The Soleymani and Collins Obstetric morbidity score (SaCOMS): A quantitative tool for measuring maternal morbidity from complex obstetric surgery such as placenta accreta spectrum (PAS).

It is currently very difficult to compare different management strategies for complex obstetric surgery, such as hysterectomy for severe Placenta Accreta Spectrum (PAS), as there is no widely accepted consensus for the classification of maternal surgical morbidity. Many studies focus on the amount of blood products transfused or admission to intensive care units (ICU). However, these are dependent on local policies and available resources.

Mixed Endometrial Epithelial Carcinoma: Epidemiology, Treatment and Survival Rates-A 10-Year Retrospective Cohort Study from a Single Institution.

Mixed endometrial carcinoma (MEEC) refers to rare endometrial tumours that are composed of two or more distinct histotypes, at least one of which is serous or clear cell. The aim of this study was to evaluate the epidemiology, treatment outcomes and survival rates of patients with mixed endometrial carcinoma. The medical records of 34 patients diagnosed with MEEC between March 2010 and January 2020 were reviewed retrospectively.

Neo-adjuvant chemotherapy does not reduce surgical complexity nor the accuracy of intra-operative visual assessment of disease in advanced ovarian cancer.

Aim: Compare the surgical complexity and histological accuracy of visual inspection of disease in patients undergoing primary debulking (PDS) versus delayed debulking surgery (DDS) following neo-adjuvant chemotherapy (NACT) for advanced ovarian cancer (AOC).

Materials And Methods: All patients undergoing PDS or DDS for stage III / IV AOC at a UK cancer centre between January 2014-October 2021 were included. Retrospective data was collected accessing an electronic gynaecological oncology database, operation and histology records.

The Prognostic Characteristics and Recurrence Patterns of High Grade Endometrioid Endometrial Cancer: A Large Retrospective Analysis of a Tertiary Center.

High grade endometrioid endometrial cancer (HGEEC) is a heterogeneous group of tumors with unclear prognostic features. The aim of the present study is to evaluate the independent risk factors for recurrence and mortality and to describe the recurrence patterns of HGEEC. Ninety-six consecutive cases of HGEEC treated with primary surgery in a single Tertiary Center were retrospectively reviewed.

Combined direct hysteroscopic and real-time ultrasound guidance facilitating safe insertion of intra-uterine brachytherapy applicator for locally advanced cervical cancer with significant endocervical stenosis: A novel collaborative approach.

Locally advanced cervical cancer is treated with combined chemoradiation (CCRT) - with the radiotherapy component comprising delivery of both external beam (EBRT) and intra-uterine brachytherapy (IUBT). Following initial pelvic and tumour irradiation via EBRT, secondary tissue fibrosis can obliterate the vagina and / or endocervical canal. 30-88% of women will develop some degree of stenosis, with complete stenosis reported in up to 11% of patients - making accessing the uterine cavity to insert brachytherapy applicators challenging and high risk (Bran et al.

Bartholin's gland carcinoma-the diagnostic and management challenges of a rare malignancy-a case report and review of current literature.

Background: Bartholin's gland carcinoma (BGC) accounts for approximately 5% of all vulval malignancies-making it an extremely rare malignancy of the female genital tract. It commonly manifests as a painless unilateral mass, near the introitus. BGC more commonly occurs in post-menopausal women.

Does the presence of single compared to multiple endometrial polyps alter the risk of cancer in post-menopausal women?

Objective: To evaluate the relative rates of malignancy in women with single and multiple polyps presenting to a UK Cancer Centre with postmenopausal bleeding (PMB).

Study Design: A retrospective review of patients treated at Royal Derby Hospital (RDH) for PMB who underwent outpatient hysteroscopy based on ultrasonographic suspicion of endometrial polyps between May 2014 to December 2019. The main outcome measure was the rates of precancerous and malignant histology for single or multiple polyps.

Does the character of the hospital of primary management influence outcomes in patients treated for presumed early stage endometrial cancer and atypical endometrial hyperplasia: a comparison of outcomes from a cancer unit and cancer centre.

A retrospective study from 2015 to 2020 comparing overall survival (OS) outcomes of a cancer unit and centre for presumed early stage endometrial cancers is presented. Cancer centres manage these presumed early endometrial cancer (EC) in situations of complex co-morbidities, surgical challenges as well as their own local unit patients. Our analysis compares 138 patients at KMH (unit) and 282 patients at RDH (centre) on OS, patient demographics, grading histology and final histology.

What are the implications of radiologically abnormal cardiophrenic lymph nodes in advanced ovarian cancer? An analysis of tumour burden, surgical complexity, same-site recurrence and overall survival.

Introduction: Our paper evaluates the relationship between radiologically abnormal cardiophrenic lymph nodes (CPLN) in advanced ovarian cancer and pattern of disease distribution, tumour burden, surgical complexity, rates of cytoreduction and same-site recurrence. Impact of suspicious CPLN and CPLN dissection on overall survival also determined.

Materials And Methods: Retrospective review of index CT imaging for 151 consecutive patients treated for stage III/IV ovarian malignancy in a large UK cancer centre to identify radiologically abnormal CPLN.

Lactate Is a Reliable Predictor of ICU Length of Stay Following Ultra-radical Ovarian Cancer Surgery.

Background/aim: With a greater proportion of women with advanced ovarian cancer (AOC) successfully undergoing radical cytoreductive surgery, the demand on peri-operative resources - including intensive care (ICU) beds - is also on the rise. Extended post-operative ICU length of stay (LOS) confers increased patient morbidity and mortality. Several variables associated with prolonged ICU LOS following AOC surgery have been identified.

Transdiaphragmatic resection of enlarged cardiophrenic lymph node during interval debulking surgery for advanced ovarian cancer.

Surgery in advanced ovarian malignancy is indicated when complete debulking can be achieved. In patients with disease above the diaphragm, achieving R0 can present a surgical challenge and bring into question the feasibility of surgery (Soleymani majd et al., 2016, Pinelli et al.

Adamantinoma: metastatic disease masquerading as a gynaecological malignancy.

Adamantinoma is a rare low-grade malignancy of the appendicular skeleton with unclear histogenesis. We present the case of a 65-year-old woman with known recurrent and metastatic right tibial disease despite clear resection margins. On further investigation, a positron emission tomography-CT scan identified a primary breast lesion and an 11 cm mass in the right iliac fossa of suspected ovarian malignancy amenable to surgical resection.

Aggressive anaplastic ovarian carcinoma in a young nulliparous patient.

Ovarian tumours harbouring foci of anaplastic carcinoma are extremely rare. With just a handful of cases reported in the literature, understanding of the disease and optimal management remains limited. A 38-year-old woman was referred to the gynaeoncologists with a multiloculated complex ovarian mass.

Primary diaphragmatic closure following diaphragmatic resection and cardiophrenic lymph node dissection during interval debulking surgery for advanced ovarian malignancy.

•Gaining trans-diaphragmatic access to thoracic cavity during de-bulking laparotomy.•Assessment and dissection of bulky cardiophrenic lymph nodes to achieve optimal cytoreduction.•Technique for primary closure of diaphragm following radical resection.

Laparoscopic resection of single site pelvic side wall recurrence 6 years after stage IIIc high grade serous primary peritoneal cancer.

The findings of the DESKTOP 3 (Du Bois et al., 2017) ​study advocate secondary cytoreduction in patients with disease relapse of ovarian or peritoneal malignancy meeting specified criteria. We present a surgical video demonstrating the technique of laparoscopic resection of single site pelvic side wall recurrence 6 years after stage IIIc high grade serous primary peritoneal cancer.

The modified radical peripartum cesarean hysterectomy (Soleymani-Alazzam-Collins technique): a systematic, safe procedure for the management of severe placenta accreta spectrum.

Background: The prevalence of placenta accreta spectrum is rising worldwide. The severe end of the spectrum where the placenta has invaded other organs is fortunately rare, however, few surgical techniques for such a complex hysterectomy have been described in the literature.

Objective: This study aimed to describe a stepwise, systematic technique for radical cesarean hysterectomy for placenta accreta spectrum to investigate outcomes for women with severe, invasive placenta accreta spectrum who were hysterectomized using this technique.

Rectovaginal extragastrointestinal stromal tumour (EGIST): an additional entity to be considered in the differential diagnosis of tumours of the rectovaginal septum.

Gastrointestinal stromal tumours (GISTs) are rare - and rectovaginal extragastrointestinal stromal tumours (RV-EGISTs) even rarer. We share a case of RV-EGIST, complemented by high-quality radiological and surgical images. A review of current literature pertaining to RV-EGIST is also included.

Malignant struma ovarii: surgical, histopathological and survival outcomes for thyroid-type carcinoma of struma ovarii with recommendations for standardising multi-modal management. A retrospective case series sharing the experience of a single institution over 10 years.

Purpose: Struma ovarii is rare, accounting for 0.3-1% of ovarian tumours. Malignant transformation may occur, most often into papillary thyroid carcinoma.

Laparoscopic Upper Colpectomy for VAIN III after Previous Total Hysterectomy.

Study Objective: To demonstrate the feasibility of laparoscopic upper colpectomy for the treatment of vaginal intraepithelial neoplasia (VAIN) after previous total hysterectomy.

Design: Stepwise demonstration of the technique with narrated video footage.

Setting: In 2014, our patient aged 60 years underwent a routine smear that reported severe dyskaryosis.

Three-dimensional indices of renal perfusion in normal pregnancy and pre-eclampsia.

Introduction: We compared renal perfusion in normal pregnant women and women with pre-eclampsia using three-dimensional (3D) ultrasound. We measured the flow index (FI), vascular index (VI) and vascularisation flow index (VFI) which are believed to reflect vascularity and flow intensity.

Methods: Fourteen patients with normal pregnancy and 16 patients with pre-eclampsia were recruited.

Early catheter removal following laparoscopic radical hysterectomy for cervical cancer: assessment of a new bladder care protocol.

Evidence to support prolonged catheterisation after radical hysterectomy is lacking. We sought to assess feasibility of a new protocol of early post-operative catheter removal following laparoscopic radical hysterectomy for cervical cancer. A retrospective review of post-operative bladder care in patients who underwent laparoscopic radical hysterectomy for cervical cancer was carried out.

An Assessment of Fetal Cerebral and Hepatic Perfusion in Normal Pregnancy and Pre-Eclampsia Using Three-Dimensional Ultrasound.

Background: Pre-eclampsia and placental causes of intrauterine growth restriction (IUGR) are part of the same spectrum of disorders. In IUGR, there is preferential shunting of blood to the fetal brain at the expense of other organs. We wanted to demonstrate that this also occurs in pre-eclampsia using three dimensional (3D) ultrasound.