence of obesity in the Western world, it has become necessary to provide more acceptable treatment options for patients with obesity. Minimally invasive endoscopic techniques are continuously evolving. Currently, metabolic and bariatric endoscopies encompass several different techniques that can offer significant weight loss and improvement in comorbidities with a favorable safety profile. Restrictive bariatric procedures include the use of intragastric balloons and gastric remodeling techniques with different suturing devices. Several studies have demonstrated the efficacy and safety of these techniques that are widely used in clinical practice. Small intestine-targeted metabolic endoscopy is an intriguing and rapidly evolving field of research, although it is not widespread in routine practice. These techniques include duodenal-jejunal bypass liners, duodenal mucosal resurfacing, and incisionless anastomoses. The aim of this review article is to provide a detailed update on the currently available bariatric endoscopy techniques in Western countries.

Objective: To evaluate pre-operative predictors of early (<30 days) severe complications (grade Dindo 3+) in patients with gynecological malignancy submitted to pelvic exenteration (PE). Methods: We retrospectively analyzed 129 patients submitted to surgery at Fondazione Policlinico Gemelli between 2010 and 2019. We included patients affected by primary or recurrent/persistent cervical, endometrial, or vulvar/vaginal cancers. Post-operative complications were graded according to the Dindo classification. Logistic regression was used to analyze potential predictors of complications. Results: We performed 63 anterior PE, 10 posterior PE, and 56 total PE. The incidence of early severe post-operative complications was 27.9% (n=36), and the early mortality rate was 2.3% (n=3). More frequent complications were related to the urinary diversion and intestinal surgery. In univariable analysis, hemoglobin ≤10 g/dL (odds ratio [OR]=4.2; 95% confidence interval [CI]=1.65–10.7; p=0.003), low albumin levels (OR=3.9; 95% CI=1.27–12.11; p=0.025), diabetes (OR=4.15; 95% CI=1.22–14.1; p=0.022), 2+ comorbidities at presentation (OR=5.18;95% CI=1.49–17.93; p=0.012) were predictors of early severe complications. In multivariable analysis, only low hemoglobin and comorbidities at presentation were independent predictors of complications. Conclusion Pelvic exenteration is an aggressive surgery characterized by a high rate of postoperative complications. Pre-operative assessment of comorbidities and patient health status are crucial to better select the right candidate for this type of surgery.

With the alarmingly increasing prevalence of obesity in the Western world, it has become necessary to provide more acceptable treatment options for patients with obesity. Minimally invasive endoscopic techniques are continuously evolving. Currently, metabolic and bariatric endoscopies encompass several different techniques that can offer significant weight loss and improvement in comorbidities with a favorable safety profile. Restrictive bariatric procedures include the use of intragastric balloons and gastric remodeling techniques with different suturing devices. Several studies have demonstrated the efficacy and safety of these techniques that are widely used in clinical practice. Small intestine-targeted metabolic endoscopy is an intriguing and rapidly evolving field of research, although it is not widespread in routine practice. These techniques include duodenal-jejunal bypass liners, duodenal mucosal resurfacing, and incisionless anastomoses. The aim of this review article is to provide a detailed update on the currently available bariatric endoscopy techniques in Western countries.

Objective: To evaluate pre-operative predictors of early (<30 days) severe complications (grade Dindo 3+) in patients with gynecological malignancy submitted to pelvic exenteration (PE). Methods: We retrospectively analyzed 129 patients submitted to surgery at Fondazione Policlinico Gemelli between 2010 and 2019. We included patients affected by primary or recurrent/persistent cervical, endometrial, or vulvar/vaginal cancers. Post-operative complications were graded according to the Dindo classification. Logistic regression was used to analyze potential predictors of complications. Results: We performed 63 anterior PE, 10 posterior PE, and 56 total PE. The incidence of early severe post-operative complications was 27.9% (n=36), and the early mortality rate was 2.3% (n=3). More frequent complications were related to the urinary diversion and intestinal surgery. In univariable analysis, hemoglobin ≤10 g/dL (odds ratio [OR]=4.2; 95% confidence interval [CI]=1.65–10.7; p=0.003), low albumin levels (OR=3.9; 95% CI=1.27–12.11; p=0.025), diabetes (OR=4.15; 95% CI=1.22–14.1; p=0.022), 2+ comorbidities at presentation (OR=5.18;95% CI=1.49–17.93; p=0.012) were predictors of early severe complications. In multivariable analysis, only low hemoglobin and comorbidities at presentation were independent predictors of complications. Conclusion Pelvic exenteration is an aggressive surgery characterized by a high rate of postoperative complications. Pre-operative assessment of comorbidities and patient health status are crucial to better select the right candidate for this type of surgery.

Perimesencephalic subarachnoid hemorrhage (P-SAH) is a benign subset of subarachnoid hemorrhage. Only two cases of P-SAH during pregnancy have been reported in the literature. We describe a case of P-SAH detected at 29 weeks’ gestation, arose with severe bilateral frontal headache, neck rigidity, and vomiting. A diagnosis of P-SAH was confirmed on magnetic resonance angiography with no evidence of vascular malformation or bleeding sources and conservatively treated. Hemorrhage, vasospasm, and cerebellar edema observed on initial magnetic resonance angiography resolved after two months. The clinical course of P-SAH during pregnancy appears to be favorable. Our case shows for the first time in literature that magnetic resonance angiography is a valid diagnostic test for P-SAH during pregnancy that circumvents radiological risk associated with conventional imaging.

Perimesencephalic subarachnoid hemorrhage (P-SAH) is a benign subset of subarachnoid hemorrhage. Only two cases of P-SAH during pregnancy have been reported in the literature. We describe a case of P-SAH detected at 29 weeks’ gestation, arose with severe bilateral frontal headache, neck rigidity, and vomiting. A diagnosis of P-SAH was confirmed on magnetic resonance angiography with no evidence of vascular malformation or bleeding sources and conservatively treated. Hemorrhage, vasospasm, and cerebellar edema observed on initial magnetic resonance angiography resolved after two months. The clinical course of P-SAH during pregnancy appears to be favorable. Our case shows for the first time in literature that magnetic resonance angiography is a valid diagnostic test for P-SAH during pregnancy that circumvents radiological risk associated with conventional imaging.

Immunotherapy is an effective treatment option for gynecological malignancies. Radiologists dealing with gynecological patients undergoing treatment with immune checkpoint inhibitors should be aware of unconventional immune-related imaging features for the evaluation of tumor response and immune-related adverse events. In this paper, immune checkpoint inhibitors used for gynecological malignancies and their mechanisms of action are briefly presented. In the second part, patterns of pseudoprogression are illustrated, and different forms of immune-related adverse events are discussed.