Farr R Nezhat

• St. Luke's Hospital (MO, USA)

Background/Objectives: Endometriosis is a chronic gynecological disorder affecting up to 10% of women of reproductive age. The etiology of endometriosis remains unclear; however, there is growing interest in identifying modifiable risk factors, particularly dietary influences. The present study aims to systematically evaluate the association betwee...

Bowel endometriosis is a complex condition predominantly impacting women in their reproductive years, which may lead to chronic pain, gastrointestinal symptoms, and infertility. This review highlights current approaches to the diagnosis and management of bowel endometriosis, emphasizing a multidisciplinary strategy. Diagnostic methods include detai...

Introduction Traditional surgical techniques risk tumor spillage, which can disseminate cancerous cells and worsen patient outcomes. This abstract details the use of a novel robot-assisted contained excision technique in the cytoreductive surgery for a 74-year-old patient with recurrent ovarian carcinosarcoma, highlighting its efficacy in minimizin...

Introduction/Background Laparoscopic surgery has become widely accepted in oncology, but concerns regarding tumor spillage persist. This video article addresses the issue of intraoperative tumor spillage and presents a ‘no-touch’ containment technique to mitigate this risk. Methodology The patient, a 74-year-old female with a history of stage 3A o...

Introduction Mesonephric-like adenocarcinoma (MLA) of the uterine corpus is a rare and distinct gynecological malignancy. MLA has a similar appearance to mesonephric adenocarcinoma of the uterine cervix or vagina, which originates from mesonephric remnants. Despite presenting with symptoms and signs similar to more common types of endometrial carci...

Introduction In this surgical film, we present a robot-assisted upper vaginectomy and partial cystectomy for resection of endometrial cancer recurrence at the vaginal cuff involving the bladder. We highlight the use of indocyanine green dye guidance to avoid ureteral injury and review techniques to prevent fistula formation. Description The patien...

Cesarean scar defect, also known as niche, isthmocele, uteroperitoneal fistula and uterine diverticulum, is a known complication after cesarean delivery. Due to the rising cesarean delivery rates, niche has become more common and can present as irregular bleeding, pelvic pain, infertility, cesarean scar pregnancy and uterine rupture. Treatments for...

In this review, we aim to evaluate the current literature on reproductive and oncologic outcomes after fertility-sparing surgery for early-stage cervical cancer (stage IA1-IB1). This is a systematic review of the existing literature using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist to report on fertilit...

Adnexal masses are a common finding among women. They must be appropriately evaluated in order to determine the course of management. The majority of these masses have a benign etiology. However, it is the smaller percentage of malignant masses that are worrisome and must be ruled out. If misdiagnosed and mismanaged, these adnexal masses could resu...

•Fertility treatment prior to definitive cancer therapy in stage IIB EOC.•Both fertility and oncologic outcomes were successful.•The role of Multidisciplinary team is critical.

Ever since Vincent Knapp published his 1999 article “How old is Endometriosis?” [1], there seems to have been renewed interest in identifying just when endometriosis was discovered as a distinct disease entity.

•Highly suspicious pelvic mass may require preoperative biopsy for diagnosis.•Neoadjuvant imatinib lowers EGIST tumor burden in extensive disease preoperatively.•EGIST resection aims at complete surgical resection and negative margins.•This case was managed with complete surgical resection and adjuvant imatinib.•Prognostic factors in EGIST are size...

Endometriosis is a gynecologic disease that affects over 10% of women of reproductive age causing pelvic pain, dysmenorrhea, and infertility, resulting in significant disability and reduced quality of life. Very recent genetic studies have suggested that endometriosis is a clonal disease in the epithelium and its development is independent of strom...

This review sought to evaluate the current literature on reproductive and oncologic outcomes after fertility-sparing surgery for early stage cervical cancer (stage IA1–IB1) including cold-knife conization/simple trachelectomy, vaginal radical trachelectomy, abdominal radical trachelectomy, and laparoscopic radical trachelectomy with or without robo...

Background: Endometriosis is a widely known benign disease, but 0.5%-1% of cases are associated with malignancy. It has been linked with ovarian neoplasms, particularly endometrioid and clear cell adenocarcinoma histology. Rhabdomyosarcomas are rarely associated with endometriosis. Case: A 35-year-old patient underwent surgical management of end...

Vaginal cuff dehiscence is an infrequent complication of hysterectomy, with the potential for evisceration and additional morbidity. This review aims to describe the incidence, risk factors, preventative measures, and management. Identification of specific risk factors is problematic because many studies either lack comparison groups or are underpo...

Although primary and secondary prevention has dramatically reduced the incidence of cervical cancer, it still remains the seventh most common malignant tumor worldwide and third in female population [1]. Traditionally, early stages of cervical cancer have been treated with radical abdominal hysterectomy and pelvic lymphadenectomy, whereas more adva...

The most common location of extra-genital endometriosis is the bowel. Medical treatment may not provide long-term improvement in patients who are symptomatic, and consequently most of these patients may require surgical intervention. Over the past century, surgeons have continued to debate the optimal surgical approach to treating bowel endometrios...

This article focuses on the anatomy, literature, and our own experiences in an effort to assist in the decision-making process of choosing between an umbilical or vaginal port. Umbilical access is more familiar to general surgeons; it is thicker than the transvaginal entry, and has more nerve endings and sensory innervations. This combination incre...

Background and Objectives The inadvertent dissemination of uterine cancer cells with the power morcellator has received much attention in the press and a warning from the U.S. Food and Drug Administration. Many hospitals prohibit the use of the morcellator in gynecologic surgery. We conducted a survey in an attempt to assess gynecologic surgeons' b...

Background and Objectives: The relationship between leiomyoma and endometriosis is poorly understood. Both contribute to considerable pain and may cause subfertility or infertility in women. We conducted this retrospective study to assess the rate of coexistence of endometriosis in women with symptomatic leiomyoma. The primary outcome measured was...

Laparoscopic myomectomy is an alternative to the abdominal approach, with fewer complications, shorter hospital stay, and less disability [1, 2]. The laparoscopic route for performing myomectomy has been proven feasible in numerous studies. With the advent of better insufflators, light sources, cameras, improvement in suturing instrumentation and t...

To describe our technique for the repair of a cesarean section uterine scar defect following the removal of an ectopic pregnancy from the scar in a patient desiring future pregnancies. Step-by-step explanation of the procedure using video. Uterine scar dehiscence/defect is one of the known complications of multiple cesarean deliveries .It can resul...

Patients' perception of minimally invasive gynecologic surgical procedures affects their decision to undergo such procedures and their expectations after surgery. A questionnaire was distributed to patients referred for minimally invasive gynecologic surgical procedures to assess for perceptions and understanding. A total of 103 patients agreed to...

Endometriosis is a common gynecologic disorder characterized by the presence of ectopic endometrial glands and stroma. Although endometriosis is considered a benign condition, malignant transformation of endometriosis has been reported. We report our findings on the association between endometriosis and different benign neoplastic ovarian histology...

To determine if surgery using ultrasonic energy for dissection results in less adhesion formation than monopolar electrosurgical energy in the late (8 weeks) postoperative period. Injuries were induced in rabbits by using ultrasonic energy on one uterine horn and the adjacent pelvic sidewall and using monopolar energy on the opposite side. Eight we...

Despite advances in medicine, ovarian cancer remains the deadliest of the gynecologic malignancies. Herein, we present the latest information on the pathophysiology of ovarian cancer and its significance for ovarian cancer screening and prevention. A new paradigm for ovarian cancer pathogenesis presupposes two distinct types of ovarian epithelial c...

To determine perioperative outcome differences in patients undergoing robotic-assisted laparoscopic surgery (RALS) versus conventional laparoscopic surgery (CLS) for advanced-stage endometriosis. This retrospective cohort study at a minimally invasive gynecologic surgery center at 2 academically affiliated, urban, nonprofit hospitals included all p...

Uterine leiomyomas affect 20-30 % of women 35 years and older. Extrauterine leiomyomas are rare and present a greater diagnostic challenge. Those unusual growth patterns occur more often in women of reproductive age with a history of hysterectomy or surgery for uterine leiomyomas. They have been reported in the literature in case reports and small...

To determine long-term outcome differences in patients undergoing robotic-assisted compared with conventional laparoscopy for advanced-stage endometriosis. Cases were collected from our prospectively maintained computerized database of robotic-assisted and conventional laparoscopic surgical treatments for endometriosis. Included were all patients t...

INTRODUCTION: To determine outcome differences in patients undergoing robotic-assisted compared with conventional laparoscopy for advanced-stage endometriosis. METHODS: Cases were collected from our prospectively maintained computerized database of robotic-assisted and conventional laparoscopic surgical treatments for endometriosis performed by one...

The objective of this study was to determine incidence and risk factors for bowel injury and postoperative complications in laparoscopy compared with laparotomy in primary gynecologic procedures. Laparoscopy is well known for better visualization, less blood loss, and faster recovery time; however, incidence of bowel injury has not been well docume...

Objective: To show the feasibility and safety of robotic-assisted laparoscopic fertility-sparing surgery for earlystage ovarian cancer in women of reproductive age. Methods and design: The first patient was a 29-year-old para 0 woman with well-differentiated endometrioid adenocarcinoma of the ovary and complex endometrial hyperplasia with marked...

The objectives of this study were to evaluate the current evidence of the association of endometriosis and subsequent carcinoma of the ovary and to contextualize this evidence into daily practice issues. This study is a critical review of observational and in vitro studies. Although the lifetime risk for ovarian cancer is low in general population...

The objective of this study was to examine perioperative outcomes, including complication rates, of conventional laparoscopy (CL) versus robotic-assisted laparoscopy (RALS) in the evaluation and management of early, advanced, and recurrent ovarian, fallopian tube, and peritoneal cancer. This is a retrospective analysis of a prospectively maintained...

This study aims to describe a hybrid laparoscopic and robotic-assisted laparoscopic technique to access all four abdominal quadrants during pelvic procedures. This technique was utilized in the surgical management of select cases that included early, advanced, and recurrent ovarian, fallopian tube, and peritoneal cancer. A retrospective analysis of...

Among American women, the most common cause of death from gynecologic malignancy is ovarian cancer. With the discovery and publicizing of hereditary cancer gene mutations, patients are actively seeking their physician’s advice on how to manage risk. As a cancer prevention measure, risk-reducing surgery has become a popular procedure. Based on studi...

The standard treatment of ovarian cancer includes upfront surgery with intent to accurately diagnose and stage the disease and to perform maximal cytoreduction, followed by chemotherapy in most cases. Surgical staging of ovarian cancer traditionally has included exploratory laparotomy with peritoneal washings, hysterectomy, salpingo-oophorectomy, o...

Abstract Proper development of each component of the reproductive tract is imperative for successful natural reproduction. The aim was to investigate some morphological features of the fetal uterus in early phases of its development. The uteruses of 65 fetuses of different gestational age were included and each of them was measured in three dimensi...

Deep infiltrative endometriosis of the rectovaginal septum can be one of the most severe forms of endometriosis.We suggest a novel theory explaining this entity.Endometriosis implants could start either by retrograde menstruation and implant retroperitoneally through a peritoneal defect ,or congenitally through the mullerian remnant of the rectovag...

Recently, we have shown advantages of a direct optical entry (DOE) using a bladeless trocar in comparison with the open Hasson technique (OHT) in older reproductive-age women with previous operations, as well as in comparison with Veress needle entry in reproductive-age and postmenopausal women. A prospective multicenter randomized study to determi...

Laparoscopic surgery has profoundly revolutionized the concept of minimally invasive surgery in the last three decades [1]. Studies have clearly shown that laparoscopy has several advantages compared with laparotomy, including faster postoperative recuperation, shorter hospitalization course, cosmetic benefits, improved intraoperative visualization...

OBJECTIVE: Lymphoceles are among the most common postoperative complications of pelvic lymphadenectomy (PL), with a reported incidence of 1% to 50%. Symptoms are pelvic pain, leg edema, gastrointestinal obstruction, obstructive uropathy, and deep vein thrombosis, and severe complications such as sepsis and lymphatic fistula formation. After lapar...

Objective: Lymphoceles are among the most common postoperative complications of pelvic lymphadenectomy (PL), with a reported incidence of 1% to 50%. Symptoms are pelvic pain, leg edema, gastrointestinal obstruction, obstructive uropathy, and deep vein thrombosis, and severe complications such as sepsis and lymphatic fistula formation. After laparo...

: To compare postoperative pain after conventional laparoscopic and robotically assisted laparoscopic surgery in gynecology. : This is a prospective nonrandomized analysis of patients undergoing conventional laparoscopy or robotically assisted laparoscopy in a university-affiliated hospital between March 2011 and March 2012. Postoperative pain was...

The robotic surgical platform is increasingly used in gynecology and, similar to laparoscopy, it has risks of electrocautery-associated injury. We present three cases of injury caused by failures of the monopolar scissors' insulating sheath while coagulation and cutting currents were set at 35 W. In case 1, an external iliac vein injury required bl...

Objective: The purpose of this review is to evaluate the risk factors for endometrial cancer in young women as well as fertility preservation options. Design: A literature search using the key words fertility preservation, endometrial cancer, uterine cancer, and risk factors was conducted in MEDLINE,® EMBASE, and the Cochrane Database of Systematic...

We performed a search of PUBMED and MEDLINE for articles concerning surgical management of early stage endometrial cancer from 1950 to 2011. From the articles collected we extracted data such as estimated blood loss, operating room time, complications, conversion to laparotomy, and length of hospital stay. Forty-seven relevant sources were analyzed...

The role of lymphadenectomy in the management of endometrial carcinoma remains controversial in gynecologic oncology. Comprehensive pelvic and paraaortic lymphadenectomy should be performed in patients with intermediate- and high-risk endometrial cancer.

Although supracervical hysterectomy is an increasingly popular modality for surgical management of benign uterine conditions data exploring all of its consequences are still forth coming. This case report will discuss the scenario of leiomyoma recurrence at the cervical stump after supracervical hysterectomy. After supracervical hysterectomy, the r...

Obturator nerve injury may occur in gynecologic surgery, particularly in cases in which extensive pelvic sidewall retroperitoneal dissection is performed. The lack of tactile feedback from the robotic surgical system may contribute to obturator nerve injury. If surgical division occurs, microsurgical end-to-end anastomosis of the obturator nerve ma...

To compare the outcomes of total laparoscopic to robotic approach for hysterectomy and all indicated procedures after controlling for surgeon and other confounding factors. Retrospective chart review of all consecutive cases of total laparoscopic and da Vinci robotic hysterectomies between August 2007 and July 2009 by two gynecologic oncology surge...

With the continued expansion of endoscopic techniques and instruments, laparoscopy and minimally invasive techniques are quickly emerging as a feasible alternative to laparotomy in managing adnexal masses and ovarian cancer.Laparoscopy has the potential to completely and successfully treat both benign and malignant adnexal pathology while decreasin...

As cesarean sections become a more common mode of delivery, they have become the most likely cause of vesicouterine fistula formation. The associated pathology with repeat cesarean deliveries may make repair of these fistulas difficult. Computer-enhanced telesurgery, also known as robotic-assisted surgery, offers a 3-dimensional view of the operati...

Research highlights ► Metastatic spread of gynecologic cancers to the adrenal gland is rare. ► We present two cases of metastatic cervical squamous cell carcinoma and endometrial adenocarcinoma. ► Laparoscopic adrenalectomy is appropriate for isolated metastatic disease as demonstrated by our post-operative outcomes.

To focus on the recent adoption, patents, experience, and future of Robotic assisted surgery (RAS) applications in gynecologic surgery, a computer aided and manual search for clinical and systematic reviews, randomized controlled trials, prospective observational studies, retrospective studies and case reports published between 1970 and January of...

To compare the feasibility and safety of the laparoscopic management of adnexal masses appearing preoperatively benign with those suspicious for malignancy. Retrospective study of 694 women that underwent laparoscopic management of an adnexal mass. Laparoscopic management of an adnexal mass was completed in 678 patients. Six hundred and thirty five...

Chylous ascites is an uncommon postoperative complication of gynecological surgery. We report a case of chylous ascites following a robotic lymph node dissection for a cervical carcinoma. A 38-year-old woman with IB2 cervical adenocarcinoma with a palpable 3 cm left external iliac lymph node was taken to the operating room for robotic-assisted lapa...

The aim of this study was to retrospectively compare the safety, morbidity, and recurrence rate of total laparoscopic radical hysterectomy (TLRH) with lymphadenectomy and total robotic radical hysterectomy (RRH) with lymphadenectomy for early cervical carcinoma in a series of 99 consecutive women. We studied 99 consecutive patients with FIGO stage...

To describe our experience with laparoscopic primary or interval tumor debulking in patients with presumed advanced ovarian, fallopian tube, or peritoneal cancers. This is a retrospective analysis of a prospective case series. Women with presumed advanced (FIGO stage IIC or greater) ovarian, fallopian tube, or primary peritoneal cancers deemed appr...

Endometrial sampling for histopathology examination is essential to diagnose endometrial cancer. There are many ways to obtain the specimen including endometrial biopsy or hysteroscopy. Hysteroscopy provides an accurate evaluation of the endometrial cavity and allows directed sampling of suspected lesion. However, there have been concerns that endo...

To describe 3 cases of peritoneal mesothelioma associated with endometriosis that were managed laparoscopically. Case series. University and community hospitals. Three women with well-differentiated papillary mesothelioma of the peritoneum associated with endometriosis. Laparoscopic excision and treatment of mesothelioma and endometriosis. Three pa...

Computer-enhanced telesurgery, called robotic-assisted surgery, is the latest innovation in the minimal invasive surgery field. In gynecology, this machine has been applied in several applications, in the fields of benign gynecology, reproductive medicine, urogynecology, and oncology. The purpose of this paper was to review the published scientific...

Studies on the role of laparoscopy in secondary or tertiary cytoreduction for recurrent ovarian cancer are limited. Our objective is to describe our preliminary experience with laparoscopic secondary/tertiary cytoreduction in patients with recurrent ovarian, fallopian, and primary peritoneal cancers. This is a retrospective analysis of a prospectiv...