History and Perspectives of Hyperradical, Laterally Extended Parametrectomy (LEP).

Cervical cancer has been and still is a major global health problem and a major treatment challenge for which surgical interventions have played a key role throughout the past century. In early stages (I/A2-II/B), where high-risk factors are not present, the efficacy of surgical and radiotherapy treatment has been considered equivalent with different (treatment modality specific) complications and quality of life consequences. Negative prognostic factors in early stages of the disease (pelvic lymph-node positivity) and in more advanced stages (parametrial and/or surgical margins' tumor involvement) forecast the deterioration of outlooks for good life expectancy.

[The need, potential and unresolved issues of fertility preservation in the early stages of cervical cancer].

In the choice of a planned fertility preservation procedure for stage IA1 and IB1 cervical cancer, optimal oncological safety is the main focus of virtually all protocols. The surgeon should remove the appropriate proportion of the cervix for oncological safety, ensuring an adequate tumour-free surgical margin. However, some of the literature on fertility preservation, referring to histological parameters, still considers conisation with excellent fertility results to be optimal for the treatment of tumours with a diameter of 2 cm.

Laterally extended parametrectomy.

Objective: To describe the laterally extended parametrectomy (LEP) surgical technique, emphasizing the main challenges of the procedure.

Methods: LEP was designed as a more radical surgical procedure aiming to remove the entire parametrial tissue from the pelvic sidewall. Its initial indications were for lymph node positive Stage Ib (current International Federation of Gynecology and Obstetrics 2018 Stage IIIc) and Stage IIb cervical cancer.

Use of abdominal radical trachelectomy to treat cervical cancer greater than 2 cm in diameter.

Objective: Invasive cervical cancer is one of the most common cancers, with 500,000 new cases diagnosed annually. Fertility preservation has become an important component of the overall quality of life of many cancer survivors. Expert opinion has suggested that fertility-sparing surgery should be limited to those patients diagnosed with cervical cancer less than 2 cm in diameter.

Surgical treatment of stage IB cervical cancer.

Introduction: Recurrence originating from the pelvic lymph node containing fibro-fatty tissue has consistently been identified as the most frequent pattern of treatment failure in early-stage cervical cancer. A surgical technique for the complete removal of the connective tissue content of the pelvis was introduced at St. Stephen Hospital in 1993 to improve oncological outcome by reducing the risk of recurrence from the pelvis.

Immunology of uterine transplantation: a review.

The idea of using organ transplantation to solve quality-of-life issues was first introduced a century ago, with cornea transplants and thrusted before the world again in 1998, following a controversial hand transplant. Uterus transplantation (UTn) has been proposed as another quality-of-life transplant for the cure of permanent uterine factor infertility. In order to proceed in humans, a greater appreciation of the immunological mechanisms that underlie UTn is desirable.

Surgical treatment of lymph node metastases in stage IB cervical cancer. The laterally extended parametrectomy (LEP) procedure: experience with a 5 year follow-up.

Introduction: In 2003, we published our preliminary experience with the use of an operative technique (laterally extended parametrectomy, the LEP procedure) without adjuvant therapy, in the treatment of 29 stage IB, cervical cancer patients with pelvic lymph node metastases. In our present paper, by an extended recruiting period, with a completed 5 year follow up, we studied the outcome of LEP operations, used with the same indications.

Methods: In 70 out of 106 LEP-Wertheim operated patients, no adjuvant treatment was used.

Rescue radical trachelectomy for preservation of fertility in benign disease.

Objectives: To report a series of patients treated with modified radical abdominal trachelectomy to preserve fertility in benign disease that would normally result in hysterectomy.

Design: We reviewed all cases of radical abdominal trachelectomy performed for nonneoplastic indications.

Patient(s): Of the >160 radical abdominal trachelectomies we performed, four cases were performed for benign indications.

Gynecologic cancers in pregnancy: guidelines of an international consensus meeting.

Background: Gynecologic cancer during pregnancy is a special challenge because cancer or its treatment may affect not only the pregnant women in general but directly involve the reproductive tract and fetus. Currently, there are no guidelines on how to deal with this special coincidence.

Methods: An international consensus meeting on staging and treatment of gynecological malignancies during pregnancy was organised including a systematic literature search, and interpretation followed by a physical meeting of all participants with intensive discussion.

Cold ischaemic preservation of human uterine tissue.

Uterine transplantation may be a possible treatment option in the future for absolute uterine infertility. The tolerance of human uterine tissue to cold ischemic preservation is one of the issues that need to be resolved. The objective of this study was to assess the morphological changes in human uterine tissue after cold ischemic preservation in a transplant solution.

Primary pelvic exenteration in cervical cancer patients.

Despite the reports of a number of leading institutions concerning the use of primary exenteration, there are differences in regard to definition, indications, and interpretation of results of this treatment approach to cervical cancer. In this paper we present our own experience with 41 cervical cancer patients treated with primary exenteration at St. Stephen Hospital Budapest.

Human uterus retrieval from a multi-organ donor.

Objective: To determine if a uterus can be retrieved for reproductive organ transplantation and to describe the surgical technique.

Methods: We participated in a local organ donor network retrieval team for over 6 months. Heart-beating, brain-dead multi-organ donors were identified through an existing donor network following routine protocols.

Abdominal radical trachelectomy during pregnancy to preserve pregnancy and fertility.

Background: For 10,000-40,000 women each year, cervical cancer complicates pregnancy. Current therapy usually terminates the pregnancy and results in the loss of future fertility. Abdominal radical trachelectomy is a fertility-preserving alternative to radical hysterectomy for young women with cervical cancer.

Pulse oximetry and perfusion index measurement to assess uterine perfusion and viability.

This study was designed to establish if pulse oximetry (O2Sat) and perfusion index (PI) could be used to assess the contribution that uterine and ovarian vessels make to the overall perfusion of the uterus. During routine hysterectomies, the O2Sat and PI were measured over the right and left uterine cornu. These measurements were taken before any vessels were ligated (baseline), after only the ovarian vessels were clamped and then after the uterine vessels were clamped.

Pelvic vascular prospects for uterine transplantation.

While developing the technique of abdominal radical trachelectomy for conservative cervical cancer management, the vascular supply of the uterus was thoroughly examined. This was a prelude to study the possibility of uterine transplantation where initial concerns were about how uterine artery anastomosis might be achieved and the subsequent function of these vessels in pregnancy. In experiment 1, the uterine arteries in two sows were divided and reanastomosed.

Is it feasible to use a large vessel patch with a uterine allograft en bloc for uterine transplantation?

Uterine auto-transplantation in the porcine model using a microvascular anastomotic technique failed because of gradual vessel thromboses. A macrovascular patch harvest with the uterus en bloc is probably less likely to undergo vessel thrombosis. The objective of this study was to assess the feasibility of an aortic/inferior vena caval vascular patch harvest with the uterus en bloc for uterine cross-transplantation purposes.

Possibilities for fertility restoration: a new surgical technique.

Previously published work concluded that uterine artery microvascular anastomosis in the porcine model was feasible with subsequent normal vascular function in pregnancy. of the anastomosed vessels. The objective of this study was to assess the feasibility of uterine autotransplantation in a porcine model using microvascular anastomoses.

Complications after fertility-preserving radical trachelectomy.

Objective: We report a case of cervical cancer treated by radical trachelectomy complicated by pelvic inflammatory disease, tubo-ovarian complex, and infertility.

Design: Case report.

Setting: Tertiary referral university hospital.

Abdominal radical trachelectomy: a fertility-preserving option for women with early cervical cancer.

Abdominal radical trachelectomy is a fertility-preserving alternative to radical hysterectomy or chemoradiation for young women with stage IA2 to IB cervical cancers. Thirty-three patients were offered this procedure. The mean age was 30.

Laterally extended parametrectomy (LEP), the technique for radical pelvic side wall dissection: Feasibility, technique and results.

A new surgical method was introduced for the treatment of Ib lymph node positive and IIb cervical cancer patients. The lateral resection plane corresponds to the true pelvic side wall, the plane represented by the internal obturator muscle, the linea arcuata, and the piriformis muscle with the convergent branches of the sacral plexus. The LEP procedure overcomes the limitations of the standard class III-IV radical hysterectomy, which leaves in situ the gluteal superior, inferior and pudendal nodes, thus improving local control and survival.