The case against endometrial ablation for treatment of heavy menstrual bleeding
Purpose of review Endometrial ablation is a common treatment for heavy menstrual bleeding, but serious limitations and long-term complications exist. Our purpose is to summarize the use of endometrial ablation devices, potential short-term and long-term complications, cost effectiveness, and quality of life in relation to alternative treatments. Recent findings There is insufficient evidence to strongly recommend one endometrial ablation device over another. Providers should consider and discuss with their patients, complications including risk of future pregnancy, endometrial cancer, and hysterectomy for continued bl...
Source: Current Opinion in Obstetrics and Gynecology - July 6, 2018 Category: OBGYN Tags: MINIMALLY INVASIVE GYNECOLOGIC PROCEDURES: Edited by Matthew T. Siedhoff Source Type: research

Alternatives to excisional therapy: a clinical review of our current options to conservatively manage symptomatic leiomyomas
This article provides a clinical review of the alternatives to traditional excisional surgical therapies for uterine leiomyomas, such as myomectomy or hysterectomy. Recent findings In this review, currently available hormonal medications will be briefly discussed. Then, nonhormonal medical therapy will be addressed with respect to mechanism of action, safety, and efficacy. Finally, the risk–benefit profile of nonexcisional procedures for management of leiomyomas will be addressed. Summary This provides an update on the information available for more conservative options for symptomatic leiomyoma management (Sou...
Source: Current Opinion in Obstetrics and Gynecology - July 6, 2018 Category: OBGYN Tags: MINIMALLY INVASIVE GYNECOLOGIC PROCEDURES: Edited by Matthew T. Siedhoff Source Type: research

Adverse events related to Trendelenburg position during laparoscopic surgery: recommendations and review of the literature
Purpose of review Laparoscopy is routinely performed for the treatment and management of gynaecologic disorders. During gynaecologic laparoscopy, the patient is placed in the Trendelenburg position to optimize visualization and access to the pelvis. The Trendelenburg position may result in complications in many organ systems. Recent findings Trendelenburg positioning may cause rare, potentially life-threatening complications of the respiratory and cardiovascular systems. Case reports of visual field loss and cognitive aberrations following Trendelenburg positioning have been published. Few intervention studies have be...
Source: Current Opinion in Obstetrics and Gynecology - July 6, 2018 Category: OBGYN Tags: MINIMALLY INVASIVE GYNECOLOGIC PROCEDURES: Edited by Matthew T. Siedhoff Source Type: research

Minimally invasive gynecologic surgery in the pregnant patient: considerations, techniques, and postoperative management per trimester
Purpose of review Nonobstetric surgery is performed in 1 : 200 to 1 : 500 of pregnant women in the United States annually. Previously, many argued that laparoscopy was contraindicated during pregnancy because of concerns for uterine injury and fetal malperfusion. Because surgeons have gained more experience with laparoscopy, it has become the preferred treatment modality for many surgical diseases in the gravid patient. Recent findings Specific preoperative considerations, intraoperative techniques, and postoperative management per trimester will be reviewed to optimize patient and surgical outcomes. Summary ...
Source: Current Opinion in Obstetrics and Gynecology - July 6, 2018 Category: OBGYN Tags: MINIMALLY INVASIVE GYNECOLOGIC PROCEDURES: Edited by Matthew T. Siedhoff Source Type: research

Into the void: a review of postoperative urinary retention after minimally invasive gynecologic surgery
Purpose of review Postoperative urinary retention (POUR) is a common occurrence after minimally invasive gynecologic surgery (MIGS). This review discusses the definition, incidence, evaluation, diagnosis, and treatment of POUR after MIGS. Recent findings Reported incidence of POUR after MIGS ranges from 0.5 to 21%. Active void trials or awaiting spontaneous void after surgery are both viable options for diagnosing POUR, but active void trials appear to be more accurate, quicker, and preferred by patients. The use of enhanced recovery after surgery pathways and minimizing postoperative opioids can help reduce POUR. Su...
Source: Current Opinion in Obstetrics and Gynecology - July 6, 2018 Category: OBGYN Tags: MINIMALLY INVASIVE GYNECOLOGIC PROCEDURES: Edited by Matthew T. Siedhoff Source Type: research

Preoperative evaluation for gynecologic surgery: a guide to judicious, evidence-based testing
Purpose of review Preoperative testing is a routine component of surgical planning, however, the majority of literature agree that laboratory and diagnostic studies are over utilized. We aim to summarize the available literature and provide gynecologists performing elective surgery for benign indications guidance to determine when, in whom, and in what time frame preoperative studies should be collected. Recent findings Current literature supports previous publications indicating routine laboratory and diagnostic testing for elective surgery is unnecessary and continues to be excessive. The frequency of abnormal resul...
Source: Current Opinion in Obstetrics and Gynecology - July 6, 2018 Category: OBGYN Tags: MINIMALLY INVASIVE GYNECOLOGIC PROCEDURES: Edited by Matthew T. Siedhoff Source Type: research

Hysteroscopic myomectomy: a comparison of techniques and review of current evidence in the management of abnormal uterine bleeding
Purpose of review Submucosal uterine leiomyomas are a common benign pelvic tumor that can cause abnormal uterine bleeding and may contribute to infertility and miscarriage. Hysteroscopic myomectomy is the treatment of choice to alleviate bleeding from these myomas and to normalize the uterine cavity. This review discusses the techniques and recent evidence for hysteroscopic myomectomy and examines the two primary surgical tools employed today: the bipolar resectoscope and hysteroscopic mechanical morcellator. Recent findings Hysteroscopic myomectomy has been a popular treatment for symptomatic submucosal fibroids for ...
Source: Current Opinion in Obstetrics and Gynecology - July 6, 2018 Category: OBGYN Tags: MINIMALLY INVASIVE GYNECOLOGIC PROCEDURES: Edited by Matthew T. Siedhoff Source Type: research

The role of appendectomy at the time of laparoscopic surgery for benign gynecologic conditions
Purpose of review The risk–benefit ratio of concurrent appendectomy at the time of gynecologic surgery has long been debated and remains controversial. However, emerging data on the appendix's role in chronic pain syndromes point to a previously unrecognized link between gynecologic disorders and appendicular pathology. In this article, we review the indications for appendectomy at the time of laparoscopic gynecologic surgery for the treatment of endometriosis and chronic pelvic pain. Recent findings The incidence of appendiceal endometriosis is highly variable depending on the patient population selected. Altho...
Source: Current Opinion in Obstetrics and Gynecology - July 6, 2018 Category: OBGYN Tags: MINIMALLY INVASIVE GYNECOLOGIC PROCEDURES: Edited by Matthew T. Siedhoff Source Type: research

Implantation failure of endometrial origin: what is new?
Purpose of review To review recent findings related to possible causes of recurrent implantation failure of endometrial origin in normal uterus. Recent findings Recent evidences suggest that in apparently normal endometria, RIF may associate with molecular and functional changes in the uterus such as abnormal endometrial microbiota, including the presence of chronic endometritis, poor synchronization between the blastocyst and endometrium, and/or excessive uterine peristalsis. An altered endometrial microbiota detected by molecular techniques has been recently related to poorer embryo implantation, even in apparently ...
Source: Current Opinion in Obstetrics and Gynecology - July 6, 2018 Category: OBGYN Tags: REPRODUCTIVE ENDOCRINOLOGY: Edited by David L. Olive Source Type: research

Endometrioma, fertility, and assisted reproductive treatments: connecting the dots
Purpose of review Surgery has traditionally been the primary treatment option for endometriosis-related infertility of any phenotype. However, advances and refinements of assisted reproductive technologies (ART) permit a more conservative approach in many scenarios. This review summarizes the latest findings in the field of reproductive medicine, which have supported a paradigm shift towards more conservative management of ovarian endometrioma. Recent findings The presence of ovarian endometrioma per se is likely to impair ovarian reserve and alter ovarian functional anatomy. Conventional laparoscopic surgery is assoc...
Source: Current Opinion in Obstetrics and Gynecology - July 6, 2018 Category: OBGYN Tags: REPRODUCTIVE ENDOCRINOLOGY: Edited by David L. Olive Source Type: research

Mitochondrial replacement therapy
Purpose of review The present study briefly reviews the history of mitochondrial replacement therapy (MRT); however, the focus is on recent advancements and future directions of the field. Specifically addressing societal and legal concerns and advances in MRT. Recent findings There continue to be new ethical debates surrounding MRT. In addition, there have been advancements in MRT techniques which could improve potential outcomes. Furthermore, advances in genetics continue to provide alternative approaches to treatment of many diseases, including alternatives to MRT. Summary MRT may be beneficial to eradicate a se...
Source: Current Opinion in Obstetrics and Gynecology - July 6, 2018 Category: OBGYN Tags: REPRODUCTIVE ENDOCRINOLOGY: Edited by David L. Olive Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Obstetrics and Gynecology)
Source: Current Opinion in Obstetrics and Gynecology - July 6, 2018 Category: OBGYN Tags: Editorial Introductions Source Type: research

Therapeutic strategies involving uterine stem cells in reproductive medicine
Purpose of review The current review provides an update on recent advances in stem cell biology relevant to female reproduction. Recent findings Stem cells are undifferentiated cells that often serve as a reservoir of cells to regenerate tissue in settings or injury or cell loss. The endometrium has progenitor stem cells that can replace all of the endometrium during each menstrual cycle. In addition, multipotent endometrial cells replace these progenitor cells when depleted. Recruitment of stem cells from outside of the uterus occurs in setting of increased demand such as ischemia or injury. Bone marrow-derived multi...
Source: Current Opinion in Obstetrics and Gynecology - May 3, 2018 Category: OBGYN Tags: FERTILITY, IVF AND REPRODUCTIVE GENETICS: Edited by Emre Seli and Juan A. García-Velasco Source Type: research

Fertility, IVF and reproductive genetics
Purpose of review Telomere attrition and dysfunction has become a well established pathway involved in organismal aging, not only because it imposes a limitation to cell division and therefore, tissue regeneration but also because telomere homeostasis influences other pathways involved in aging. However, the implication of telomere biology in ovarian aging and fertility is barely starting to be unveiled. Recent findings During the last years, mounting evidence in favor of the relationship between the accumulation of short telomeres and ovarian senescence has emerged. Telomere attrition and the loss of telomerase activ...
Source: Current Opinion in Obstetrics and Gynecology - May 3, 2018 Category: OBGYN Tags: FERTILITY, IVF AND REPRODUCTIVE GENETICS: Edited by Emre Seli and Juan A. García-Velasco Source Type: research

Should we consider telomere length and telomerase activity in male factor infertility?
Purpose of review The purpose of this review is to analyze what is known to date about the relation between telomeres and male fertility, and if it is possible for telomeres, or elements related to them, to be used as new prognostic biomarkers in fertility treatment. Recent findings Cells in germ series, including spermatozoids, have longer telomeres (10–20 kb), and do not seem to undergo the shortening that takes place in somatic cells with age as they present telomerase activity. Longer telomere length found in the sperm of older fathers, influences their offspring possessing cells with longer telomere length....
Source: Current Opinion in Obstetrics and Gynecology - May 3, 2018 Category: OBGYN Tags: FERTILITY, IVF AND REPRODUCTIVE GENETICS: Edited by Emre Seli and Juan A. García-Velasco Source Type: research

Embryo morphokinetic characteristics and euploidy
Purpose of review The purpose of the current review is to provide an update on time-lapse morphokinetic assessment related to embryo ploidy status. Recent findings The main limitation of the available studies regarding correlation between morphokinetic variables and ploidy is that each embryo is considered as an independent unit whereas recent findings show that embryo kinetics may be affected by patient and ovarian stimulation-related factors, so that clustered data analysis is more appropriate. Moreover, some experimental evidences show how embryos with irregular developmental patterns, often used as deselection cri...
Source: Current Opinion in Obstetrics and Gynecology - May 3, 2018 Category: OBGYN Tags: FERTILITY, IVF AND REPRODUCTIVE GENETICS: Edited by Emre Seli and Juan A. García-Velasco Source Type: research

The dilemma of aneuploidy screening on low responders
Purpose of review Preimplantation genetic testing for aneuploidy (PGT-A) has been demonstrated to improve implantation and pregnancy rates and decrease miscarriage rates over standard morphology-based embryo selection. However, there are limited data on its efficacy in patients with diminished ovarian reserve or a poor response to stimulation who may have fewer embryos to select amongst. Recent findings Early findings demonstrate that PGT-A reduces the miscarriage rate and decreases the time to delivery in poor responders. These studies highlight the importance of designing trials that compare outcomes over multiple c...
Source: Current Opinion in Obstetrics and Gynecology - May 3, 2018 Category: OBGYN Tags: FERTILITY, IVF AND REPRODUCTIVE GENETICS: Edited by Emre Seli and Juan A. García-Velasco Source Type: research

Extracellular vesicles: a promising tool for assessment of embryonic competence
Purpose of review Extracellular vesicles have recently emerged as a promising field of research due to their pivotal roles in intercellular communication and potential to serve as biomarkers. This review focuses on extracellular vesicles secreted by the human preimplantation embryo. The most recent findings on embryo-derived extracellular vesicles are described and discussed, as well as current technical challenges to study them. Recent findings So far, only a few studies have addressed extracellular vesicles of embryonic origin and explored their potential as biomarkers for embryo selection. Two main hypotheses have ...
Source: Current Opinion in Obstetrics and Gynecology - May 3, 2018 Category: OBGYN Tags: FERTILITY, IVF AND REPRODUCTIVE GENETICS: Edited by Emre Seli and Juan A. García-Velasco Source Type: research

Metabolism of the oocyte and the preimplantation embryo: implications for assisted reproduction
Purpose of review To discuss the common aspects of energy generation in the cell, substrate utilization by the oocyte and the preimplantation embryos, metabolic characteristics of the reproductive tract, and how metabolic characteristics of an embryo can be exploited to assess viability. Recent findings Utilization of pyruvate, lactate and glucose by the oocyte and the preimplantation embryo seems to be tightly controlled by the most essential molecular regulatory pathways. Summary Accumulating data on the metabolic needs of the preimplantation embryo and the substrate concentrations in the reproductive tract guide...
Source: Current Opinion in Obstetrics and Gynecology - May 3, 2018 Category: OBGYN Tags: FERTILITY, IVF AND REPRODUCTIVE GENETICS: Edited by Emre Seli and Juan A. García-Velasco Source Type: research

What is new in the management of poor ovarian response in IVF?
Purpose of review The management and treatment of patients with poor ovarian response is still a controversial issue in IVF. Increasing evidences demonstrate that the number of oocytes retrieved after a controlled ovarian stimulation (COS) greatly influences the clinical outcome in terms of cumulative live birth per started cycle. For this reason, any COS should aim to optimize the number of oocytes according to the ovarian reserve of the patient. The aim of this review is to provide an overview of new strategies proposed to manage poor responders according to the novel POSEIDON classification. Recent findings Gonadot...
Source: Current Opinion in Obstetrics and Gynecology - May 3, 2018 Category: OBGYN Tags: FERTILITY, IVF AND REPRODUCTIVE GENETICS: Edited by Emre Seli and Juan A. García-Velasco Source Type: research

Is gonadotropin stimulation bad for oocytes?
In conclusion, each fertility clinic setup has its own benefits and gonadotropin hyperstimulation in IVF has to be related to this and the specific patient demographic in the clinic; however, epigenetics and time to pregnancy are still issues open to debate. (Source: Current Opinion in Obstetrics and Gynecology)
Source: Current Opinion in Obstetrics and Gynecology - May 3, 2018 Category: OBGYN Tags: FERTILITY, IVF AND REPRODUCTIVE GENETICS: Edited by Emre Seli and Juan A. García-Velasco Source Type: research

Added value today of hormonal measurements in ovarian stimulation in gonadotropin-releasing hormone antagonist treatment cycle
Purpose of review Traditional approach of ovarian stimulation monitoring for in-vitro fertilization involves transvaginal sonography and serum estradiol measurements. Accumulating evidence has shown that hormonal evaluations during ovarian stimulation allow individual cycle optimization, moving away from only predicting the risk of ovarian hyperstimulation syndrome, but in addition assessing the impact of ovarian stimulation on endometrial receptivity, quality of oocytes, and subsequently embryos. The purpose of this review is to discuss the relevance and added value of hormonal monitoring during ovarian stimulation in g...
Source: Current Opinion in Obstetrics and Gynecology - May 3, 2018 Category: OBGYN Tags: FERTILITY, IVF AND REPRODUCTIVE GENETICS: Edited by Emre Seli and Juan A. García-Velasco Source Type: research

Complexities and potential pitfalls of clinical study design and data analysis in assisted reproduction
Purpose of review The purpose of the current review is to describe the common pitfalls in design and statistical analysis of reproductive medicine studies. It serves to guide both authors and reviewers toward reducing the incidence of spurious statistical results and erroneous conclusions. Recent findings The large amount of data gathered in IVF cycles leads to problems with multiplicity, multicollinearity, and over fitting of regression models. Furthermore, the use of the word ‘trend’ to describe nonsignificant results has increased in recent years. Finally, methods to accurately account for female age in...
Source: Current Opinion in Obstetrics and Gynecology - May 3, 2018 Category: OBGYN Tags: FERTILITY, IVF AND REPRODUCTIVE GENETICS: Edited by Emre Seli and Juan A. García-Velasco Source Type: research

How new technical knowledge impacts clinical approach to infertile patients
No abstract available (Source: Current Opinion in Obstetrics and Gynecology)
Source: Current Opinion in Obstetrics and Gynecology - May 3, 2018 Category: OBGYN Tags: FERTILITY, IVF AND REPRODUCTIVE GENETICS: Edited by Emre Seli and Juan A. García-Velasco Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Obstetrics and Gynecology)
Source: Current Opinion in Obstetrics and Gynecology - May 3, 2018 Category: OBGYN Tags: Editorial Introductions Source Type: research

Evaluation of stillbirth
Purpose of review To review current evidence regarding the most useful tests for evaluation of potential causes of stillbirth. Recent findings Stillbirth remains one of the most devastating obstetric complications. Recent advances include work investigating the highest yield diagnostic tests for determining a cause of death in stillbirths. Placental pathology and fetal autopsy improve the diagnostic yield when combined with maternal clinical history. Additional tools include genetic evaluation, and testing for antiphospholipid antibodies and fetal–maternal hemorrhage based on the clinical scenario. However, rout...
Source: Current Opinion in Obstetrics and Gynecology - March 1, 2018 Category: OBGYN Tags: PRENATAL DIAGNOSIS: Edited by Jane Chueh Source Type: research

Updates in fetal spina bifida repair
Purpose of review To examine updates in fetal spina bifida surgical repair, as well as promising results emerging from translational medicine. Recent findings Although the Management of Myelomeningocele Study sponsored by the National Institutes of Health helped establish the neonatal benefits of prenatal spina bifida repair via uterine hysterotomy, also known as ‘open’ fetal surgery, fetoscopic approaches may yield better maternal and obstetric outcomes. Summary Spina bifida is a severe congenital malformation associated with significant neonatal and childhood morbidity and mortality. Although ‘o...
Source: Current Opinion in Obstetrics and Gynecology - March 1, 2018 Category: OBGYN Tags: PRENATAL DIAGNOSIS: Edited by Jane Chueh Source Type: research

Zika virus: a public health perspective
Purpose of review Zika virus’ impact on pregnancy became widely known in 2015 with a dramatic increase in the number of babies born with microcephaly in Recife, Brazil. A mosquito-borne virus resulting in congenital anomalies is unique, and Zika's ability to cause neurological defects on a large scale was a grim reminder of the Rubella epidemic in the 1950s. Over the past 2 years, studies have provided insight on how Zika virus (ZIKV) infects cells and causes disease, but much remains unknown about the long-term risks of Zika exposure on infant growth and development. Recent findings The impact of ZIKV on pregna...
Source: Current Opinion in Obstetrics and Gynecology - March 1, 2018 Category: OBGYN Tags: PRENATAL DIAGNOSIS: Edited by Jane Chueh Source Type: research

Prenatal transplantation of human amniotic fluid stem cells for spinal muscular atrophy
Purpose of review To review the current medical and stem-cell therapy for spinal muscular atrophy (SMA) and prenatal transplantation of amniotic fluid stem cells in the future. Recent findings SMA is an autosomal recessive inheritance of neurodegenerative disease, which is caused of the mutation in survival motor neuron. The severe-type SMA patients usually die from the respiratory failure within 2 years after birth. Recently, researchers had found that 3-methyladenine could inhibit the autophagy and had the capacity to reduce death of the neurons. The first food and drug administration-approved drug to treat SMA, Nus...
Source: Current Opinion in Obstetrics and Gynecology - March 1, 2018 Category: OBGYN Tags: PRENATAL DIAGNOSIS: Edited by Jane Chueh Source Type: research

Copy number variations and fetal ventriculomegaly
Purpose of review Ventriculomegaly is one of the most common abnormal sonographic findings, which is associated with congenital infection, chromosomal and additional structural abnormalities. Currently, karyotype analysis is the primary method to detect chromosomal abnormalities in fetuses with ventriculomegaly. Recently, with the introduction of chromosomal microarray analysis (CMA) in prenatal diagnosis, copy number variations (CNVs) have been identified in cases of ventriculomegaly. The purpose of this review is to summarize the current knowledge about the genetic cause of fetal ventriculomegaly, with particular atten...
Source: Current Opinion in Obstetrics and Gynecology - March 1, 2018 Category: OBGYN Tags: PRENATAL DIAGNOSIS: Edited by Jane Chueh Source Type: research

Prenatal diagnosis
No abstract available (Source: Current Opinion in Obstetrics and Gynecology)
Source: Current Opinion in Obstetrics and Gynecology - March 1, 2018 Category: OBGYN Tags: PRENATAL DIAGNOSIS: Edited by Jane Chueh Source Type: research

Maternal fetal medicine: recent developments and moving forward
No abstract available (Source: Current Opinion in Obstetrics and Gynecology)
Source: Current Opinion in Obstetrics and Gynecology - March 1, 2018 Category: OBGYN Tags: MATERNAL FETAL MEDICINE: Edited by Deirdre J. Lyell, Martha Rode, and Mark Boddy Source Type: research

30 years of Current Opinion in Obstetrics and Gynecology: looking back and looking forward
No abstract available (Source: Current Opinion in Obstetrics and Gynecology)
Source: Current Opinion in Obstetrics and Gynecology - March 1, 2018 Category: OBGYN Tags: Editorial Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Obstetrics and Gynecology)
Source: Current Opinion in Obstetrics and Gynecology - March 1, 2018 Category: OBGYN Tags: Editorial Introductions Source Type: research

Morcellation in gynecologic oncology
Purpose of review Morcellation of uteri with unsuspected malignancies has been the focus of reports for decades. More intensive evaluation of clinical outcomes and evaluation of impact of changes in practice has occurred since the release of FDA statement advising against the use of power morcellators. The review summarizes some of the most relevant publications on this topic. Recent findings The Society of Gynecologic Oncology and the American College of Obstetricians and Gynecologists concur that symptomatic women should undergo appropriate evaluation, morcellation should not be performed whenever malignancy is susp...
Source: Current Opinion in Obstetrics and Gynecology - January 17, 2018 Category: OBGYN Tags: GYNECOLOGIC MORCELLATION: Edited by David L. Olive Source Type: research

Economics of gynecologic morcellation
Purpose of review As the Food and Drug Administration raised concern over the power morcellator in 2014, the field has seen significant change, with patients and physicians questioning which procedure is safest and most cost-effective. The economic impact of these decisions is poorly understood. Recent findings Multiple new technologies have been developed to allow surgeons to continue to afford patients the many benefits of minimally invasive surgery while minimizing the risks of power morcellation. At the same time, researchers have focused on the true benefits of the power morcellator from a safety and cost perspec...
Source: Current Opinion in Obstetrics and Gynecology - January 17, 2018 Category: OBGYN Tags: GYNECOLOGIC MORCELLATION: Edited by David L. Olive Source Type: research

The prevalence of occult leiomyosarcoma in women undergoing presumed fibroid surgery and outcomes after morcellation
Purpose of review To review the data-derived prevalence rates for occult leiomyosarcoma (LMS), and outcomes for women who have these tumors inadvertently morcellated. Recent findings In 2014, the Food and Drug Administration presented data showing the prevalence rates of occult LMS at 2.02/1000 surgeries for presumed benign fibroids. They also attributed poorer outcomes for women undergoing power morcellation of these tumors. Two more recent meta-analyses have shown much lower rates, as low as one in 8300 surgeries when including only prospective studies, and one in 1428 surgeries when including both prospective and r...
Source: Current Opinion in Obstetrics and Gynecology - January 17, 2018 Category: OBGYN Tags: GYNECOLOGIC MORCELLATION: Edited by David L. Olive Source Type: research

Indications for morcellation in gynecologic surgery
Purpose of review Minimally invasive gynecologic procedures, in particular laparoscopic hysterectomy and myomectomy, often require tissue morcellation. Recent findings Whether morcellated or not, myometrial cells can be found in the abdomen and pelvis after either laparoscopic or open myomectomy. Following morcellation, careful inspection for and removal of tissue fragments and copious irrigation and suctioning of fluid can remove residual tissue and cells without the use of containment bags. The dogma of not ‘cutting-through’ cancer is not correct for many surgical specialties and irrelevant with regards ...
Source: Current Opinion in Obstetrics and Gynecology - January 17, 2018 Category: OBGYN Tags: GYNECOLOGIC MORCELLATION: Edited by David L. Olive Source Type: research

Morcellation equipment: past, present, and future
This article will review the most current research on electronic power morcellation and the multiple attempts to prove superiority from the many different types of equipment, and also the many different approaches to morcellation. In addition, with the adaptation to contained morcellation, this review will cover research focused on optimizing a containment system and the techniques involved. Summary In summary, this review is aimed at describing many of the currently available power morcellation products and contained morcellation systems in an effort to allow physicians to understand the different options available, an...
Source: Current Opinion in Obstetrics and Gynecology - January 17, 2018 Category: OBGYN Tags: GYNECOLOGIC MORCELLATION: Edited by David L. Olive Source Type: research

Development and history of morcellators
Purpose of review Controversy exists surrounding extraction of tissue in gynecologic surgery using morcellators following cases of disseminated uterine cancers discovered after the use of electromechanical morcellators. This chapter traces the history of tissue extraction in gynecology and reviews the evolving scientific data and opinions regarding the future of morcellation. Recent findings Since the initial Food and Drug Administration warning about morcellation in 2014, subsequent studies do not support the Food and Drug Administration's high incidence of occult uterine cancer. Current research continues, focusing ...
Source: Current Opinion in Obstetrics and Gynecology - January 17, 2018 Category: OBGYN Tags: GYNECOLOGIC MORCELLATION: Edited by David L. Olive Source Type: research

Alternative facts and morcellation
Purpose of review Since the recent black-box warning regarding the use of electromechanical morcellation, there has been a hesitancy to utilize the product and even to perform other types of morcellation by gynecologists. Unfortunately, this Food and Drug Administration action and the continued public criticisms of this procedure are grounded in poor data and faulty reasoning. To truly perform informed consent to patients considering procedures involving morcellation, a thorough review of the facts, not alternative facts, must be communicated. Recent findings Misrepresentation of the ethics surrounding this procedure,...
Source: Current Opinion in Obstetrics and Gynecology - January 17, 2018 Category: OBGYN Tags: GYNECOLOGIC MORCELLATION: Edited by David L. Olive Source Type: research

Advances in targeting HER2-positive breast cancer
Purpose of review Breast cancer is the most common malignancy in women and HER2-positive disease comprises about 15% of all breast cancer cases. Over the last few years, substantial advances have been made in treatment of early breast cancer (EBC) and advanced (ABC) HER2-positive (HER2+) breast cancer. The present review summarizes the major publications on HER2+ breast cancer in the year 2017 and discusses their clinical relevance. Recent findings The clinically most relevant data in 2017 relates to the EBC setting. The St. Gallen Consensus 2017 for the first time recommended neoadjuvant treatment as standard of care...
Source: Current Opinion in Obstetrics and Gynecology - January 17, 2018 Category: OBGYN Tags: BREAST CANCER: Edited by Gottfried E. Konecny Source Type: research

Hormone receptor positive breast cancer: state of the art
Purpose of review Hormone receptor (HR) positive breast cancer represents the vast majority of breast cancer cases. Treatment for these patients has been 5 years of endocrine therapy in the localized setting and endocrine therapy alone in the metastatic setting until progression of disease and switch to chemotherapy until quite recently. Recent findings The current article will review recent data on role of extended endocrine therapy with tamoxifen and aromatase inhibitors and adjuvant bisphosphonates in the localized disease setting. It will then review the role of targeted agents such as cyclin dependent kinases 4/6...
Source: Current Opinion in Obstetrics and Gynecology - January 17, 2018 Category: OBGYN Tags: BREAST CANCER: Edited by Gottfried E. Konecny Source Type: research

The target invites a foe: antibody–drug conjugates in gynecologic oncology
Purpose of review Antibody–drug conjugates (ADCs) represent a promising new class of cancer therapeutics. Currently more than 60 ADCs are in clinical development, however, only very few trials focus on gynecologic malignancies. In this review, we summarize the most recent advances in ADC drug development with an emphasis on how this progress relates to patients diagnosed with gynecologic malignancies and breast cancer. Recent findings The cytotoxic payloads of the majority of the ADCs that are currently in clinical trials for gynecologic malignancies or breast cancer are auristatins (MMAE, MMAF), maytansinoids (...
Source: Current Opinion in Obstetrics and Gynecology - January 17, 2018 Category: OBGYN Tags: GYNECOLOGIC ONCOLOGY: Edited by Gottfried E. Konecny Source Type: research

Palliative care in gynecologic oncology
Purpose of review Patients with gynecologic malignancies face many difficult issues in the course of their diseases, ranging from physical symptoms to advance care planning in light of a poor prognosis. This review examines the evidence supporting integration of palliative care early in the course of disease and symptom management, and provides a framework for difficult conversations. Recent findings Palliative care has been demonstrated to improve quality of life and promote survival if integrated early in the course of disease. An evidence-based approach should guide symptom management, such as pain and nausea. Adva...
Source: Current Opinion in Obstetrics and Gynecology - January 17, 2018 Category: OBGYN Tags: GYNECOLOGIC ONCOLOGY: Edited by Gottfried E. Konecny Source Type: research

Cell-based immunotherapy in gynecologic malignancies
Purpose of review To provide an overview of the principles, safety and efficacy of adoptive cell therapy (ACT) in solid tumors particularly in gynecological cancers. Recent findings Efforts to target solid tumors using tumor-infiltrating lymphocytes and genetically modified T cells have shown promising efficacy in some patients. Two food and drug administration approvals for the treatment of leukemia are the first gene therapies available for cancer treatment in the United States. Summary Genetic engineering of antitumor immunity using T cells has the potential to target specific tumor-associated antigens and overc...
Source: Current Opinion in Obstetrics and Gynecology - January 17, 2018 Category: OBGYN Tags: GYNECOLOGIC ONCOLOGY: Edited by Gottfried E. Konecny Source Type: research

Endocrine therapy in ovarian cancer: where do we stand?
Purpose of review Hormonal factors play a pivotal role in epithelial ovarian tumorigenesis and steroid receptor expression has been associated with epithelial ovarian cancer (EOC) response and survival in recent studies. However, the degree of activity of endocrine therapy overall and by specific agents remains unclear. The purpose of this work is to summarize the evidence provided by the recent literature on the effectiveness of endocrine treatment for advanced EOC. Recent findings The results of 53 trials of different endocrine therapies in EOC indicate a clinical benefit of 41% [95% confidence interval (CI), 0.34&n...
Source: Current Opinion in Obstetrics and Gynecology - January 17, 2018 Category: OBGYN Tags: GYNECOLOGIC ONCOLOGY: Edited by Gottfried E. Konecny Source Type: research

Novel poly-ADP-ribose polymerase inhibitor combination strategies in ovarian cancer
Purpose of review The recent United States Food and Drug Administration approvals of niraparib and olaparib as maintenance monotherapy for platinum-sensitive, high-grade ovarian cancers independent of BRCA status reflect a willingness to seek indications for poly-ADP-ribose polymerase (PARP) inhibitors beyond cancers with deleterious breast cancer 1 and breast cancer 2 mutations. In this review, I describe the rationale behind current PARP combination clinical trials with chemotherapies, angiogenesis inhibitors, cell cycle checkpoint inhibitors, and inhibitors of the phosphoinositide 3-kinase/AK thymoma/mechanistic targe...
Source: Current Opinion in Obstetrics and Gynecology - January 17, 2018 Category: OBGYN Tags: GYNECOLOGIC ONCOLOGY: Edited by Gottfried E. Konecny Source Type: research

Frontline therapy of ovarian cancer: trials and tribulations
Purpose of review The current article reviews the advances and challenges in the fight with cancer and the hope for cure, with a focus on clinical trials, at the one time with the best outcomes; first-line therapy. Recent findings To date there have been four great stories that bridge inception to development of new drugs in ovarian cancer: Serendipitous insight into the role of platinum, discovery of taxanes, understanding the microenvironment and angiogenesis, and following the science in the development of Poly (ADP-Ribose) Polymerase (PARP) inhibitors. There is a fundamental difference between overall survival (OS...
Source: Current Opinion in Obstetrics and Gynecology - January 17, 2018 Category: OBGYN Tags: GYNECOLOGIC ONCOLOGY: Edited by Gottfried E. Konecny Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Obstetrics and Gynecology)
Source: Current Opinion in Obstetrics and Gynecology - January 17, 2018 Category: OBGYN Tags: Editorial Introductions Source Type: research