[Different radical surgical treatment of cervical cancer based on the histopathological characteristics of the tumour]. / A méhnyakrák különbözo radikalitású mutéti kezelése a daganat hisztopatológiai jellemzoi alapján.

The surgical treatment of cervical tumours is a complex problem that often puzzles the gynaecological surgeon. The operation was previously named after Ernst Wertheim, who performed the first radical hysterectomy more than a century ago, and has since undergone many modifications. Today, almost 50% of patients are diagnosed at an early stage, when the disease is still localised to the cervix, with a 5-year survival rate of more than 90%. Surgical treatment is the first-line treatment for this group of patients, which offers a good solution in terms of long-term quality of life through ovarian preservation and surgical technique. In the majority of cases where fertility preservation is not an option, radical removal of the uterus and removal of lymph nodes is the basis for surgery. For both interventions, there have been many changes in the last decades and a detailed description of these changes and treatment planning is the main aim of this study.

Surgical Trends and Time Frame Comparison of Surgical Types of Hysterectomy: A Nationwide, Population-based 15-year Study.

STUDY OBJECTIVE: To investigate the surgical trends among different types of hysterectomy (abdominal, vaginal, laparoscopic, and subtotal) over a 15-year period in Taiwan. DESIGN: A retrospective cohort study. SETTING: A population-based National Health Insurance Research Database. PATIENTS: Women undergoing various types of hysterectomy for noncancerous lesions. INTERVENTIONS: Data for this study were extracted from the inpatient expenditures by admissions files of Taiwan's National Health Insurance Research Database from 1998 through 2012 and divided into three 5-year time frames: first (1998-2002), second (2003-2007), and third (2008-2012). The variables included types of hysterectomy, patient age, gynecologist age and sex, hospital accreditation level, and surgical volume. Chi-square and trend tests were used to examine the association between the variables. MEASUREMENTS AND MAIN RESULTS: A total of 329 438 patients who underwent various types of hysterectomy were identified; 306 257 were included in the study. During the 15-year period, 45% underwent total abdominal hysterectomy, 41% underwent laparoscopic hysterectomy (LH), 9.8% underwent vaginal hysterectomy, and 4.2% underwent subtotal abdominal hysterectomy. The frequency of LHs increased from 35.9% in the first period to 43.9% in the second period and remained at 44.2% in the third period. During the same time period, there was a decrease in the frequency of total abdominal hysterectomies. Typically, younger patients underwent LHs by gynecologists with large volume surgical practices and medical centers. CONCLUSION: This 15-year study describes an increase of LHs and subtotal abdominal hysterectomies over time and provides evidence of surgical trends and a paradigm shift of hysterectomies. Surgical skills and performance extended from high- to low-surgical volume gynecologists and from medical centers to regional and local hospitals. This shift may have a great influence on patient and health care provider choice of treatment.

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 on methods of contained tissue morcellation, both laparoscopically and vaginally. SUMMARY: Minimally invasive surgical techniques have revolutionized gynecology, drastically reducing the need for open procedures. To maximize patient safety while preserving the rapid recovery and low morbidity of laparoscopic and vaginal approaches, optimal methods of tissue extraction need to be developed and promulgated.

The Wertheim hysterectomy: Development, modifications, and impact in the present day.

Ernst Wertheim was a pioneer in the history of the surgical treatment of cervical cancer. His English-language manuscript "The extended abdominal operation for carcinoma uteri (based on 500 operative cases)," which was published in 1912, detailed his standardization of the radical hysterectomy and formed the basis of the current treatment for early stage cervical cancer. We contextualize the Wertheim hysterectomy, emphasizing medical advances that allowed for its development and subsequent modification. We then discuss modifications to the originally proposed procedure, including a maximally extended parametrical resection pioneered by Takayama, and the addition of the Taussig en bloc lymph node dissection by Meigs, both of which afforded an improved mortality profile due to decreased disease recurrence. Finally, we discuss progress that has been made in the present day, such as the development of nerve-sparing and fertility-sparing surgeries, as well as the introduction of the robotic platform. In this way, we hope to provide a historical background for the Wertheim hysterectomy-a cornerstone of gynecologic oncology.

Obstetricians' and Gynecologists' Opinion on Surrogacy in Japan: The Successful Use of Human In Vitro Fertilization in 1983.

This study confirmed opinions on surrogacy conducted by obstetricians who were affiliated with a university in the 1980s, based on the clue that a child was born using human in vitro fertilization (IVF) in 1983. This research also examined the question of why Japanese obstetricians limited the target population for IVF to legally married couples and excluded women (wives) who had undergone total hysterectomies. The women's movement has criticized the gender discrimination that occurred in IVF. Obstetricians had predicted the advancement of human IVF, and that it would raise legal and ethical issues regarding this form of surrogacy. Around this time, there was a lawsuit known as the Fujimi Obstetrics and Gynecology Hospital Case, which exposed the realities of performing a total hysterectomy after an unjustified diagnosis. It was believed that obstetricians had obstructed the normal sequence of events in which a patient selects surrogacy after undergoing a hysterectomy.

Types of radical hysterectomies : From Thoma Ionescu and Wertheim to present day.

The treatment for cervical cancer is a complex, multidisciplinary issue, which applies according to the stage of the disease. The surgical elective treatment of cervical cancer is represented by the radical abdominal hysterectomy. In time, many surgeons perfected this surgical technique; the ones who stood up for this idea were Thoma Ionescu and Ernst Wertheim. There are many varieties of radical hysterectomies performed by using the abdominal method and some of them through vaginal and mixed way. Each method employed has advantages and disadvantages. At present, there are three classifications of radical hysterectomies which are used for the simplification of the surgical protocols: Piver-Rutledge-Smith classification which is the oldest, GCG-EORTC classification and Querlow and Morrow classification. The last is the most evolved and recent classification; its techniques can be adapted for conservative operations and for different types of surgical approaches: abdominal, vaginal, laparoscopic or robotic.

[When Marie Bonaparte turned a deaf ear]. / Als Marie Bonaparte sich taub stellte....

Between 1927 and 1931 Marie Bonaparte had herself operated upon her clitoris three times. She did so against Freud's advice with whom she was in analysis. Among psychoanalysts these operations are still often regarded as "errors" or aberrations. But for Marie Bonaparte, who was in various ways familiar with physics and a somatic approach, surgery was the first choice, psychoanalysis only a possible alternative. She was not impressed by the scepticism of her colleagues, and adhered even more emphatically to her own strategy.

The great surgeon Jean-Louis Faure (1863-1944) and his contribution in the treatment of uterine cancer.

At the beginning of the 20th century, Professor Jean-Louis Faure, one of the leading surgeons of the innovative Parisian Medical School, published an exhaustive work on uterine cancer. He was the first to perform in France the procedure of total abdominal hysterectomy by median section of the uterus contributing to the evolution of cancer surgery.

[Laparoscopic hysterectomy--brief history, frequency, indications and contraindications].

Hysterectomy is the most common gynecological operation after Caesarean section and the laparoscopic access to uterus removal is one of the contemporary methods showing slow but steady growth in time. In reference to indications and contraindications for laparoscopic hysterectomy, the following directions emerge as controversial: malignant gynecological tumors, uterus size, and high body mass index. Laparoscopic hysterectomy can be taken into consideration at the first stage of endometrial, cervical and ovarian cancer. If there is doubt about an uterus sarcoma and a laparoscopic access is accomplished, a conversion to abdominal hysterectomy must be done. Obesity and big uteri are not a contrarindication for that minimally-invasive access. Today, laparoscopic hysterectomy is a reasonable alternative to total abdominal and vaginal hysterectomy.

History of caesarean hysterectomy.

Caesarean hysterectomy evolved as a life-saving procedure following caesarean delivery. The concept underlying caesarean hysterectomy dates back to the mid 1700s and with a description of the procedure performed on laboratory animals. Eduardo Porro of Milan performed the first planned caesarean hysterectomy in which both the infant and the mother survived. He documented his operation in a paper published in 1876. Porro advocated hysterectomy combined with caesarean section to control post partum haemorrhage and to prevent infection. The maternal death rate following the operation remained high, but was substantly below the rate prior to the introduction of the procedure. The Porro procedure contributed to more favourable outcome for both the mother and the infant, having sterility and premature menopause as its side effects. Fortunately, the need for the procedure was soon minimised following the proposal to close the uterine incision with sutures. Although elective caesarean hysterectomy is still a controversial issue, there is no doubt that emergency post partum hysterectomy in case of massive obstetric haemorrhage is potentially life-saving. Over the past decades, the availability of potent uterotonics and broad-spectrum antibiotics, the development of embolisation techniques, and new methods of vessel ligation, have markedly reduced the need for caesarean hysterectomy, which, however, remains an important procedure in modern obstetric practice.

Advances in surgical care.

The numerous advances in the surgical care of gynecologic oncology patients are allowing clinicians to offer improved quality of life while maintaining excellent cancer outcomes. Advances in technology and disease understanding will only enhance our surgical abilities beyond what can be imagined today. Surgeons have a responsibility to evaluate new technology critically and incorporate the technology into patient care safely and efficiently.

"Because of their praiseworthy modesty, they consult too late": regime of hope and cancer of the womb, 1800-1910.

The birth of the "do not delay" principle in cancer treatment has often been linked with developments in late nineteenth century: the rise of histology and cellular theory of malignancy that favored the definition of cancer as a local pathology, then the development of radical surgical techniques that transformed malignant tumors into a potentially curable condition. This text seeks to nuance this view. It points out important continuities in the understanding of the natural history of uterine cancers. At its center, the wish, already present in early nineteenth century, is to detect "early," that is, small and localized malignant lesions, then to extirpate or destroy these lesions before they become fully blown cancer. The long history of this particular regime of hope helps demonstrate why it is so difficult today to promote more nuanced views of the efficacy of early detection of malignant tumors.

The history of radical hysterectomy.

Carcinoma of the uterine cervix provides one of the few examples in medical history of a method of treatment that was once discarded by most of the medical profession and was later reclaimed. In addition, radical hysterectomy (RH) competed with radical vaginal hysterectomy during the early history of RH. The primitive form of RH was first described by Clark and Reis in 1895. Radical hysterectomy was then described in detail and performed by Wertheim, more than 100 years ago. Afterward, RH was abandoned for the treatment of carcinomas because of the use of radiotherapy; however, RH was then modified and repopularized by Meigs in the 1950s. The surgical principles of this operation have undergone only minor modifications throughout the years and remained the basis of the surgical approach used by gynecologic oncologists today. The history of the treatment of cervical carcinoma and the history of RH are unique in medicine. Because of the efforts of the surgeons and scientists, cervical carcinoma has become rarer, and its mortality rate has decreased, although it is still common in undeveloped countries. The history of the treatment of cervical carcinoma includes 3 Nobel Prize winners and 1 Nobel Prize nominee. We therefore think that knowledge of the historical development of this filed will inspire and contribute to the education of future generations. In this article, the historical development of the surgical treatment of cervical carcinoma, the contributors to this surgical procedure, and the pioneers of the surgical and medical treatment of cervical carcinoma are summarized; pictures and illustrations are also provided. Our aim was to inform the gynecologic oncology community about the pioneers that devoted their professional lives to develop of these techniques.

Hysterectomy throughout history.

Hysterectomy, which is one of the most common surgeries performed on women, dates back to ancient times. The history of hysterectomy comprises biographies of many humble men and the significant individual efforts that they made to fight the skepticism of the medical communities of their times. Many of the pioneers were ignored. Although there are a number of alternatives to hysterectomy available, it remains one of the most frequently performed gynaecological operations. The introduction of antisepsis, anaesthesia, antibiotics and blood transfusion made hysterectomy a safe procedure. Nowadays, we distinguish three different surgical approaches to hysterectomy: vaginal, abdominal and laparoscopic. The limitations of conventional laparoscopy have led to the development of robotic surgery, which has evolved over the past decade from simple adjustable arms to support cameras in laparoscopic surgery to more sophisticated four-armed machines now being in use worldwide.

História de vidas de mulheres submetidas à histerectomia / Life histories of women undergoing hysterectomy / Historia de vida de las mujeres sometidas a histerectomía

Trata-se de uma pesquisa de abordagem qualitativa de natureza descritiva, desenvolvida na Fábrica deCuidados, localizada na Escola de Enfermagem Alfredo Pinto, e no setor de ambulatório de ginecologia do Hospital Universitário Gafrée e Guinle no período de abril a julho de 2009. Foram entrevistadas 30 mulheres submetidas à histerectomia.O objetivo era conhecer o significado da histerectomia para as mulheres e a sua repercussão na sua saúde sexual e reprodutiva. Para isso, foi utilizada uma entrevista do método história de vida com uma única questão (aberta): “Fale-me sobre a sua vida e a interferência da histerectomia com relação àsaúde sexual”. A análise dos depoimentos foi fundamentada na análise temática. As descobertas da pesquisaderam origem a duas categorias: 1) A saúde sexual, o cotidiano e a qualidade de vida das mulheres que vivemcom hemorragias uterinas; 2) Mitos e verdades relacionados à histerectomia e à interferência na saúde sexual. As mulheres descreveram o procedimento como mutilador, mas, apesar disso, viram a histerectomia comopositiva para a saúde sexual. Elas revelaram otimismo, esperando que após a realização da histerectomia sua qualidade de vida melhorasse, pois estariam livres dos sintomas que as incomodavam, e assim poderiam retomar suas vidas desempenhando regularmente seus papéis sexuais e sociais.

This research has a qualitative approach and a descriptive nature. It was carried out at the “Fábrica de Cuidados”(a care center), that is at the Nursing School Alfredo Pinto and also in the gynecology outpatient clinic ofUniversity Hospital and Gafrée Guinle from April to July 2009. We interviewed 30 women who had beensubmitted to hysterectomy. The goal was to learn about the meanings of hysterectomy and interference in theirsexual health. For this, we used an interview method of life history with a single question: How did hysterectomy change your history of life, and interfered on your sexual health? The analysis of the statements was based onthematic analysis. Research findings led to two categories: 1) Sexual health, daily life, and quality of life ofwomen living with uterine bleeding, 2) Myths and truths related to hysterectomy and sexual health interference.Women described the procedure of hysterectomy as mutilating but at the same time they saw the procedure positive for their sexual health, they were optimist hoping that after the hysterectomy their quality of life couldimprove, because they would be free of symptoms that bothered them, and they could resume their lives, theirsexual and social roles.

Se trata de una investigación de abordaje cualitativo de carácter descriptivo, desarrollada en la Fábrica de Cuidados, ubicada en la Escuela de Enfermería Alfredo Pinto, en el departamento de ginecología del HospitalUniversitario Gafrée Guinle en el período de abril a julio de 2009. Fueron entrevistados 30 mujeres que sesometieron a una histerectomía. El objetivo era conocer el significado de la histerectomía para las mujeres y surepercusión en su salud sexual y reproductiva. Para ello, fue utilizada una entrevista del método historia de vidacon un único tema: “Hábleme sobre su vida y la interferencia de la histerectomía con relación a la salud sexual”.El análisis de las declaraciones fue fundamentada en el análisis temático. Los resultados de la investigación handado lugar a dos categorías: 1) La salud sexual, la vida cotidiana y la calidad de vida de las mujeres que vivencon hemorragia uterina; 2) Mitos y verdades acerca de la intervención de la histerectomía e interferencias en lasalud sexual. Las mujeres describieron el procedimiento de la histerectomía como mutilador, sin embargo vieronel procedimiento como positivo para la salud sexual. Ellas revelaron optimismo, esperando que después de larealización de la histerectomía su calidad de vida mejorase, porque estarían libres de los síntomas molestos, yde esta manera podrían retomar sus vidas desempañando regularmente sus roles sexuales y sociales de nuevo.

[150 years since the birth of Thomas Ionescu (1860-1926)]. / Thoma Ionescu (1860-1926): 150 de ani de la mastere.

One of the most important surgeons of the 1900 period was the Romanian-born Thomas Jonnesco. He became a surgeon in Paris (1885-1890) under the guidance of D.M. Bourneville and J. Peyrot (Bicatre), P. Berger (Tenon), A. Le Dentu (St. Louis) and A. Verneuil (Pitié-Salpétrire). In 1894, he gained at the Paris Faculty of Medicine the title of professor of anatomy. In the same year he was selected by the professors Poirier, Charpy and Nicolas to be their collaborator in a treatise of anatomy, published in 1894. In 1895, he returned to Bucharest to lead the Institute of Topographic Anatomy and Experimental Surgery, especially created for him. He also accepted the Chair of the Clinical Surgery of Coltzea Hospital in Bucharest. In 1896 he founded in Paris the French periodical "Archives des Sciences Medicales'". Jonnesco was a prolific surgeon in the field of experimental surgery, especially cervical sympathectomy, general spinal anaesthesia but also in surgical oncology and genito-urinary field. He also drew clinical correlations on surgical techniques of gastrectomy for cancer, on total abdominal genital ablation as treatment for septic conditions of the uterus and the adnexa or on the large abdominal hysterectomy with complete ilio-lumbo-pelvic lymph node dissection in uterine cancer, which refined Wertheim's hysterectomy method. Thomas Jonnesco is now considered the founder of the modem Romanian school of