Andrea Giannini

• MD
• Associate Professor at University of Pisa

Background: The objective in epithelial ovarian cancer is to reach maximal cytoreduction with no visible residual tumor. Tumor detection during cytoreductive surgery depends on visual inspection, palpation, or blind biopsy, methods that lack reliability for identifying microscopic disease. Although the importance of microscopic disease in epithelia...

Introduction: Mature cystic teratomas (MCTs) are the most common neoplasm of the ovary, occurring in 10-20% of women during their lifetimes. MCTs may rarely undergo malignant transformation, of which squamous cell carcinoma is the most common histopathology. This rare malignancy is poorly understood; therefore, medical and surgical treatment have...

Background/Objectives: Our objective was to describe the use of intraoperative radiation therapy (IORT) for the treatment of recurrent/persistent cervical or endometrial cancer and assess predictors of postoperative complications and 3-year mortality. Methods: In this multi-site retrospective study, data were abstracted for recurrent/persistent end...

Endometriosis is a common estrogen-dependent inflammatory disease with a chronic course and a tendency to recur. The association between endometriosis and cancer has been studied for several years. Numerous reports have demonstrated a strong association between specific ovarian malignancies and endometriotic lesions. Atypical endometriosis has been...

Background and objective Pelvic organ prolapse (POP) affects 40% of women, with a 12%–19% lifetime surgical risk. Italy showed high practice variation in POP surgery, possibly impacting equity of access to healthcare services, a central goal of Beveridge-like health systems. According to the literature, unwarranted variation, influenced by physicia...

Introduction and hypothesis Lateral suspension is an abdominal prosthetic surgical procedure used to correct apical prolapse. The procedure involves the placement of a T-shaped mesh on the anterior vaginal wall and on the isthmus or uterine cervix that is suspended laterally and posteriorly to the abdominal wall. Since its description in the late 9...

Women experiencing menopausal symptoms usually undergo estrogen plus progestogen therapy. Most of them experience bleeding abnormalities, one of the most common side effects during hormonal therapy, requiring primary-care settings to exclude severe pathologies. This chapter aims to quantify the incidence of abnormal bleeding in women receiving meno...

The primary use of sex steroid hormones is due to their contraceptive effect. However, they may be exploited for therapeutic purposes in different clinical conditions with satisfying extra-contraceptive benefits. Therapeutic effects can be achieved by ovulation inhibition, antiestrogenic, antiandrogenic, and progestin effects reducing not only side...

Abnormal uterine bleeding (AUB) can depend on various causes, and there are various risk factors, which mostly depend on the woman’s age. In the reproductive years, abnormal uterine bleeding may result from pregnancy, miscarriage, ectopic pregnancy, hormonal disorders, cervical or endometrial polyps, or, more rarely, endometrial hyperplasias and ev...

Uterine fibroids (also referred to as leiomyomas or myomas) represent the most common pelvic neoplasm in women. Incidence is difficult to determine since there are few longitudinal studies. They are noncancerous monoclonal tumors arising from the smooth muscle cells and fibroblasts of the myometrium. The pathogenesis of leiomyomas is not well under...

Endometriosis is characterized by the growth of endometrial-like tissue outside the uterus, and it is associated with alterations in the expression of hormone receptors and inflammation. Estetrol (E4) is a weak estrogen that recently has been approved for contraception. We evaluated the effect of E4 on the growth of endometriotic-like lesions and t...

Menopause marks the end of menstrual cyclicity and, depending on individual vulnerability, has several consequences related to gonadal steroid deprivation, especially if it is premature. Menopause may be more burdensome for some women than for others. Individual factors, such as personal history, socioeconomic status, ethnicity, and current health...

The debate about contraception has become increasingly important as more and more people seek safe and effective contraception. More than 1 billion women of reproductive age worldwide need a method of family planning, and wellbeing, socio-economic status, culture, religion and more influence the reasons why a woman may ask for contraception. Differ...

Objective The scope of this work is to evaluate an operative protocol for emergency C-section to improve teamwork and reduce surgical setup time. Methods Sixty-six health care operators working together in the delivery ward (gynecologists, midwives, anesthesiologists) simulated an emergency scenario applying a “five actions for each operator” proto...

Menopause generally occurs at around 51 years of age, in European population. Nowadays, the postmenopausal period includes a third of a woman’s lifetime, considering the life expectancy of women in developed nations. The reducing sex steroid hormones is a critical consequence of normal aging and loss in gonadal function, and it could affect hormone...

The clinical relevance of amenorrhea associated with contraception and postpartum period is still a matter of debate for researchers in the field of reproductive endocrinology. The contraceptive needs of women in the postpartum period are probably underestimated. It is possible that sexual activity and fertility begin early while, on the other hand...

Background Robotic surgery has gained popularity for the reconstruction of pelvic floor defects. Nonetheless, there is no evidence that robot-assisted reconstructive surgery is either appropriate or superior to standard laparoscopy for the performance of pelvic floor reconstructive procedures or that it is sustainable. The aim of this project was t...

Objective: Overactive bladder (OAB) is a complex and multifactorial syndrome associated with urinary frequency, urgency and incontinence. The menopause-associated hormonal changes play a role in the development of this condition. Vaginal estrogens are effective in improving OAB in postmenopausal women (PMW) with vulvovaginal atrophy (VVA). Ospemif...

Objectives To explore determinants of practice variation in both access, and quality and efficiency of surgical care for pelvic organ prolapse (POP). Design and setting A retrospective cohort study employing administrative health data from the Tuscany region, Italy. Participants All women over 40 years hospitalised for apical/multicompartmental P...

Healthy women carrying pathogenic germline mutations in BRCA1 or BRCA2 genes have an increased risk of breast and ovarian cancer. Prophylactic gynecological surgery includes risk-reducing bilateral salpingo-oophorectomy, which, in selected cases, can be combined with hysterectomy. Prophylactic gynecological surgery is recommended after completion o...

Objective To evaluate an operative protocol for emergency cesarean section to improve teamwork and reduce surgical setup time. Methods sixty-six health care operators working together in the delivery ward (gynecologists, midwives, anesthesiologists) simulated an emergency scenario applying a “five actions for each operator” protocol. For each simu...

Objective The Italian healthcare jurisdiction promotes patient mobility, which is a major determinant of practice variation, thus being related to the equity of access to health services. We aimed to explore how travel times, waiting times, and other efficiency- and quality-related hospital attributes influenced the hospital choice of women needing...

The aim of this study was to investigate the factors in feasibility and safety of same-day dismissal (SDD) of endometrial cancer patients undergoing robotic hysterectomy and staging. A single-institution retrospective chart review of endometrial cancer patients who underwent robotic hysterectomy and staging between 2012 and 2021 was performed. Pati...

Study objective: To investigate the feasibility and predictive factors for same day discharge (SDD) following robotic hysterectomy (RH) for benign indications to optimize patient selection by incorporating pre-, intra-, and postoperative variables. Design: A single-center retrospective cohort study SETTINGS: : Tertiary Academic Hospital. Patien...

Depressive disorders and anxiety states represent one of the most frequent psychiatric pathologies occurring transiently in vulnerable women throughout their life, from puberty to menopause. It is now known that sex hormones play a key role on the nervous system, interfering with neuronal plasticity and enhancing the processes of learning, memory,...

Introduction/Background Women carrying a mutation in BRCA 1 or BRCA 2 genes face complex decisions regarding strategies for managing their increased breast and gynecologic cancer risk. Prophylactic mastectomy in high genetic risk of female cancers could severely affect body esteem decreasing sexual satisfaction. Risk-reducing bilateral salpingo-oop...

Objectives: To investigate factors determining the feasibility and safety of same-day dismissal (SDD) of patients after robotic hysterectomy and associated lymph node procedures for endometrial cancer. Methods: A single-institution retrospective chart review was performed of patients with pathologic diagnosis of endometrial cancer who underwent rob...

Background: The application of carbon dioxide (CO2) laser for laparoscopic gynecologic surgery was introduced in 1979 and spread after improving instrumentation, due to the versatility of the CO2 laser technology and the parallel increase of laparoscopic use. In a gynecologic setting, laser laparoscopy has been demonstrated to be effective in trea...

Augmented Reality (AR) can avoid some of the drawbacks of Minimally Invasive Surgery and may provide opportunities for developing innovative tools to assist surgeons. In laparoscopic surgery, the achievement of easy and sufficiently accurate registration is an open challenge. This is particularly true in procedures, such as laparoscopic abdominal S...

involvement occurred in 40% of patients with tumors localized in the pelvic cavity and 70% of cases with extrapelvic metastasis. Many gynecology oncology surgeons believe that invasive diaphragmatic disease is the most challenging disease localization to be wholly eradicated, second only to portal triad disease. The knowledge of diaphragm anatomy,...

Context Fetal Autonomic Nervous sysTem Evaluation (FANTE) is a non-invasive tool that evaluates the autonomic nervous system activity in a fetus. Autonomic nervous system maturation and development during prenatal life are pivotal for the survival and neuropsychiatric development of the baby. Objective Aim of the study is to evaluate the effect of...

In 12 to 21% of women, the diagnosis of epithelial ovarian cancer is at the advanced stage, and patient survival is negatively correlated with residual disease diameter in many series and meta-analyses. This evidence emphasizes the role of maximal cytoreduction in this particular oncologic population. In patients with disrupted pelvic anatomical co...

Introduction and hypothesisSeveral technical alternatives to repair mesh using laparoscopic sacrocolpopexy exist. We aim to describe the outcomes and surgical technique of robotic-assisted colpo-/cervicosacropexy using a standardized suturing scheme to repair the mesh.Methods We retrospectively reported data of 60 consecutive cases of robotic-assis...

The definition of health given by the World Health Organization is that “Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” Being a man or a woman has a significant impact on health, as a result of both biological and gender-related differences.

Obesity and its related severe consequences have been a major public health problem worldwide. A significant weight gain and intra-abdominal adipose tissue accumulation are observed as women begin the menopausal transition. Nowadays, the change of body weight during menopausal transition represents an important topic of discussion. A number of clin...

Menopause is the permanent cessation of menstrual cycles following the loss of ovarian follicular activity. Quality of life of postmenopausal woman is the result of a series of psychobiological transformations, that see in the reduction of sex hormones and steroids the etiopathogenetic determinant moment. Symptoms of menopause range from somatic si...

BACKGROUND Menopausal symptoms can be very distressing and considerably affect a woman’s personal and social life. It is becoming more and more evident that leaving bothersome symptoms untreated in midlife may lead to altered quality of life, reduced work productivity and, possibly, overall impaired health. Hormone therapy (HT) for the relief of me...

Introduction Endometriosis is characterised by the presence of functional endometrial tissue outside the uterus. Salpinges are a common location of endometriotic implants. Endometriosis located into the broad ligament is a rare event. Case description A 38-year-old infertile woman presented to our attention with moderate left iliac fossa pain afte...

The management of pelvic organ disorders is common and challenging work. Nowadays, midlife women are more active than they were in the past, and the development of pelvic organ prolapse (POP) disrupts quality of life and impairs social and personal activities. The aging process and hormonal changes have a role in influencing the structure and funct...

Since the 1980s, the international literature has reported variations for healthcare services, especially for elective ones. Variations are positive if they reflect patient preferences, while if they do not, they are unwarranted, and thus avoidable. Benign hysterectomy is among the most frequent elective surgical procedures in developed countries,...

Introduction: Menopausal symptoms can be very overwhelming for women. Over the years, many pharmacotherapeutic options have been tested, and others are still being developed. Hormone therapy (HT) is the most efficient therapy for managing vasomotor symptoms and related disturbances. The term HT comprises estrogens and progestogens, androgens, tibol...

Objective evaluation of technical skills of the operators during the obstetrical device application for operative vaginal delivery, named kiwi-cup in a simulation training program. Methods Thirty-five residents in obstetrics and gynecology of the University of Pisa, Italy were recruited and evaluated with an assessment scale on technical skills fr...

We directly compared perioperative outcomes and technical features between previous da Vinci Si and the newer Xi robotic platform during total hysterectomy plus salpingo-oophorectomy with or without lymphadenectomy for early-stage endometrial cancer. We retrospectively analyzed147 patients with histological confirmation of endometrial carcinoma sta...

Background The aim of this study was to evaluate feasibility of Integrated Table Motion (ITM), comparing perioperative outcomes of patients with diagnosed endometrial endometrioid cancer who underwent total robotic hysterectomies and case‐related staging procedures with and without ITM. Methods 5 patients underwent surgery with da Vinci Xi system...

Integrating tactile feedback for lump localization in Robot-assisted Minimally Invasive Surgery (RMIS) represents an open research issue, which is still far to be solved. Main reasons for this are related e.g. to the need for a transparent connection with the teleoperating console, and an intuitive decoding of the delivered information. In this art...

Objective creation of an assessment scale to evaluate technical skills of the operators during the obstetrical device application for operative vaginal delivery, named kiwi-cup Methods 35 residents in obstetrics and gynecology of the University of Pisa, Italy were recruited and evaluated with an assessment scale on technical skills from 0 to 55 poi...

Introduction: The prevalence of urinary incontinence and of other lower urinary tract symptoms increases after the menopause and affects between 38 % and 55 % of women aged over 60 years. While urinary incontinence has a profound impact on quality of life, few affected women seek care. Aim: The aim of this clinical guide is to provide an evidenc...

Background: Functional Hypothalamic Amenorrhea (FHA) is a stress-induced blockade of the reproductive axis. Such impairment is mainly due to altered control of GnRH-induced gonadotropin secretion as well as alterations of other endocrine functions. Methods: Seventeen patients with FHA participated in the study. Basal hormonal profiles and GnRH and...

Pheochromocytoma is a rare catecholamine producing tumor. During pregnancy, this tumor can mimic gestational hypertension, preeclampsia or eclampsia. We present a case of a 38-year-old, multiparous woman admitted at 36 weeks of gestation due to hypertension. After cesarean section, she developed an unexplainable worsening of her hypertension that w...

Background: Maturity of the autonomic nervous system (ANS) is of paramount importance for fetal adaptation to extrauterine life and for early neurological development. Markers of ANS maturity, such as electrophysiological heart rate parameters, are of interest as tools to determine prenatal fetal maturity. The available technology, fetal magnetoca...

Menopause is associated with a rapid increase in fat mass and a redistribution of body fat from the periphery to the abdomen, resulting in a transition from a gynoid to an android pattern of fat distribution. In postmenopausal women, increase in body mass index and proportion of visceral fat are strongly correlated with the development of hypertens...

Background and purpose: Despite the recent increase in research and development of mobile self-care tools, there is still a marked lack of solutions focusing on prevention of the negative health effects of the menopause. Moreover, most of the solutions that do exist are not based on well-founded user models, such as personas, and fail to exploit th...

Objective: We assessed the effect on lower urinary tract symptoms (LUTS) of a supplement containing cranberry, D-mannose and anti-inflammatory molecules in postmenopausal women undergoing surgery for cystocele. Study design: Forty postmenopausal women were randomized 1:1 to an active group receiving the nutritional supplement twice a day for 2 week...

Background: Simulation in laparoscopic surgery is nowadays recognized as a valid instrument for learning and training surgeons in different procedures. However, its role as evaluation test and self-assessment tool to verify basic surgical skills is still under discussion. Methods: Thirty-three residents in obstetrics and gynecology at University...

Over the last twenty years, robotic surgery has become an increasingly important form of surgical intervention. However, it can have complications. Trocar site hernia (TSH), also known as port site hernia (PSH), is an uncommon complication, but in the case of bowel incarceration or strangulation it can cause significant morbidity. The lateral troca...

Objective: The present study analyzed long-term outcomes and complications of laparoscopic lateral suspension (LLS) with mesh to treat apical and anterior pelvic organ prolapse (POP). Study design: A prospective cohort study on 125 patients with vaginal bulge and apical +/- anterior prolapse scheduled for LLS who consecutively underwent LLS betw...

Introduction and hypothesis Robotic abdominal lateral suspension (RALS) is an innovative mini-invasive surgical technique that allows treating apical and anterior prolapse. The safety and efficacy of this strategy have not yet been tested. Methods We completed a prospective case series of 115 RALS to treat apical and anterior prolapse stage III or...

Metabolic syndrome (MetS) has been associated with the endocrine, metabolic, and immunological functions of the adipose tissue. In parallel, obesity is strongly associated with disorder of glucose, lipid metabolism, and insulin resistance, and it is considered a common predisposing factor for elevated risk of several serious health conditions inclu...

Starting from birth, sex hormonal fluctuations mark the various phases of female life leading from puberty to menopause.

Sleep disorders increase in prevalence during the menopausal transition and they constitute a complex phenomenon. Insomnia, the main sleep disorder, can be a primary disorder or it can be secondary to hot flushes (HF), mood disorders, psychosocial factors, medical conditions, and other sleep disturbances, such as obstructive sleep apnoea (OSA) or r...

During menopausal transition, the ovaries are depleted of follicles, oestradiol and inhibin B production falls, and ovulation and menstruation no longer occur. The loss of ovarian sensitivity to follicle-stimulating hormone (FSH) and luteinizing hormone (LH) and the loss of negative feedback of oestradiol and inhibin B on the hypothalamic–pituitary...

The steroidogenic endocrine glands and local synthesis both contribute to the pool of steroids present in the central nervous system and peripheral nervous system. The available clinical and experimental findings support the critical role of neurosteroids during fertile life and reproductive aging and their relationship with endogenous and exogenou...

Introduction and hypothesis: Multi-compartment prolapse correction represents one of the major challenges in pelvic floor surgery. This study aims to evaluate the clinical outcome of robotic assisted lateral suspension (RALS) for the treatment of advanced anterior and apical pelvic organ prolapse (POP). Methods: We completed a prospective cohort s...

Uterine fibromatosis is common in women, with an estimated prevalence of up to 15–50% after 35 years. About 80% of women affected by fibromatosis have symptoms and require medical or surgical treatment. Nowadays, the gold standard for the surgical treatment of uterine fibromatosis is the use of minimally invasive surgery. The surgical skills and im...

ß-endorphin is a neuropeptide involved in several brain functions: its plasma levels are higher in obese women and its release increases after oral glucose tolerance test (OGTT) in normal or obese women. The study included 46 healthy women and evaluated the effect of oral dehydroepiandrosterone [DHEA] (50 mg/day) in early postmenopausal women (50–5...

In multiple pregnancies with threatened premature delivery or preterm premature rupture of membranes (pPROM) of a single sac, prolonging pregnancy after the delivery of the first baby may improve the chances of survival of the second baby. We report the delayed delivery of a second baby in a twin pregnancy with pPROM and very premature delivery of...

Over the past two decades, minimally invasive surgery (MIS) abdominal surgery has increasingly been used to treat pelvic organ prolapse. Besides the several advantages associated with minimal invasiveness, this approach bridged the gap between the benefits of vaginal surgery and the surgical success rates of open abdominal procedures. The most comm...

Pelvic floor dysfunctions are a complex condition in elderly women; pelvic organ prolapse, urinary or fecal incontinence, constipation, pelvic pain, and sexual dysfunction are common problems. The goal of surgical treatment is functional reconstruction with symptom management and repair of anatomic defects. The recent advancements in surgical treat...

Menopause-related symptoms such as hot flushes, night sweats, weight gain, and decreased sexual functioning all have negative impacts on quality of life and affect daily activities such as sleep, work, and leisure activities. During the menopause transition, neurotransmitters, neuropeptides, and neurosteroids undergo important changes as a conseque...

Uterine anomalies result from the failure of complete fusion of the Müllerian ducts during embryogenesis. A unicornuate uterus with a rudimentary horn is the rarest anomaly and results from the failure of one of the Müllerian ducts to develop completely and an incomplete fusion with the contralateral side. Diagnosis and surgical management of a 5-w...

The pelvic floor in women is a complex and highly vulnerable structure. Injuries and functional modifications of this complex due to pregnancy, life events, and aging often lead to pelvic organ prolapse (POP). Following the definition of a joint report by the two leading urogynecological societies [1], POP is defined as “any descent of one or more...

The decline in the reproductive capacity of women in the late fourth to fifth decade of life is accompanied by diverse sequelae, including vasomotor symptoms, an increased risk of osteoporosis, psychogenic disturbance and cardiovascular and cerebrovascular disease. Attempts to ameliorate losses in oestrogen through hormone replacement therapy (HRT)...

Introduction: Surgical treatment of ureteral endometriosis is necessary to relieve urinary symptoms of obstruction and to preserve renal function. Which surgical approach to ureteral endometriosis should be considered the most appropriate is debated, due to the lack of scientific evidence. The aim of the present study is to assess the feasibility a...

Background: Minimally-invasive sacrocolpopexy is the gold standard procedure for advanced apical prolapse. Nonetheless, sacrocolpopexy has potential serious complications leading many surgeons to avoid this excellent surgical procedure. To overcome these limitations, preoperative planning with 3D models of the female pelvis is proposed. The aim of...

Ulipristal acetate (UPA) is a selective progesterone receptor modulator (SPRM) used for emergency contraception and for the medical management of symptomatic uterine fibroids (UF). Treatment with UPA turns in amenorrhea and UF volume reduction. Treatment with UPA is associated with the frequent development of benign, transitory endometrial changes...

Effects of 10 μM Ara-C on ESC proliferation. ESC were treated with E2 10−9, P4 10−8, UPA 10−8, ICI 10−6 M. and MIF 10−5 M and the combinations for 72 h. Proliferation was measured by MTS assay every 24 h. Results are shown as the mean ± SEM of proliferation indexes (PI) of three experiments performed in triplicate. Data were analyzed statistically...

UPA modulates the effects of E2 and P4 on ESC motility, similar to ICI and MIF. Wound Healing micro-inserts assay, was tested with culture–insert 2 well. ESC were treated with UPA, P4, E2, ICI, MIF, and the combinations for 24 h. (A) Representative phase contrast microscopy image taken at 0 and 24 h. (B) Quantitative analysis graph of cell migratio...

Gonadotrophins are mainly known to influence the body through the formation of gonadal steroids. However, receptors for luteinizing hormone (LH) and follicular-stimulating hormone (FSH) are present in a set of extra-gonadal tissues in humans and animals, but their functional relevance is uncertain. In this article, we present experimental evidence...

Background The learning process of physiological mechanisms of childbirth and its management are important elements in the education of medical students. In this study, we verify how the use of a high-fidelity simulator of childbirth improves competence of students in this regard. Methods A total of 132 medical students were recruited for the stud...

Objective: The aim of the present study was to examine feasibility, safety, and efficacy, in the first postmarket case series in gynecologic surgery, using an integrated table motion (ITM) device, which is a new surgical device including a unique operating table that connects wirelessly with the da Vinci® Xi surgical platform. This new feature is e...