All patients with the International Federation of Gynecology and Obstetrics (FIGO) stage IIIC-IV ovarian cancer who had VPD and RSR were included in the study. Non-conclusive evidence can be extrapolated regarding the efficacy of surgery in improving the likelihood of pregnancy in the infertile population. This site needs JavaScript to work properly. ; Bongers, M.Y. However, we ignore if the lack of improvement of PR and preterm delivery rate after surgery could be related to a real inefficiency of the treatment or to the inconsistency of the trials currently available in the literature (high heterogeneity, poor number of high-quality studies). In case of a newly diagnosed uterine septum in patients seeking pregnancy without a prior history of reproductive failure, any advantages from septum removal cannot be established due to a lack of clinical scientific data. WebCorrespondence to Roberto Tozzi, Department of Gynaecologic Oncology, Oxford Cancer Centre, Churchill Hospital, Oxford University Hospital, Old Road, Oxford OX3 7LJ, UK. WebOxford Gynaecological Cancer Centre Lead Clinician - Mr Roberto Tozzi. Patients with: Rokitansky syndrome, hypoplastic, arcuate, bicornuate, didelphis, unicornuate uterus. Author to whom correspondence should be addressed. https://doi.org/10.3390/jcm11123290, Noventa, Marco, Giulia Spagnol, Matteo Marchetti, Carlo Saccardi, Giulio Bonaldo, Antonio Simone Lagan, Francesco Cavallin, Alessandra Andrisani, Guido Ambrosini, Salvatore Giovanni Vitale, Luis Alonso Pacheco, Sergio Haimovich, Attilio Di Spiezio Sardo, Jose Carugno, Marco Scioscia, Simone Garzon, Stefano Bettocchi, Giovanni Buzzaccarini, Roberto Tozzi, and Amerigo Vitagliano. Int Urogynecol J. Septum resection may be effective in increasing the live birth rate and reducing the risk of spontaneous abortion in women with poor reproductive histories. Jayaprakasan, K.; Chan, Y.Y. Join Facebook to connect with Roberto Tozzi and others you may know. Indeed, Pang et al., one of the few prospective studies, demonstrated that women with a history of recurrent spontaneous abortion who underwent hysteroscopic metroplasty had higher rates of pregnancy and full-term delivery, and lower rates of spontaneous abortion and preterm delivery than women without metroplasty [, Recently, the first multicentric randomized trial on this topic was published (TRUSTThe Randomised Uterine Septum Trial) [, First, we must reassure the patients that office based hysteroscopic septum resection without cervical dilatation could be considered a safe procedure that can be performed without anesthesia or with local anesthesia, with a low rate of only minor complications. He has a special interest in developing new surgical techniques in ultra The ESHRE/ESGE consensus on the classification of female genital tract congenital anomalies. On the one hand, several observational studies reported an association between the uterine septum and obstetrical complications including recurrent spontaneous abortions (both in the first and second trimester), preterm delivery, intrauterine growth restriction (IUGR) and placental abruption [, According to recent studies, the uterine septum may impair the embryo implantation and development through both molecular and mechanical mechanisms. He is a BSCCP accredited colposcopist and trainer, as well as a member of the British Gynaecological Cancer Society (BGCS). Odds ratios (OR) with 95% confidence intervals (CI) were calculated for the outcome measures. Reproductive performance of women with uterine anomalies after abdominal or hysteroscopic metroplasty or no surgical treatment. Higgins, J.P.T. The surgery is mainly practised in cancer centres by board-certified gynaecologists, and requires a 2-3 year period of additional training in gynaecological oncology. "Oxford University" is a registered trade mark of the University of Oxford, and is used with the University's permission. Roberto Tozzi, Giorgio Fachechi, Kumar Gubbala, Yang, J.; Yin, T.L. Hysteroscopic septum resection of complete septate uterus with cervical duplication, sparing the double cervix in patients with recurrent spontaneous abortions or infertility. Transcervical resection (TCR) or a Jones modified metroplasty. Rigid hysteroscopy with operating channel into which an optic fiber can be inserted, connected with a Nd-YAG laser. 2001;83:286291. Pregnancy Outcomes in Women With a History of Recurrent Early Pregnancy Loss and a Septate Uterus, With and Without Hysteroscopic Metroplasty. 1. ; Acin, M.; Alcazar, J.L. The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, mllerian anomalies and intrauterine adhesions. 8-mm Karl Storzmonopolar operative hysteroscope. The Pediatric Center for Heart Disease, Hackensack, NJ, 07601. Electric section performed in 55 cases (87.3%). WebRoberto Tozzi - Consultant Profile - NHS Roberto Tozzi Male GMC membership number: 6084178 Specialises in: Obstetrics And Gynaecology Obstetrics And Gynaecology Hollett-Caines, J.; Vilos, G.A. Rectosigmoid resection by gynecologic oncologists versus colorectal surgeons: as long as it catches the mouse, does the color of the cat matter? and transmitted securely. Rikken, J.F.W. Grimbizis, G.F.; Gordts, S.; Di Spiezio Sardo, A.; Brucker, S.; De Angelis, C.; Gergolet, M.; Li, T.-C.; Tanos, V.; Brlmann, H.; Gianaroli, L.; et al. The concept of fertility-sparing surgery for women with cervical cancer is now supported by mature data. ; Lin, J.; Chen, X.Z. Noventa, M.; Spagnol, G.; Marchetti, M.; Saccardi, C.; Bonaldo, G.; Lagan, A.S.; Cavallin, F.; Andrisani, A.; Ambrosini, G.; Vitale, S.G.; Pacheco, L.A.; Haimovich, S.; Di Spiezio Sardo, A.; Carugno, J.; Scioscia, M.; Garzon, S.; Bettocchi, S.; Buzzaccarini, G.; Tozzi, R.; Vitagliano, A. MRI: Magnetic Resonance Imaging. Vercellini, P.; Chiaffarino, F.; Parazzini, F. Its all too much: The shadow of overtreatment looms over hysteroscopic metroplasty for septate uterus. He has worked at consultant level since 1997 and his main research interests are in ovarian and vulval cancers. 2011 Sep;32 Suppl 3:S224-31. Nd-YAG laser with an 8-mm operating hysteroscope. most exciting work published in the various research areas of the journal. TV-US: transvaginal-ultrasound. Please note that many of the page functionalities won't work as expected without javascript enabled. Sendag, F.; Mermer, T.; Yucebilgin, S.; Oztekin, K.; Bilgin, O. ; Jayaprakasan, K.; Tan, A.; Thornton, J.G. Before A literature search of relevant papers was conducted using the electronic bibliographic databases (Medline, Scopus, Embase, Science direct, Cochrane library, Clinicaltrials.gov, Cochrane Central Register of Controlled Trials, EU Clinical Trials Register and World Health Organization International Clinical Trials Registry Platform). Reproductive outcome of septate uterus after hysteroscopic treatment with neodymium:YAG laser. This study was similar with our results, but they only considered treated uterine septum versus untreated septum without evaluating the uterine septum versus controls (no septum) [, In the last section of our meta-analysis, we included all observational non-comparatives studies that reported reproductive outcomes before and after septum removal in the same subset of the population. European Journal of Obstetrics & Gynecology and Reproductive Biology. After visualization of the tubal ostia the resection was started from the lower margin of the septum and continued until the muscular component until a normal cavity was obtained and the hysteroscope could be moved freely from one tubal ostium to the other without any intervening obstruction. Medical Info, Education Study eligibility criteria: we included in this meta-analysis all types of observational studies that evaluated the clinical impact of the uterine septum and its resection (hysteroscopic metroplasty) on reproductive and obstetrics outcomes. Two main classification systems were developed: the ASRM (AFS) classification initially published in 1988, which was subsequently modified in 2016, and the ESHRE-ESGE classification [, Whether the uterine septum increases the risk of reproductive failure is still uncertain. https://doi.org/10.3390/jcm11123290, Noventa M, Spagnol G, Marchetti M, Saccardi C, Bonaldo G, Lagan AS, Cavallin F, Andrisani A, Ambrosini G, Vitale SG, Pacheco LA, Haimovich S, Di Spiezio Sardo A, Carugno J, Scioscia M, Garzon S, Bettocchi S, Buzzaccarini G, Tozzi R, Vitagliano A. Disclaimer. Clipboard, Search History, and several other advanced features are temporarily unavailable. An official website of the United States government. Rikken, J.; Leeuwis-Fedorovich, N.E. Groups were comparable for all pre-operative features other than: albumin (1<2) hemoglobin (2<1) and up-front surgery (1>2). In conclusion, there is broad consensus on the importance of TVUS and the need for further investigation based on risk factors of EC.Keywords: transvaginal ultrasound, endometrial thickness, postmenopausal bleeding, tamoxifen, hormone-replacement therapy. Please be aware, if you are requesting a diagnostic scan such as an MRI, or CT, you must have a referral from a relevant clinician or Allied Health professional such as a physiotherapist. Duval, S.J. Unit of Gynecology and Obstetrics, Department of Women and Childrens Health, University of Padua, 35100 Padua, Italy, Unit of Gynecology Oncology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialities (PROMISE), University of Palermo, 90127 Palermo, Italy, Independent Researcher, 36020 Solagna, Italy, Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, 95124 Catania, Italy, Endoscopy Unit, Centro Gutenberg, 29003 Mlaga, Spain, Hillel Yaffe Medical Center, Technion-Israel Technology Institute, Hadera 38100, Israel, Department of Public Health, School of Medicine, University of Naples Federico II, 80138 Naples, Italy, Minimally Invasive Gynecology Unit, Obstetrics, Gynecology and Reproductive Sciences Department, Miller School of Medicine, University of Miami, Miami, FL 33136, USA, Unit of Gynecology, Mater Dei Hospital, 70125 Bari, Italy, Department of Obstetrics and Gynaecology, AOUI Verona, University of Verona, 37126 Verona, Italy, Inter-Departmental Project Unit of Minimal-Invasive Gynecological Surgery, Policlinico of Bari, University of Bari Aldo Moro, 70121 Bari, Italy. A higher proportion of SA was associated with septate uterus vs. controls (OR 2.69, 95% CI 1.11 to 6.52; In two studies, SA was not different in women with subseptate uterus vs. controls (OR 2.24, 95% CI 0.51 to 9.83; In one study, SA was not different in women with complete septate uterus vs. subseptate uterus (OR 1.04, 95% CI 0.29 to 3.67; In three studies with medium/high quality, SA was not different in women with septate uterus vs. controls (OR 0.79, 95% CI 0.21 to 2.92; Preterm labor was investigated in three studies [. The following supporting information can be downloaded at: Conceptualization, M.N. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. document.getElementById("ak_js_2").setAttribute("value",(new Date()).getTime()); Consultant Gynaecologist / Urogynaecologist, Gynaecologist, Menopause & HRT (BMS accredited specialist). Sources of heterogeneity were explored by meta-regression analysis according to the features of the included studies: assisted reproductive technology/spontaneous conception, study design (prospective/retrospective) and quality of papers included (low/medium/high). Disclaimer. R Tozzi. The Gynaecological Oncology MDT includes these core members. Homer, H.A. ; Verhorstert, K.W.J. 12: 3290. When we analyzed the SA rate in patient with history of infertility versus recurrent miscarriage, it seems that the detrimental effect of the septum is slightly higher in the population of infertile patients than in those with recurrent abortions (OR 7.56 vs 2.29, respectively). Surgical and survival outcomes of primary vs. interval surgery. Select; 2. Review. ; investigation, A.A. and S.G.V. Ramaseshan AS, Felton J, Roque D, Rao G, Shipper AG, Sanses TVD. Find Roberto Tozzi's email address, contact information, LinkedIn, Twitter, other social media and more. Author links open overlay panel Roberto Tozzi a Tomaevi, T.; Ban-Frange, H.; Virant-Klun, I.; Verdenik, I.; Polep, B.; Vrtanik-Bokal, E. Septate, subseptate and arcuate uterus decrease pregnancy and live birth rates in IVF/ICSI. ; Berlin, J.A. Higgins, J.P.T. Clinical Nurse Specialists (CNS) are senior nurses who work as core members of our team. Outcome definitions: Pregnancy rate (PRdefined as the presence of a gestational sac on transvaginal ultrasound; Live birth rate (LBRdefined as the delivery of one or more living and viable infants). 2016 Mar;140(3):430-5. doi: 10.1016/j.ygyno.2015.12.004. Soleymani Majd H, Ferrari F, Gubbala K, Campanile RG, Tozzi R. Curr Opin Obstet Gynecol. Valle, R.F. Analyzing the nine papers that compared treated versus untreated uterine septum, we found that hysteroscopic metroplasty could significantly improve LBR on general analysis. In two studies reporting data from infertile patients, preterm labor was not different after vs. before the removal of the uterine septum (OR 11.61, 95% CI 0.05 to 2702.21; In three studies reporting data from recurrent miscarriages, preterm labor was lower after vs. before the removal of the uterine septum (OR 0.03, 95% CI 0.01 to 0.09; In two studies with medium/high quality, preterm labor was lower after vs. before the removal of the uterine septum (OR 0.03, 95% CI 0.02 to 0.08; Excluding data from three abstracts, preterm labor was lower after vs. before the removal of the uterine septum (OR 0.04, 95% CI 0.02 to 0.08; Considering the nine papers of the section Treated uterine septum versus controls (untreated septum) a total of eleven complications were reported (, Considering the nineteen papers of the section Before and after septum removal a total of 30 complications were reported (, The septate uterus represents a clinical dilemma for the physician who is treating the patient affected with this enigmatic congenital uterine anomaly. 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