Biography:

In the past Stefano Uccella has collaborated on articles with Stefano Salvatore and Fabio Ghezzi. One of their most recent publications is Chapter 9 - Hysterectomy With Pelvic and Paraaortic Lymphadenectomy. Which was published in journal .

More information about Stefano Uccella research including statistics on their citations can be found on their Copernicus Academic profile page.

Stefano Uccella's Articles: (13)

Chapter 9 - Hysterectomy With Pelvic and Paraaortic Lymphadenectomy

AbstractEndometrial cancer is the most common gynecologic malignancy in developed countries. Hysterectomy with bilateral salpingo-oophorectomy represents the mainstay of treatment. No data suggest that the route of hysterectomy influences oncologic outcomes (disease-free survival and overall survival) of this disease. Accordingly, minimally invasive surgery (robotic assisted and laparoscopic) is replacing abdominal surgery for endometrial cancer staging because of the lower morbidity and faster recovery associated with the former. However, the total abdominal approach has been the hallmark of therapy for endometrial cancer. Also, sentinel lymph nodes are rapidly becoming the new accepted procedure for endometrial cancer staging. However, when sentinel lymph nodes are not available or not feasible, pelvic lymphadenectomy (with or without paraaortic lymphadenectomy) has been shown to guarantee appropriate evaluation for patients with endometrial cancer at moderate and high risk of lymphatic metastasis. According to the traditional Mayo Clinic criteria, pelvic lymphadenectomy is required in patients with endometrioid endometrial cancer grade 3, or endometrioid endometrial cancer grade 1 or 2 with cervical stromal invasion, or endometrioid endometrial cancer grade 1 or 2 with primary tumor diameter greater than 2 cm. Paraaortic lymphadenectomy may be indicated in patients with type II (serous, clear cell, carcinosarcoma) endometrial cancer, myometrial invasion of 50% or more, or both, and every time a pelvic lymph node is revealed to be positive at frozen section analysis.

Case reportCognitive dysfunction with tolterodine use

This is the first case of a 65 year old healthy woman developing de novo mental confusion during treatment with 2 mg tolterodine twice daily. It is a rare complication of therapy for overactive bladder and resolved when dosage was reduced to 1 mg, although overactive bladder symptoms were still controlled.

ResearchGeneral gynecologyTransumbilical versus transvaginal retrieval of surgical specimens at laparoscopy: a randomized trial

ObjectiveWe sought to compare transumbilical (TU) and transvaginal (TV) route for retrieval of surgical specimens at laparoscopy.Study DesignWomen scheduled for a laparoscopic resection of an adnexal mass were randomized to have their surgical specimen removed either through a posterior colpotomy (n = 34) or the umbilical port site (n = 32). Group allocation was concealed from patients and bedside clinicians. The primary outcome was postoperative incisional pain assessed by a 10-cm visual analog scale at 1, 3, and 24 hours after surgery.ResultsTV retrieval caused less postoperative pain than TU specimen extraction at each time point (visual analog scale score at 1 hour: 2.6 ± 2.9 vs 1.2 ± 2.0, P = .03; at 3 hours: 2.4 ± 2.0 vs 1.4 ± 2.0, P = .02; and at 24 hours: 1.1 ± 1.5 vs 0.5 ± 1.4, P = .02). A higher proportion of women in the TU group than in the TV group indicated the umbilicus as the most painful area at 1 and 3 hours postoperatively. Two months after surgery, the participants scored similarly as to their overall satisfaction, cosmetic outcome, and dyspareunia upon resumption of intercourse.ConclusionA TV approach for specimen removal after laparoscopic resection of adnexal masses offers the advantage of less postoperative pain than TU retrieval.

Laparoscopic vs. open treatment of endometrial cancer in the elderly and very elderly: An age-stratified multicenter study on 1606 women☆☆☆

Highlights•In elderly EC patients, laparoscopy has less complications than open surgery.•The advantages of laparoscopy are maintained even among elderly/very elderly subjects.•Elderly subjects with EC are more delicate and have a higher risk of complications.

A comparison between vaginal estrogen and vaginal hyaluronic for the treatment of dyspareunia in women using hormonal contraceptive

AbstractObjectiveTo evaluate the efficacy of topical vaginal estrogens in comparison to hyaluronic acid for the treatment of de novo dyspareunia in women using hormonal oral contraceptive (COC).Study designConsecutive sexually active women using COC and complaining of de novo dyspareunia were enrolled in the study. Two attending physicians were involved in the study: the first, prescribed a 12-week vaginal estrogenic therapy with estriol 50 μg/g gel twice a week (group 1) and the second a hyaluronic acid vaginal gel therapy once a day (group 2). We evaluated dyspareunia levels using visual analogic scale (VAS) and sexual function using Female Sexual Function Index (FSFI). Vaginal atrophy was graded per the vaginal maturation index (VM).ResultsOverall, 31 women were enrolled. Seventeen and 14 patients were allocated in group 1 and 2, respectively. In both groups, after the topical therapy, dyspareunia, sexual function and VM were significantly improved. However, patients in group 1 experienced a significantly lower score of dyspareunia than patients in the group 2 (2 (1–7) vs. 4 (2–7); p = 0.02). Additionally, women in the group 1 had higher FSFI (29.20 (24.60–34.50) vs. 28.10 (23.60–36.50); p = 0.04) scores and VM (73.80 (±8.78) vs. 64.50 (±12.75); p = 0.003) values in comparison to the patients in group 2.ConclusionsOur study showed that vaginal supplementation with estriol 50 μg/g gel or with hyaluronic acid could reduce the de novo dyspareunia related to COC. In this cluster of patients, both treatments improve sexuality. However, estriol 50 μg/g gel appears to be significantly more effective in comparison with hyaluronic acid.

Female Urology – IncontinenceIs There a Synergistic Effect of Topical Oestrogens When Administered with Antimuscarinics in the Treatment of Symptomatic Detrusor Overactivity?☆

AbstractBackgroundNo authors have investigated whether the administration of local oestrogens in addition to antimuscarinics could have a synergistic effect in the therapy of overactive bladder (OAB).ObjectivesTo compare the efficacy of antimuscarinics alone versus antimuscarinics in combination with local oestrogens for OAB; to verify whether risk factors for lower antimuscarinic efficacy can be overcome by the concomitant use of local oestrogens.Design, setting, and participantsSome 229 postmenopausal women with symptomatic urodynamically proven detrusor overactivity were prospectively enrolled at a tertiary level urogynaecology centre and divided into two groups.InterventionWomen in group 1 (n = 129) were prescribed tolterodine extended release (ER) 4 mg once daily; women in group 2 (n = 100) were prescribed both tolterodine ER 4 mg and concomitant oestriol cream application once daily.MeasurementsAll women underwent clinical evaluation and urodynamics in accordance with the Good Urodynamic Practices Guidelines. After 12 wk of treatment the two groups were compared in terms of subjective efficacy for OAB symptom improvement using a three-point scale. Nonresponders were compared to the patients who improved or were cured in order to identify risk factors for resistance to therapy.Results and limitationsThere was no significant difference between the two groups in terms of efficacy of therapy: 80.6% in group 1 versus 82% in group 2 (p = 0.86). Patients with urodynamically proven detrusor overactivity (DO) occurring during provocative manoeuvres and patients with coital incontinence during orgasm reported a higher failure rate both in the overall study population and in group 2. A possible limitation of the study is the nonrandomised design.ConclusionsNo synergistic effect of local oestrogens and antimuscarinics in the treatment of OAB was found. Antimuscarinic treatment has lower cure rates in women with symptomatic DO complaining of incontinence at orgasm or in patients with DO following provocative manoeuvres. The association of local oestrogens does not influence the role of the two mentioned risk factors.

Original articleLaparoscopic-assisted vaginal hysterectomy versus total laparoscopic hysterectomy for the management of endometrial cancer: A randomized clinical trial

AbstractStudy objectiveTo compare laparoscopic-assisted vaginal hysterectomy (LAVH) and total laparoscopic hysterectomy (TLH) for the treatment of endometrial cancer.DesignRandomized, controlled trial.Design classificationRandomized controlled trial (Canadian Task Force classification I).SettingTwo gynecologic oncologic units of university hospitals.PatientsSeventy-two women with endometrial cancer randomized to undergo either LAVH or TLH.InterventionsTotal laparoscopic hysterectomy or laparoscopic-assisted vaginal hysterectomy, bilateral salpingo-oophorectomy, peritoneal washing, and systematic pelvic lymphadenectomy.Measurements and main resultsParameters of technical feasibility (operating time of hysterectomy phase, estimated blood loss, perioperative complications) were considered as major statistical endpoints. Thirty-seven women were allocated to the LAVH arm, and 35 were allocated to the TLH arm. Mean total operating time was significantly shorter in the TLH than in the LAVH group (184.0 ± 46.0 vs 213.2 ± 39.4 minutes, p = .003). The hysterectomy phase was longer in the LAVH than in the TLH group only in overweight (77.9 ± 9.8 vs 68.1 ± 9.3 min, p = .005) and obese patients (87.7± 13.1 vs. 62.1± 9.9 min, p < .0001). The median estimated blood loss during hysterectomy was similar between groups. Intraoperative complications occurred in three (8.1%) patients in the LAVH group and in one patient (2.8%) in the TLH group (p = .61). No difference was found in the postoperative complication rate between women undergoing LAVH and those who had TLH (24.3% vs 17.1%, p = .56). Within a median follow-up period of 10 months (range 3–17 months), 2 patients in the LAVH group developed recurrent disease. No port site metastasis and no vaginal cuff recurrence were detected in either group.ConclusionBoth LAVH and TLH can be performed successfully to manage endometrial cancer, with similar surgical outcomes. Obese patients benefit more from TLH than from LAVH in terms of shorter operating time.

Original articleImmediate Foley removal after laparoscopic and vaginal hysterectomy: Determinants of postoperative urinary retention

AbstractStudy objectiveWe sought to evaluate the incidence of postoperative voiding dysfunction in patients undergoing vaginal hysterectomy (VH) or total laparoscopic hysterectomy (TLH) and to identify risk factors for the development of postoperative urinary retention after uncomplicated total hysterectomy.DesignProspective cohort study (Canadian Task Force classification II-2).SettingGynecology department of a university hospital.PatientsTwo hundred thirty-three consecutive women undergoing TLH or VH for benign gynecologic disease.InterventionsA regimen of immediate catheter removal after the operation was instituted. A strict voiding trial protocol was used during the study period. Postoperative voiding dysfunction was defined as failure of first voiding trial after surgery (urinary retention) or postvoid residual volume of greater than 150 mL necessitating recatheterization.Measurements and main resultsA total of 49 women (21%) developed postoperative voiding dysfunction, of which 32 (13.7%) had complete urinary retention and 17 (7.3%) had a postvoid residual volume greater than 150 mL. None of these patients experienced voiding dysfunction beyond 48 hours. There was no statistical correlation between development of postoperative voiding dysfunction and demographic, historic, preoperative, and postoperative variables collected. The only factor with significant impact on postoperative voiding dysfunction was vaginal approach to hysterectomy (OR 2.8; 95% CI 1.5–5.4). Hospital stay was significantly longer for women experiencing voiding difficulties than for those who voided efficiently (2.2 ± 0.8 [95% CI 1.5–1.9] vs 1.7 ± 1.2 [95% CI 1.9–2.4] days; p <.0001). Voiding dysfunction was an independent predictor of postoperative urinary tract infection (OR 4.9; 95% CI 1.6–15.4).ConclusionPatients undergoing VH are more likely to develop postoperative voiding dysfunction than those who undergo TLH, when a policy of immediate catheter removal after surgery is used.

Original ArticleLaparoscopic Versus Open Abdominal Management of Cervical Cancer: Long-Term Results From a Propensity-Matched Analysis

AbstractStudy ObjectiveTo compare perioperative and long-term outcomes related to laparoscopic and open abdominal surgical management of cervical cancer.DesignPropensity-matched comparison of prospectively collected data (Canadian Task Force classification II-1).SettingUniversity teaching hospital.PatientsSixty-five propensity-matched patient pairs (130 patients) undergoing either laparoscopy or open abdominal surgical procedures to treat cervical cancer.InterventionRadical hysterectomy plus lymphadenectomy was performed via the laparoscopic (LRH) or open abdominal approach (RAH).Measurement and Main ResultsBaseline characteristics of the study populations were similar. In the LRH group the procedure was converted to open surgery in 2 patients (2%). Compared with the RAH group, patients undergoing LRH experienced less blood loss (200 vs 500 mL; p < .001), a lower transfusion rate (6% vs 22%; p = .02), similar operative time (245 vs 259.5 minutes; p = .26), and shorter length of hospital stay (4 vs 8 days; p < .001). No between-group differences in intraoperative complications were recorded (p = 1.0); however, a trend toward a lower postoperative complication rate (Accordion system grade ≥3) was observed for LRH compared with RAH (4 patients [6%]) vs 12 patients [18%]; p = .06). Five-year disease-free survival (p = .6, log-rank test) and overall survival (p = .31, log-rank test) did not differ statistically between women undergoing LRH or RAH.ConclusionLaparoscopy ensures the same results as open surgery insofar as radicality and long-term survival. Use of the laparoscopic approach is associated with improved short-term results, minimizing the occurrence of severe postoperative complications.

Original ArticleLaparoscopic Management of Ovarian Cancer Patients With Localized Carcinomatosis and Lymph Node Metastases: Results of a Retrospective Multi-institutional Series

AbstractStudy ObjectiveTo investigate the feasibility and safety of laparoscopic cytoreduction in ovarian cancer patients with localized carcinomatosis or lymph node involvement.DesignRetrospective cohort study (Canadian Task Force classification II-2).SettingMulti-institutional study performed in 6 referral gynecologic oncology units.PatientsBetween June 2005 and December 2014, preoperatively presumed early-stage ovarian cancer patients, who accidentally revealed localized carcinomatosis or lymph node involvement at laparoscopic evaluation or at postoperative pathological examination managed by the laparoscopic approach.InterventionsAll patients with limited carcinomatosis and/or lymph node metastases underwent complete laparoscopic cytoreduction.Measurements and resultsSixty-nine patients were included in the analysis. Twenty-eight (40.6%) patients were staged III C because they had lymph node metastases. Pelvic lymphadenectomy was performed in 75.4% of cases, whereas aortic lymphadenectomy was performed in 79.7% of cases. Lymph node metastases were found in pelvic and aortic regions in 11 and 13 patients, respectively, whereas 4 patients had lymph node metastases in both regions. Twelve (17.4%) patients underwent complete pelvic peritonectomy because of the presence of nodules localized in several pelvic region sites. As of May 2015, the median follow-up was 35 months, and the median disease-free survival was 29 months. The 2-year disease-free survival rate was 77.1%, whereas the 2-year overall survival rate was 90.6%. The median time to recurrence was 26 months (range, 6 -55 months); 15 (21.7%) patients developed recurrence.ConclusionThe present study shows the technical and clinical feasibility of laparoscopic cytoreduction in ovarian cancer patients with limited carcinomatosis or lymph node involvement.

Original ArticleLaparoscopic Versus Open Hysterectomy for Benign Disease in Women with Giant Uteri (≥1500 g): Feasibility and Outcomes

AbstractStudy ObjectiveTo evaluate perioperative outcomes and complications of laparoscopic hysterectomy (LH) in women with giant uteri (≥1.5 kg) compared with open abdominal hysterectomy (AH), which is considered the reference.DesignA retrospective analysis of prospectively collected data (Canadian Task Force Classification II-2).SettingAn academic research center.PatientsAll consecutive women who underwent hysterectomy for uteri weighing ≥1500 g (total = 51) between 2000 and 2015 were analyzed. Twenty-seven (53%) patients had been scheduled for the laparoscopic approach (LH), whereas 24 (48%) had been scheduled for AH.InterventionsHysterectomy ± mono/bilateral salpingo-oophorectomy.Main Outcome MeasuresPerioperative details, incidence, severity, and type of complications were analyzed according to surgical approach (AH vs LH). We also evaluated the trends over time in terms of perioperative outcomes.ResultsAH was associated with a shorter operative time (97.5 vs 160 minutes, p = .004) compared with LH. Blood loss (200 vs 225 mL, p = .21) and the decrease in postoperative hemoglobin (−1.2 vs −1.1, p = .89) were similar between AH and LH. Intra- and postoperative complications were similar between the 2 groups; however, hospital stay was significantly shorter in the LH group (median = 3 days vs 1 day, p < .001). A significant trend toward a progressive increase in the use of the minimally invasive approach was registered through the years (p = .001). Parallel to this increase, we observed a significant reduction in terms of length of stay. Moreover, a decrease in the total number of complications, mainly because of a decrease in the rate of early minor events, was observed through the years.ConclusionsOur experience shows that LH can be considered a feasible procedure, even in cases of uteri ≥1.5 kg, with significant advantages over open surgery in terms of postoperative hospital stay.

Original ArticleMinilaparoscopy vs Standard Laparoscopy for Sentinel Node Dissection: A Pilot Study

AbstractObjectiveTo compare 3-mm minilaparoscopy and standard 5-mm laparoscopy for sentinel lymph node (SLN) detection in apparent early-stage endometrial cancer (EC).DesignRetrospective study (Canadian Task Force classification II-2).SettingTwo academic research centers.PatientsConsecutive women with apparent early-stage EC who underwent surgical staging with SLN detection between November 2015 and April 2016.InterventionsThe surgical approach was a total laparoscopic extrafascial hysterectomy plus bilateral salpingo-oophorectomy and SLN detection. Systematic lymphadenectomy was performed in selected cases. In all patients, SLN detection was performed with cervical injection of indocyanine green and the use of an optical camera with a near-infrared high-intensity light source for detection of fluorescence imaging. All patients who underwent a minilaparoscopic approach (using one 5-mm scope and three 3-mm ancillary trocars) have been enrolled at the University of Insubria, whereas at the San Gerardo Hospital, standard laparoscopy was performed with one 10-mm scope and three 5-mm ancillary trocars.Measurements ad Main ResultsA total of 38 patients were enrolled, including 15 (39.5%) in the 3-mm group and 23 (60.5%) in the 5-mm group. No between-group differences were found in terms of demographic and tumor characteristics. Bilateral SLNs were detected in 73.3% of the patients in the 3-mm group and in 73.9% in the 5-mm group. Operative time, blood loss, hemoglobin drop, hospital stay, and the incidence and severity of complications were similar in the 2 groups. One patient (4.3%) in the standard 5-mm group had a positive SLN result (a micrometastasis in the left external iliac SLN). No positive SLNs were detected in the 3-mm group.ConclusionMinilaparoscopic SLN biopsy appears to be a promising and feasible technique for EC staging. Further research is warranted to investigate the possible benefits of 3-mm instruments in this specific setting.

ORIGINAL RESEARCHSexual Function after Radical Hysterectomy for Early-Stage Cervical Cancer: Is There a Difference between Laparoscopy and Laparotomy?

ABSTRACTIntroductionSurgical treatment for cervical cancer is associated with a high rate of late postoperative complications, and in particular with sexual dysfunction.AimTo evaluate sexual function in women who underwent radical hysterectomy (RH), in comparison with a control group of healthy women, using a validated questionnaire (Female Sexual Function Index [FSFI]). Then we tried to evaluate the possible differences between laparoscopic RH and abdominal RH in terms of their impact on sexuality.MethodsConsecutive sexually active women, who underwent RH for the treatment of early-stage cervical cancer between 2003 and 2007, were enrolled in this study (cases) and divided into two groups, according to the surgical approach. All women were administered the FSFI. The results of this questionnaire were compared between patients who underwent laparoscopic RH (LPS group) vs. women who underwent laparotomic RH (LPT group). The cases of RH were also compared with a control group of healthy women, who were referred to our outpatient clinic for a routine gynecologic evaluation.Main Outcome MeasuresFSFI questionnaire on six domains of female sexuality (desire, arousal, lubrication, orgasm, satisfaction, pain).ResultsA total of 38 patients were included. We also enrolled 35 women as healthy controls. FSFI score was significantly higher in the healthy controls vs. the cases of RH. In the LPS group, the total score and all the domains of the FSFI were lower in comparison with the healthy controls, whereas three of the six domains (arousal, lubrication, orgasm) and the total score of FSFI were lower in the LPT group if compared with the controls. There were no significant differences between LPS and LPT group.ConclusionsRH worsens sexual function, regardless of the type of surgical approach. In our experience, laparoscopy did not show any benefit on women's sexuality over the abdominal surgery for cervical cancer. Serati M, Salvatore S, Uccella S, Laterza RM, Cromi A, Ghezzi F, and Bolis P. Sexual function after radical hysterectomy for early-stage cervical cancer: Is there a difference between laparoscopy and laparotomy? J Sex Med 2009;6:2516–2522.

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