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Christos Iavazzo - Top 30 Publications

Dermatomyositis and colorectal cancer: a systematic review.

Dermatomyositis (DM) is an idiopathic inflammatory myositis. The principal characteristics are cutaneous rash, muscle ache, and muscle weakness. In the past, associations have been established between DM and malignancy, including colorectal cancer.

Cost-benefit analysis of robotic surgery in gynaecological oncology.

Robotic approach is a rather new technique that can be used to optimise the management of patients with gynaecological cancer. However, concerns have been raised regarding the cost of such an approach compared to laparoscopic or open techniques. The aim of our chapter is to review the data of papers published so far that analyse the cost of robotic gynaecological oncology. A systematic review of the current literature was performed trying to assess the cost of the robotic technique including parameters that affect it and ways to minimise it in favour of the patients and health care systems.

Fertility sparing approach as the standard of care in young patients with immature teratomas.

Immature teratomas are quite rare tumors arising in young women. They are usually diagnosed in early stage and grade and have a good prognosis. In these young patients, fertility-sparing management is suggested as the standard of care. Bilateral immature teratoma is a rare condition with an incidence of 10%, with a five-year survival rate of 80%. The majority of patients received fertility-sparing treatment followed by adjuvant chemotherapy in 78%. Older age, advanced stage, and high grade are negative prognostic factors. The surgery-only, watch-and-wait approach was evaluated; however, after a median follow-up time of 42 months, 50% of patients experienced recurrence, but they were successfully salvaged with chemotherapy. In a retrospective study, 12 out of 27 patients tried to conceive, resulting in 10 pregnancies (8 after chemotherapy). We present a narrative review of the current literature regarding the essential multidisciplinary approach of such patients in order to achieve the best oncologic and fertility-sparing outcome.

The possible role of the da Vinci robot for patients with vulval carcinoma undergoing inguinal lymph node dissection.

Inguinal lymph node dissection represents the gold standard of treatment for patients with vulval carcinoma. The application of minimally invasive techniques, such as robotics, in the surgical treatment of gynecologic cancer, reduced the rate of postoperative complications, which has an important impact on the quality of patients' life. Robotic inguinal lymph node dissection is a safe and oncologically effective but expensive and time-consuming approach in patients with penile cancer or melanoma. However, it is related with less postoperative complications, especially less lymphocele or lymphedema rates, and can improve the patients' quality of life while minimizing cost for health systems. The introduction of robot- assisted inguinal lymph node dissection in the treatment of vulval carcinoma may be identified as a provisional option for the gynecologic oncologist. Our intention was to present a brief review/commentary on the possible use of a robot-assisted technique on inguinal lymphadenectomy for patients with vulval cancer.

Robotics in general surgery: A systematic cost assessment.

The utilisation of robotic-assisted techniques is a novelty in the field of general surgery. Our intention was to examine the up to date available literature on the cost assessment of robotic surgery of diverse operations in general surgery. PubMed and Scopus databases were searched in a systematic way to retrieve the included studies in our review. Thirty-one studies were retrieved, referring on a vast range of surgical operations. The mean cost for robotic, open and laparoscopic ranged from 2539 to 57,002, 7888 to 16,851 and 1799 to 50,408 Euros, respectively. The mean operative charges ranged from 273.74 to 13,670 Euros. More specifically, for the robotic and laparoscopic gastric fundoplication, the cost ranged from 1534 to 2257 and 657 to 763 Euros, respectively. For the robotic and laparoscopic colectomy, it ranged from 3739 to 17,080 and 3109 to 33,865 Euros, respectively. For the robotic and laparoscopic cholecystectomy, ranged from 1163.75 to 1291 and from 273.74 to 1223 Euros, respectively. The mean non-operative costs ranged from 900 to 48,796 from 8347 to 8800 and from 870 to 42,055 Euros, for robotic, open and laparoscopic technique, respectively. Conversions to laparotomy were present in 34/18,620 (0.18%) cases of laparoscopic and in 22/1488 (1.5%) cases of robotic technique. Duration of surgery robotic, open and laparoscopic ranged from 54.6 to 328.7, 129 to 234, and from 50.2 to 260 min, respectively. The present evidence reveals that robotic surgery, under specific conditions, has the potential to become cost-effective. Large number of cases, presence of industry competition and multidisciplinary team utilisation are some of the factors that could make more reasonable and cost-effective the robotic-assisted technique.

Women Physicians in Byzantium.

Women were allowed to practice the medical profession during the Byzantine Empire. The presence of female physicians was not an innovation of the Byzantine era but actually originated from ancient Greece and Rome. The studies and the training of women doctors were apparently equivalent to those of their male colleagues. The principal medical specialties of the female doctors were gynecology and midwifery. Byzantine legislation treated relatively equally both female and male doctors. For this reason, it can be assumed that the presence of female doctors was correlated with the position of women in Byzantine society. However, there is not sufficient information in the literature to clarify whether female and male doctors used to earn equal payment for the same service.

Advantages by using the intradermal microbubbles for sentinel lymph node detection in penile cancer.

Dear Editor, Penile cancer has a relatively low incidence of 0.6% among all types of neoplasms. These incidents can reach up to 10% in the developing countries. Resection of the primary cancer and early dissection of nodal metastases may improve survival. Nevertheless, inguinal lymphadenectomy may have a negative impact on patient's quality of life due to possible surgical site infection, lymphocyst formation or lymphoedema. Sentinel lymph node (SLN) detection by radiopharmaceuticals, was first applied in penile cancer and is defined as the identification of the first regional lymph node by the primary site of cancer. In the case of penile cancer, the retrieval of a positive node necessitates a complete inguinofemoral nodal dissection including also the deep femoral lymph nodes. The method for identifying SLN has been successfully used in various cancers like vulval, breast cancers and melanomas. The utilization of contrast-enhanced ultrasonography (CEUS) combined with the administration of a contrast medium is used as a routine test for imaging tissue vasculature. This test is using various dispersions with sulfur hexafluoride gas microbubbles (SonoVue, Bracco Imaging). The mean diameter of these microbubbles is 2.5μm, smaller than the red blood cells diameter. The test has been recently applied in UK by the Maidstone group for the detection of SLN, in patients with breast cancer. The sentinel lymph node mapping CEUS technique combined with sulfur hexafluoride gas microbubbles is quite simple to apply and reasonably cost effective. Additionally, both in the blue dye and the radioactive colloid technique, the administrated substance may surpass the SLN to the next regional lymph node group giving confusing results. Moreover, this radioactive test needs to have a specific nuclear medicine department. Furthermore, there is a probability of anaphylactic reactions in 0.9% when injecting the blue dye. Local skin necrosis or/and skin tattooing at the injection site of the blue dye can last up to a year. In contrast to the above, the CEUS technique does not have these side effects, has a shorter time of application (approximately 30min) and causes less discomfort to the patients. Comparative studies using both the radioactive, the blue dye and the CEUS technique are warranted especially in penile carcinoma.

Grigoris Lambrakis (1912-1963) - a Greek obstetrician and world renowned activist.

Grigoris Lambrakis was a Greek politician, doctor, athlete, and faculty member of the Medical School of Athens University. As an athlete, Lambrakis held the Greek record for long jump for twenty-three years and he also won several gold medals in the Balkan Athletic Games. Lambrakis received an excellent medical education. As lecturer at the University of Athens, Lambrakis became a pioneer of Gynecological Endocrinology. His philanthropy was always evident during his medical career, but he also consistently attended international pacifist meetings and demonstrations. His medical work, and his performance as lecturer of Obstetrics and Gynaecology, have been neglected, if not overshadowed, by his political career. Lambrakis is recognized worldwide as a martyr for peace. The aim in this essay is to present his life, and especially to elucidate his medical achievements.

Application of da Vinci(®) Robot in simple or radical hysterectomy: Tips and tricks.

The first robotic simple hysterectomy was performed more than 10 years ago. These days, robotic-assisted hysterectomy is accepted as an alternative surgical approach and is applied both in benign and malignant surgical entities. The two important points that should be taken into account to optimize postoperative outcomes in the early period of a surgeon's training are how to achieve optimal oncological and functional results. Overcoming any technical challenge, as with any innovative surgical method, leads to an improved surgical operation timewise as well as for patients' safety. The standardization of the technique and recognition of critical anatomical landmarks are essential for optimal oncological and clinical outcomes on both simple and radical robotic-assisted hysterectomy. Based on our experience, our intention is to present user-friendly tips and tricks to optimize the application of a da Vinci® robot in simple or radical hysterectomies.

Primary peritoneal cancer in BRCA carriers after prophylactic bilateral salpingo-oophorectomy.

The presence of deleterious mutations in breast cancer (BRCA)-1 or BRCA-2 gene has a decisive influence on the development of various types of neoplasms, such as breast, ovarian, tubal, and peritoneal cancers. Primary peritoneal cancer is an aggressive malignancy which, due to the absence of a specific screening test, cannot be diagnosed in its early stages. As a risk-reducing option, prophylactic bilateral salpingo-oophorectomy and mastectomy are often proposed in BRCA gene carriers. The effectiveness of a preventive surgical treatment is, however, unclear in the development of peritoneal cancer.

Response to the Editor.

Solo gynaecologic laparoscopic surgery: a future one-man show for the experienced surgeon and a cost-effective approach for the National Health Systems?

Hypodontia and ovarian cancer: A systematic review.

Hypodontia can be defined as the non-formation of one or more teeth during the developmental period. Mutation in several genes related to tooth formation has previously been correlated with cancer. Regarding the ovarian cancer, there are few studies that associate the presence of hypodontia with ovarian cancer. A systematic literature search was performed in PubMed and Scopus. In total, 385 patients were included in this study. Control group was present in 3 out of 4 studies (340 patients). Hypodontia was present in 56 out of 290 patients (incidence of 19.3%). Only in 2 out of 4 studies, the number of missing teeth was mentioned (47 teeth), while the majority of them were either maxillary second premolars or maxillary lateral incisors. Unilateral distribution of the missing teeth was present in 28 out of 46 patients, while bilateral distribution of the missing teeth was present in 18 out of 46 patients. The presence of ovarian cancer in the family medical history occurred in 12 out of 33 patients. Only 1 out of 4 studies examined the presence of genes with mutations in the included patients. Based on our findings, the lack of clinical studies was the principal obstacle to clarify the possible predictive value of hypodontia in the early prediction of patients with higher risk of ovarian cancer.

Robotic assisted vs laparoscopic and/or open myomectomy: systematic review and meta-analysis of the clinical evidence.

Uterine myomas are relative frequent in premenopausal women. The development of advanced minimally invasive surgical techniques proposed robotic-assisted myomectomy as an equally safe and effective treatment option.

Obese patients with endometrial cancer: is the robotic approach a challenge or a new era of safer and more cost-effective management of such patients?

Robotic assisted hysterectomy in obese patients: a systematic review.

Robotic hysterectomy is an alternative approach to the management of female genital tract pathology.

Perioperative pulmonary complications in obese patients undergoing robotic procedures for gynecological cancers.

Avenzoar's (1091-1162) clinical description of cancer.

In the 11(th) and 12(th) century the Western caliphate flourished, making Cordoba the capital of physicians and philosophers. During that period lived and practised the famous physician Ibn Zuhr or Avenzoar. In his monumental treatise Al Taysir, Avenzoar provided the first clinical description of a polypoid colorectal tumour as well as the case of a uterine cancer and a basal cell carcinoma. His medical work remained popular through middle ages, influencing the development of western medicine.

Possible role of DaVinci Robot in uterine transplantation.

Minimally invasive surgery, specifically robotic surgery, became a common technique used by gynecological surgeons over the last decade. The realization of the first human uterine transplantation commenced new perspectives in the treatment of uterine agenesia or infertility in women with history of hysterectomy at a young age. Robot-assisted technique may enhance the safety of the procedure by facilitating the microvascular anastomosis, vaginal anastomosis, and ligaments' fixation. This study proposes the formation of a multicenter collaboration group to organize a protocol with the aim to clarify the possible role of robotic surgery in uterine transplantation.

Enhanced recovery programme in robotic hysterectomy.

The standard care for endometrial cancer includes total hysterectomy, bilateral salpingo-oophorectomy, peritoneal washings with or without bilateral pelvic and/or paraaortic lymph node dissection/sampling with or without omental biopsy or omentectomy. The aim of this narrative review is to present the advantages of robotic surgery in combination with the enhanced recovery programme to offer better care to patients with endometrial cancer. The authors argue that a well-organised service for robotic hysterectomy should be set up in all hospitals. As part of this, an enhanced recovery programme including the following elements should be implemented: patient education, preoperative carbohydrate drinks, spinal or local analgesia, goal-directed fluid therapy, early feeding and intensive early mobilisation. The enhanced recovery programme includes pre, intra and postoperative changes in patient management. A comprehensive enhanced recovery programme starting in the preoperative setting and extending through to the patient's discharge, combined with robotic approach, could lead to optimal care of patients with endometrial cancer.

Diabetes mellitus and gynecologic cancer: molecular mechanisms, epidemiological, clinical and prognostic perspectives.

Diabetes mellitus, the prevalence of which has increased dramatically worldwide, may put patients at a higher risk of cancer. The aim of our study is the clarification of the possible mechanisms linking diabetes mellitus and gynecological cancer and their epidemiological relationship.

Robotic retroperitoneal lymph node dissection in gynaecological neoplasms: comparison of extraperitoneal and transperitoneal lymphadenectomy.

The main aim of our study is to review the till now available literature data on the role of robotic retroperitoneal lymph node dissection in gynaecological cancers by comparing the extraperitoneal versus the transperitoneal approach.

Use of misoprostol in myomectomy: a systematic review and meta-analysis.

Misoprostol, a prostaglandin derivative, reduces blood flow to uterus, facilitating every surgical operation on myometrium.

Comment to the letter: Prevention from port site metastasis.

Sentinel Lymph Node Detection With the Use of Intradermal Microbubbles in Vulvar Cancer.

Port-site metastases in patients with gynecological cancer after robot-assisted operations.

Port-site metastasis is an extremely rare event in patients with cancer treated with robotic-assisted surgery. However, as robotic procedures are increasing, the incidence of port-site metastases might also increase. The purpose of our review is to evaluate the up-to-now existing literature data on robotic port-site metastasis in the field of gynecological oncology.

Konstantinos Logothetopoulos (1878-1961): the controversial life of an eminent gynaecologist.

Professor Konstantinos Logothetopoulos is considered one of the founders of modern Gynaecology in Greece.

Single-incision laparoscopic splenectomy.

The single-incision approach in laparoscopic surgery is a relatively new concept. This systematic review of the literature was performed to appraise the existing clinical evidence concerning the use of the single-incision technique for spleen resection.

Ocular complications in robotic surgery.

The penetration of robotic technology in various surgical fields may increase ocular complications.

The Role of Knotless Barbed Suture in Gynecologic Surgery: Systematic Review and Meta-Analysis.

Knotless barbed sutures are an innovative suturing material that can facilitate laparoendoscopic operations. The purpose of this study is to examine the available evidence on the application of barbed sutures on both laparoscopic and robotic operations in the field of gynecologic surgery. A systematic search was performed in PubMed, Scopus, and Cochrane databases. In total, 1991 patients were included in the study. The duration of closure with knotless suture ranged from 3.9 to 13 minutes, which was less than the use of conventional suture in every study. The duration of suturing was significantly less in the barbed suture group during hysterectomy, the mean difference between the observed groups was 2.41 minutes per operation (95% confidence interval, 1.23-3.59) whereas in myomectomy there was no statistically significant difference between compared groups. Concerning the estimated blood loss and the presence of major bleeding in hysterectomy, no statistical difference between the 2 groups was observed, while the estimated blood loss in myomectomy was found to be statistically significant (P = .04). Regarding the dehiscence of vaginal cuff in hysterectomy, no statistically significant difference was observed (1031 patients, odds ratio = 1.63; 95% confidence interval = 0.37-7.25). The complete absence of knots, the even distribution of tissue strength along the wound, and the reduction of operation time are the main advantages of this type of sutures. Additional clinical trials of higher methodological quality are necessary to further clarify suturing advantages and postoperative outcomes of the barbed sutures.