The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Ignacio Zapardiel - One of the best experts on this subject based on the ideXlab platform.
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intra operative identification of ureters using indocyanine green for Gynecological Oncology procedures
International Journal of Gynecological Cancer, 2020Co-Authors: Maria Cabanes, Felix Boria, Alicia Hernandez Gutierrez, Ignacio ZapardielAbstract:It is well known that ureteral injury is a possible complication of Gynecological surgery. The literature reports rates for ureteral injuries for pelvic surgery ranging from 1% to 10%[1 2][1] as the complexity of the procedure increases. Many of these injuries remain unrecognized during the surgery
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current situation in Gynecological Oncology training in spain where we are and where we want to go
Clinical & Translational Oncology, 2018Co-Authors: Pablo Padillaiserte, Ignacio Zapardiel, Lucas Minig, Luis Chiva, Rene Laky, J De SantiagoAbstract:It is important to know what a young gynecologic oncologist perceives as a need to achieve a good training in gynecologic Oncology. This study aims to evaluate the level of training in gynecologic Oncology in Spain. A Web-based anonymous questionnaire was sent via e-mail to Spanish trainees listed in European Network of Young Gynecological Oncology (ENYGO). The survey was developed in four sections: (1) general training in gynecologic Oncology, (2) distribution of current clinical activity, (3) surgical training, and (4) perspective future gynecologic Oncology. It contained 51 questions, with multiple-choice answers that had to be answered by the ENYGO members. The questionnaire was sent to 64 people listed in the ENYGO database. Of these, 37 members responded (response rate of 58%). Overall, more training in surgery is necessary, to perform radical oncological surgeries. It is claimed a sub-specialty recognition, to ensure an equalitarian and homogeneous training.
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robotic and advanced laparoscopic surgical training in european Gynecological Oncology trainees
International Journal of Gynecological Cancer, 2017Co-Authors: Carmen Gan, Jurgen M J Piek, Michaela Bossart, M Halaska, Dimitrios Haidopoulos, Ignacio Zapardiel, Jacek P Grabowski, Vesna Kesic, Rainer Kimmig, D CibulaAbstract:Introduction Advanced minimal access surgical training is an important component of training in Gynecological Oncology (GO). Europe-wide data on this topic are lacking. We present data on availability and trainee experience of advanced laparoscopic surgical (ALS) and robotic surgical (RS) training in GO across Europe. Method A prospective web-based anonymized survey of European GO trainees was sent to the European Network of Young Gynaecological Oncologists members/trainees. It included sociodemographic information and specific questions pertaining to training experience or satisfaction in laparoscopic and robotic surgery. χ2 test was used for evaluating categorical variables and Mann-Whitney/Kruskal-Wallis (nonparametric) tests for continuous variables between 2 and more independent groups. Results A total of 113 GO trainees from 29 countries responded. The mean (standard deviation) age was 35.2 (6.1) years, 59.3% were men, 40.7% were women, and 46% were in accredited training posts. The ALS and RS training was offered in only 43% and 23% of institutes respectively, and 54% and 23% of trainees had undergone some form of formal or informal training in ALS and RS respectively. A total of 62.4% felt that RS should be a formal component of GO training programs. A total of 61% and 35% planned to go outside their institute for ALS or RS training respectively. Trainees rating (1–5 scale) of their open surgery and ALS or RS skills (3.3/2.6/1.9) and training experience (3.5/2.8/2.1), respectively, were higher for open surgery than ALS or RS (P Conclusions Training and experience in ALS and RS are poorly rated by GO trainees across Europe, and only few centers offer this. There is an urgent need to expand and harmonize training opportunities for ALS and RS. Most trainees want RS included as a formal component of their training.
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european society of Gynecological Oncology statement on fibroid and uterine morcellation
International Journal of Gynecological Cancer, 2017Co-Authors: M Halaska, Dimitrios Haidopoulos, Ignacio Zapardiel, Frederic Guyon, Philippe Morice, Vesna KesicAbstract:: Recently, there has been an intense discussion about the issue of fibroid and uterine morcellation in relation to the risk of unrecognized uterine sarcoma spread. Morcellation can negatively influence the prognosis of patients, and transecting the specimen into pieces prevents the pathologist from performing proper disease staging. Many societies have published their statements regarding this issue. The European Society for Gynecological Oncology has established a working group of clinicians involved in diagnostics and treatment of oncoGynecological patients to provide a statement from the oncological point of view. Leiomyosarcomas and undifferentiated endometrial sarcomas have generally dismal prognosis, whereas low-grade endometrial stromal sarcomas and adenosarcomas have variable prognosis based on their stage. A focus on the detection of patients at risk of having a sarcoma should be mandatory before every surgery where morcellation is planned by evaluation of risk factors (African American descent, previous pelvic irradiation, use of tamoxifen, rapid lesion growth particularly in postmenopausal patients) and exclusion of patients with any suspicious ultrasonographic signs. Preoperative endometrial biopsy should be mandatory, although the sensitivity to detect sarcomas is low. An indication for myomectomy should be used only in patients with pregnancy plans; otherwise en bloc hysterectomy is preferred in both symptomatic and postmenopausal patients. Eliminating the technique of morcellation could lead to an increased morbidity in low-risk patients; therefore, after thorough preoperative evaluation and discussion with patients, morcellation still has its place in the armamentarium of gynecologic surgery.
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the work place educational climate in Gynecological Oncology fellowships across europe the impact of accreditation
International Journal of Gynecological Cancer, 2015Co-Authors: Jurgen M J Piek, Michaela Bossart, Klarke Boor, M Halaska, Dimitrios Haidopoulos, Ignacio Zapardiel, Jacek P Grabowski, Vesna Kesic, D Cibula, Nicoletta ColomboAbstract:Background: A good educational climate/environment in the workplace is essential for developing high-quality medical (sub)specialists. These data are lacking for Gynecological Oncology training. Objective: This study aims to evaluate the educational climate in Gynecological Oncology training throughout Europe and the factors affecting it. Methods: A Web-based anonymous survey sent to ENYGO (European Network of Young Gynecological Oncologists) members/trainees to assess Gynecological Oncology training. This included sociodemographic information, details regarding training posts, and a 50-item validated Dutch Residency Educational Climate Test (D-RECT) questionnaire with 11 subscales (1–5 Likert scale) to assess the educational climate. The [chi]2 test was used for evaluating categorical variables, and the Mann-Whitney U (nonparametric) test was used for continuous variables between 2 independent groups. Cronbach [alpha] assessed the questionnaire reliability. Multivariable linear regression assessed the effect of variables on D-RECT outcome subscales. Results: One hundred nineteen Gynecological oncological fellows responded. The D-RECT questionnaire was extremely reliable for assessing the educational environment in Gynecological Oncology (subscales’ Cronbach [alpha], 0.82–0.96). Overall, trainees do not seem to receive adequate/effective constructive feedback during training. The overall educational climate (supervision, coaching/assessment, feedback, teamwork, interconsultant relationships, formal education, role of the tutor, patient handover, and overall consultant’s attitude) was significantly better (P = 0.001) in centers providing accredited training in comparison with centers without such accreditation. Multivariable regression indicated the main factors independently associated with a better educational climate were presence of an accredited training post and total years of training. Conclusions: This study emphasizes the need for better feedback mechanisms and the importance of accreditation of centers for training in Gynecological Oncology to ensure training within higher quality clinical learning climates.
D Cibula - One of the best experts on this subject based on the ideXlab platform.
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robotic and advanced laparoscopic surgical training in european Gynecological Oncology trainees
International Journal of Gynecological Cancer, 2017Co-Authors: Carmen Gan, Jurgen M J Piek, Michaela Bossart, M Halaska, Dimitrios Haidopoulos, Ignacio Zapardiel, Jacek P Grabowski, Vesna Kesic, Rainer Kimmig, D CibulaAbstract:Introduction Advanced minimal access surgical training is an important component of training in Gynecological Oncology (GO). Europe-wide data on this topic are lacking. We present data on availability and trainee experience of advanced laparoscopic surgical (ALS) and robotic surgical (RS) training in GO across Europe. Method A prospective web-based anonymized survey of European GO trainees was sent to the European Network of Young Gynaecological Oncologists members/trainees. It included sociodemographic information and specific questions pertaining to training experience or satisfaction in laparoscopic and robotic surgery. χ2 test was used for evaluating categorical variables and Mann-Whitney/Kruskal-Wallis (nonparametric) tests for continuous variables between 2 and more independent groups. Results A total of 113 GO trainees from 29 countries responded. The mean (standard deviation) age was 35.2 (6.1) years, 59.3% were men, 40.7% were women, and 46% were in accredited training posts. The ALS and RS training was offered in only 43% and 23% of institutes respectively, and 54% and 23% of trainees had undergone some form of formal or informal training in ALS and RS respectively. A total of 62.4% felt that RS should be a formal component of GO training programs. A total of 61% and 35% planned to go outside their institute for ALS or RS training respectively. Trainees rating (1–5 scale) of their open surgery and ALS or RS skills (3.3/2.6/1.9) and training experience (3.5/2.8/2.1), respectively, were higher for open surgery than ALS or RS (P Conclusions Training and experience in ALS and RS are poorly rated by GO trainees across Europe, and only few centers offer this. There is an urgent need to expand and harmonize training opportunities for ALS and RS. Most trainees want RS included as a formal component of their training.
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the work place educational climate in Gynecological Oncology fellowships across europe the impact of accreditation
International Journal of Gynecological Cancer, 2015Co-Authors: Jurgen M J Piek, Michaela Bossart, Klarke Boor, M Halaska, Dimitrios Haidopoulos, Ignacio Zapardiel, Jacek P Grabowski, Vesna Kesic, D Cibula, Nicoletta ColomboAbstract:Background: A good educational climate/environment in the workplace is essential for developing high-quality medical (sub)specialists. These data are lacking for Gynecological Oncology training. Objective: This study aims to evaluate the educational climate in Gynecological Oncology training throughout Europe and the factors affecting it. Methods: A Web-based anonymous survey sent to ENYGO (European Network of Young Gynecological Oncologists) members/trainees to assess Gynecological Oncology training. This included sociodemographic information, details regarding training posts, and a 50-item validated Dutch Residency Educational Climate Test (D-RECT) questionnaire with 11 subscales (1–5 Likert scale) to assess the educational climate. The [chi]2 test was used for evaluating categorical variables, and the Mann-Whitney U (nonparametric) test was used for continuous variables between 2 independent groups. Cronbach [alpha] assessed the questionnaire reliability. Multivariable linear regression assessed the effect of variables on D-RECT outcome subscales. Results: One hundred nineteen Gynecological oncological fellows responded. The D-RECT questionnaire was extremely reliable for assessing the educational environment in Gynecological Oncology (subscales’ Cronbach [alpha], 0.82–0.96). Overall, trainees do not seem to receive adequate/effective constructive feedback during training. The overall educational climate (supervision, coaching/assessment, feedback, teamwork, interconsultant relationships, formal education, role of the tutor, patient handover, and overall consultant’s attitude) was significantly better (P = 0.001) in centers providing accredited training in comparison with centers without such accreditation. Multivariable regression indicated the main factors independently associated with a better educational climate were presence of an accredited training post and total years of training. Conclusions: This study emphasizes the need for better feedback mechanisms and the importance of accreditation of centers for training in Gynecological Oncology to ensure training within higher quality clinical learning climates.
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new classification system of radical hysterectomy emphasis on a three dimensional anatomic template for parametrial resection
Gynecologic Oncology, 2011Co-Authors: D Cibula, Pierluigi Benedettipanici, Francesco Raspagliesi, Nadeem R Aburustum, Christhardt Kohler, D Querleu, C P MorrowAbstract:Abstract Objective The international acceptance of a universal classification system for radical hysterectomy is one of the important challenges in gynecologic Oncology. The recently published classification system by Querleu and Morrow is a relevant proposal that has been well received by the professional community. However, it does not include a description of parametrial resection in three dimensions, which mostly determines post-operative morbidity. Methods The intention of this follow-up paper was to further develop the classification system based on the four proposed types of radical hysterectomy (A–D) into a three-dimensional model using standard anatomical landmarks for definition of resection margins in longitudinal and transverse dimensions and demonstrate it on pictures. Results Resection margins were defined in longitudinal and transverse dimensions for each suggested type of radical hysterectomy on all three parts of the parametria. Besides precise description using stable anatomical landmarks, all resection lines have been shown on intra-operative photographs. Conclusion Four types of radical hysteretomy can be precisely defined on a three-dimensional anatomical template, including nerve sparing procedure. Our paper should contribute to better standardization (including nomenclature) of the radical hysterectomy, enhancing harmonization of clinical practice in Gynecological Oncology.
Vesna Kesic - One of the best experts on this subject based on the ideXlab platform.
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robotic and advanced laparoscopic surgical training in european Gynecological Oncology trainees
International Journal of Gynecological Cancer, 2017Co-Authors: Carmen Gan, Jurgen M J Piek, Michaela Bossart, M Halaska, Dimitrios Haidopoulos, Ignacio Zapardiel, Jacek P Grabowski, Vesna Kesic, Rainer Kimmig, D CibulaAbstract:Introduction Advanced minimal access surgical training is an important component of training in Gynecological Oncology (GO). Europe-wide data on this topic are lacking. We present data on availability and trainee experience of advanced laparoscopic surgical (ALS) and robotic surgical (RS) training in GO across Europe. Method A prospective web-based anonymized survey of European GO trainees was sent to the European Network of Young Gynaecological Oncologists members/trainees. It included sociodemographic information and specific questions pertaining to training experience or satisfaction in laparoscopic and robotic surgery. χ2 test was used for evaluating categorical variables and Mann-Whitney/Kruskal-Wallis (nonparametric) tests for continuous variables between 2 and more independent groups. Results A total of 113 GO trainees from 29 countries responded. The mean (standard deviation) age was 35.2 (6.1) years, 59.3% were men, 40.7% were women, and 46% were in accredited training posts. The ALS and RS training was offered in only 43% and 23% of institutes respectively, and 54% and 23% of trainees had undergone some form of formal or informal training in ALS and RS respectively. A total of 62.4% felt that RS should be a formal component of GO training programs. A total of 61% and 35% planned to go outside their institute for ALS or RS training respectively. Trainees rating (1–5 scale) of their open surgery and ALS or RS skills (3.3/2.6/1.9) and training experience (3.5/2.8/2.1), respectively, were higher for open surgery than ALS or RS (P Conclusions Training and experience in ALS and RS are poorly rated by GO trainees across Europe, and only few centers offer this. There is an urgent need to expand and harmonize training opportunities for ALS and RS. Most trainees want RS included as a formal component of their training.
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european society of Gynecological Oncology statement on fibroid and uterine morcellation
International Journal of Gynecological Cancer, 2017Co-Authors: M Halaska, Dimitrios Haidopoulos, Ignacio Zapardiel, Frederic Guyon, Philippe Morice, Vesna KesicAbstract:: Recently, there has been an intense discussion about the issue of fibroid and uterine morcellation in relation to the risk of unrecognized uterine sarcoma spread. Morcellation can negatively influence the prognosis of patients, and transecting the specimen into pieces prevents the pathologist from performing proper disease staging. Many societies have published their statements regarding this issue. The European Society for Gynecological Oncology has established a working group of clinicians involved in diagnostics and treatment of oncoGynecological patients to provide a statement from the oncological point of view. Leiomyosarcomas and undifferentiated endometrial sarcomas have generally dismal prognosis, whereas low-grade endometrial stromal sarcomas and adenosarcomas have variable prognosis based on their stage. A focus on the detection of patients at risk of having a sarcoma should be mandatory before every surgery where morcellation is planned by evaluation of risk factors (African American descent, previous pelvic irradiation, use of tamoxifen, rapid lesion growth particularly in postmenopausal patients) and exclusion of patients with any suspicious ultrasonographic signs. Preoperative endometrial biopsy should be mandatory, although the sensitivity to detect sarcomas is low. An indication for myomectomy should be used only in patients with pregnancy plans; otherwise en bloc hysterectomy is preferred in both symptomatic and postmenopausal patients. Eliminating the technique of morcellation could lead to an increased morbidity in low-risk patients; therefore, after thorough preoperative evaluation and discussion with patients, morcellation still has its place in the armamentarium of gynecologic surgery.
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european society of Gynecological Oncology task force for fertility preservation clinical recommendations for fertility sparing management in young endometrial cancer patients
International Journal of Gynecological Cancer, 2015Co-Authors: Alexandros Rodolakis, Vesna Kesic, Philippe Morice, Ioannis Biliatis, Nicholas Reed, Mandy Mangler, Dominik DenschlagAbstract:Endometrial cancer (EC) in young women of reproductive age is a relatively rare diagnosis. However, since in the modern era women delay their childbearing for a variety of social reasons, more and more women in the near future will be nulliparous and have a diagnosis of EC at the same time. Hence, a more conservative approach of EC is desirable to preserve fertility of these women, without compromising their survival. Recently, the number of studies reporting encouraging results on fertility-sparing management of EC with high dose of progestins is increasing. It seems that preserving the uterus and the ovaries in a carefully selected patient with EC confers only a very small risk combined with an enormous benefit. Selection of women suitable for such a conservative approach, as well as method of treatment, follow-up, recurrence, obstetric outcomes, and survival rates are very important parameters when consulting women with EC wishing to preserve their fertility. In this article, we try to elucidate all the previously mentioned aspects and formulate clinical recommendations, based on published data, about the most proper approach and consultation of these patients.
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the work place educational climate in Gynecological Oncology fellowships across europe the impact of accreditation
International Journal of Gynecological Cancer, 2015Co-Authors: Jurgen M J Piek, Michaela Bossart, Klarke Boor, M Halaska, Dimitrios Haidopoulos, Ignacio Zapardiel, Jacek P Grabowski, Vesna Kesic, D Cibula, Nicoletta ColomboAbstract:Background: A good educational climate/environment in the workplace is essential for developing high-quality medical (sub)specialists. These data are lacking for Gynecological Oncology training. Objective: This study aims to evaluate the educational climate in Gynecological Oncology training throughout Europe and the factors affecting it. Methods: A Web-based anonymous survey sent to ENYGO (European Network of Young Gynecological Oncologists) members/trainees to assess Gynecological Oncology training. This included sociodemographic information, details regarding training posts, and a 50-item validated Dutch Residency Educational Climate Test (D-RECT) questionnaire with 11 subscales (1–5 Likert scale) to assess the educational climate. The [chi]2 test was used for evaluating categorical variables, and the Mann-Whitney U (nonparametric) test was used for continuous variables between 2 independent groups. Cronbach [alpha] assessed the questionnaire reliability. Multivariable linear regression assessed the effect of variables on D-RECT outcome subscales. Results: One hundred nineteen Gynecological oncological fellows responded. The D-RECT questionnaire was extremely reliable for assessing the educational environment in Gynecological Oncology (subscales’ Cronbach [alpha], 0.82–0.96). Overall, trainees do not seem to receive adequate/effective constructive feedback during training. The overall educational climate (supervision, coaching/assessment, feedback, teamwork, interconsultant relationships, formal education, role of the tutor, patient handover, and overall consultant’s attitude) was significantly better (P = 0.001) in centers providing accredited training in comparison with centers without such accreditation. Multivariable regression indicated the main factors independently associated with a better educational climate were presence of an accredited training post and total years of training. Conclusions: This study emphasizes the need for better feedback mechanisms and the importance of accreditation of centers for training in Gynecological Oncology to ensure training within higher quality clinical learning climates.
M Halaska - One of the best experts on this subject based on the ideXlab platform.
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robotic and advanced laparoscopic surgical training in european Gynecological Oncology trainees
International Journal of Gynecological Cancer, 2017Co-Authors: Carmen Gan, Jurgen M J Piek, Michaela Bossart, M Halaska, Dimitrios Haidopoulos, Ignacio Zapardiel, Jacek P Grabowski, Vesna Kesic, Rainer Kimmig, D CibulaAbstract:Introduction Advanced minimal access surgical training is an important component of training in Gynecological Oncology (GO). Europe-wide data on this topic are lacking. We present data on availability and trainee experience of advanced laparoscopic surgical (ALS) and robotic surgical (RS) training in GO across Europe. Method A prospective web-based anonymized survey of European GO trainees was sent to the European Network of Young Gynaecological Oncologists members/trainees. It included sociodemographic information and specific questions pertaining to training experience or satisfaction in laparoscopic and robotic surgery. χ2 test was used for evaluating categorical variables and Mann-Whitney/Kruskal-Wallis (nonparametric) tests for continuous variables between 2 and more independent groups. Results A total of 113 GO trainees from 29 countries responded. The mean (standard deviation) age was 35.2 (6.1) years, 59.3% were men, 40.7% were women, and 46% were in accredited training posts. The ALS and RS training was offered in only 43% and 23% of institutes respectively, and 54% and 23% of trainees had undergone some form of formal or informal training in ALS and RS respectively. A total of 62.4% felt that RS should be a formal component of GO training programs. A total of 61% and 35% planned to go outside their institute for ALS or RS training respectively. Trainees rating (1–5 scale) of their open surgery and ALS or RS skills (3.3/2.6/1.9) and training experience (3.5/2.8/2.1), respectively, were higher for open surgery than ALS or RS (P Conclusions Training and experience in ALS and RS are poorly rated by GO trainees across Europe, and only few centers offer this. There is an urgent need to expand and harmonize training opportunities for ALS and RS. Most trainees want RS included as a formal component of their training.
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european society of Gynecological Oncology statement on fibroid and uterine morcellation
International Journal of Gynecological Cancer, 2017Co-Authors: M Halaska, Dimitrios Haidopoulos, Ignacio Zapardiel, Frederic Guyon, Philippe Morice, Vesna KesicAbstract:: Recently, there has been an intense discussion about the issue of fibroid and uterine morcellation in relation to the risk of unrecognized uterine sarcoma spread. Morcellation can negatively influence the prognosis of patients, and transecting the specimen into pieces prevents the pathologist from performing proper disease staging. Many societies have published their statements regarding this issue. The European Society for Gynecological Oncology has established a working group of clinicians involved in diagnostics and treatment of oncoGynecological patients to provide a statement from the oncological point of view. Leiomyosarcomas and undifferentiated endometrial sarcomas have generally dismal prognosis, whereas low-grade endometrial stromal sarcomas and adenosarcomas have variable prognosis based on their stage. A focus on the detection of patients at risk of having a sarcoma should be mandatory before every surgery where morcellation is planned by evaluation of risk factors (African American descent, previous pelvic irradiation, use of tamoxifen, rapid lesion growth particularly in postmenopausal patients) and exclusion of patients with any suspicious ultrasonographic signs. Preoperative endometrial biopsy should be mandatory, although the sensitivity to detect sarcomas is low. An indication for myomectomy should be used only in patients with pregnancy plans; otherwise en bloc hysterectomy is preferred in both symptomatic and postmenopausal patients. Eliminating the technique of morcellation could lead to an increased morbidity in low-risk patients; therefore, after thorough preoperative evaluation and discussion with patients, morcellation still has its place in the armamentarium of gynecologic surgery.
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the work place educational climate in Gynecological Oncology fellowships across europe the impact of accreditation
International Journal of Gynecological Cancer, 2015Co-Authors: Jurgen M J Piek, Michaela Bossart, Klarke Boor, M Halaska, Dimitrios Haidopoulos, Ignacio Zapardiel, Jacek P Grabowski, Vesna Kesic, D Cibula, Nicoletta ColomboAbstract:Background: A good educational climate/environment in the workplace is essential for developing high-quality medical (sub)specialists. These data are lacking for Gynecological Oncology training. Objective: This study aims to evaluate the educational climate in Gynecological Oncology training throughout Europe and the factors affecting it. Methods: A Web-based anonymous survey sent to ENYGO (European Network of Young Gynecological Oncologists) members/trainees to assess Gynecological Oncology training. This included sociodemographic information, details regarding training posts, and a 50-item validated Dutch Residency Educational Climate Test (D-RECT) questionnaire with 11 subscales (1–5 Likert scale) to assess the educational climate. The [chi]2 test was used for evaluating categorical variables, and the Mann-Whitney U (nonparametric) test was used for continuous variables between 2 independent groups. Cronbach [alpha] assessed the questionnaire reliability. Multivariable linear regression assessed the effect of variables on D-RECT outcome subscales. Results: One hundred nineteen Gynecological oncological fellows responded. The D-RECT questionnaire was extremely reliable for assessing the educational environment in Gynecological Oncology (subscales’ Cronbach [alpha], 0.82–0.96). Overall, trainees do not seem to receive adequate/effective constructive feedback during training. The overall educational climate (supervision, coaching/assessment, feedback, teamwork, interconsultant relationships, formal education, role of the tutor, patient handover, and overall consultant’s attitude) was significantly better (P = 0.001) in centers providing accredited training in comparison with centers without such accreditation. Multivariable regression indicated the main factors independently associated with a better educational climate were presence of an accredited training post and total years of training. Conclusions: This study emphasizes the need for better feedback mechanisms and the importance of accreditation of centers for training in Gynecological Oncology to ensure training within higher quality clinical learning climates.
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current classification of malignant tumours in Gynecological Oncology part ii
Ceská gynekologie Ceská lékarská spolecnost J. Ev. Purkyne, 2011Co-Authors: Borek Sehnal, M Halaska, D Driak, E Kmonickova, M Dvorska, M Hosova, K Citterbart, Dusan KolarikAbstract:Objective Review of new staging systems for gynaecological cancers and their impact on prognosis and planning treatment. Design Review article. Setting Department of Gynaecology and Obstetrics, First Faculty of Medicine and University Hospital Na Bulovce, Charles University, Prague; Department of Radiotherapeutic Oncology, First Faculty of Medicine and University Hospital Na Bulovce, Charles University, Prague; Department of Pathology, University Hospital Na Bulovce, Prague. Results Every staging system should have 3 basic characteristics: it must be valid, reliable, and practical. Over the years, these staging classifications--with the exception of cervical cancer and gestational trophoblastic neoplasia--have shifted from a clinical to a surgical-pathological basis. Changes based on new findings were proposed in 2008 by the FIGO Committee on Gynecologic Oncology, approved in September 2008 by the FIGO Executive Board, and published in 2009. The greatest changes were made in the new staging system for carcinoma of the vulva and others in the new staging systems for carcinoma of the cervix and carcinoma of the endometrium. A new stanging system was also created for uterina sarcomas, based on the criteria used in other soft tissue sarcomas. A clinical staging system for carcinoma of cervix continues because surgical staging cannot be employed worldwide (especially in third world countries). Stage 0 has been deleted from the staging of all tumours, since it is pre-invasive lesion and it is not an invasive tumour. In the revised staging system for carcinoma of the endometrium, four fundamental changes have occurred, which will be discussed. Carcinosarcoma is still staged identically to carcinoma of the endometrium. A completely new staging system was created for adenosarcomas, along with an almost identical staging system for leiomyosarcoma and endometrial stromal sarcoma. The staging system for carcinoma of ovary and Fallopian tube remains without changes. Conclusion Since medical research and practice in the field of Oncology have shown explosive growth, the staging of some of the gynaecological cancers did not give a good spread of prognostic groupings. Therefore, revised FIGO and TNM staging system has been structured to represent major prognostic factors in predicting patients' outcomes and lending order to the complex dynamic behavior of gynaecological cancers. The purpose of good staging system is to offer a classification of the extent of gynaecological cancer in order to provide a method of conveying one's clinical experience to others for the comparison of treatment methods.
Dimitrios Haidopoulos - One of the best experts on this subject based on the ideXlab platform.
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robotic and advanced laparoscopic surgical training in european Gynecological Oncology trainees
International Journal of Gynecological Cancer, 2017Co-Authors: Carmen Gan, Jurgen M J Piek, Michaela Bossart, M Halaska, Dimitrios Haidopoulos, Ignacio Zapardiel, Jacek P Grabowski, Vesna Kesic, Rainer Kimmig, D CibulaAbstract:Introduction Advanced minimal access surgical training is an important component of training in Gynecological Oncology (GO). Europe-wide data on this topic are lacking. We present data on availability and trainee experience of advanced laparoscopic surgical (ALS) and robotic surgical (RS) training in GO across Europe. Method A prospective web-based anonymized survey of European GO trainees was sent to the European Network of Young Gynaecological Oncologists members/trainees. It included sociodemographic information and specific questions pertaining to training experience or satisfaction in laparoscopic and robotic surgery. χ2 test was used for evaluating categorical variables and Mann-Whitney/Kruskal-Wallis (nonparametric) tests for continuous variables between 2 and more independent groups. Results A total of 113 GO trainees from 29 countries responded. The mean (standard deviation) age was 35.2 (6.1) years, 59.3% were men, 40.7% were women, and 46% were in accredited training posts. The ALS and RS training was offered in only 43% and 23% of institutes respectively, and 54% and 23% of trainees had undergone some form of formal or informal training in ALS and RS respectively. A total of 62.4% felt that RS should be a formal component of GO training programs. A total of 61% and 35% planned to go outside their institute for ALS or RS training respectively. Trainees rating (1–5 scale) of their open surgery and ALS or RS skills (3.3/2.6/1.9) and training experience (3.5/2.8/2.1), respectively, were higher for open surgery than ALS or RS (P Conclusions Training and experience in ALS and RS are poorly rated by GO trainees across Europe, and only few centers offer this. There is an urgent need to expand and harmonize training opportunities for ALS and RS. Most trainees want RS included as a formal component of their training.
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european society of Gynecological Oncology statement on fibroid and uterine morcellation
International Journal of Gynecological Cancer, 2017Co-Authors: M Halaska, Dimitrios Haidopoulos, Ignacio Zapardiel, Frederic Guyon, Philippe Morice, Vesna KesicAbstract:: Recently, there has been an intense discussion about the issue of fibroid and uterine morcellation in relation to the risk of unrecognized uterine sarcoma spread. Morcellation can negatively influence the prognosis of patients, and transecting the specimen into pieces prevents the pathologist from performing proper disease staging. Many societies have published their statements regarding this issue. The European Society for Gynecological Oncology has established a working group of clinicians involved in diagnostics and treatment of oncoGynecological patients to provide a statement from the oncological point of view. Leiomyosarcomas and undifferentiated endometrial sarcomas have generally dismal prognosis, whereas low-grade endometrial stromal sarcomas and adenosarcomas have variable prognosis based on their stage. A focus on the detection of patients at risk of having a sarcoma should be mandatory before every surgery where morcellation is planned by evaluation of risk factors (African American descent, previous pelvic irradiation, use of tamoxifen, rapid lesion growth particularly in postmenopausal patients) and exclusion of patients with any suspicious ultrasonographic signs. Preoperative endometrial biopsy should be mandatory, although the sensitivity to detect sarcomas is low. An indication for myomectomy should be used only in patients with pregnancy plans; otherwise en bloc hysterectomy is preferred in both symptomatic and postmenopausal patients. Eliminating the technique of morcellation could lead to an increased morbidity in low-risk patients; therefore, after thorough preoperative evaluation and discussion with patients, morcellation still has its place in the armamentarium of gynecologic surgery.
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the work place educational climate in Gynecological Oncology fellowships across europe the impact of accreditation
International Journal of Gynecological Cancer, 2015Co-Authors: Jurgen M J Piek, Michaela Bossart, Klarke Boor, M Halaska, Dimitrios Haidopoulos, Ignacio Zapardiel, Jacek P Grabowski, Vesna Kesic, D Cibula, Nicoletta ColomboAbstract:Background: A good educational climate/environment in the workplace is essential for developing high-quality medical (sub)specialists. These data are lacking for Gynecological Oncology training. Objective: This study aims to evaluate the educational climate in Gynecological Oncology training throughout Europe and the factors affecting it. Methods: A Web-based anonymous survey sent to ENYGO (European Network of Young Gynecological Oncologists) members/trainees to assess Gynecological Oncology training. This included sociodemographic information, details regarding training posts, and a 50-item validated Dutch Residency Educational Climate Test (D-RECT) questionnaire with 11 subscales (1–5 Likert scale) to assess the educational climate. The [chi]2 test was used for evaluating categorical variables, and the Mann-Whitney U (nonparametric) test was used for continuous variables between 2 independent groups. Cronbach [alpha] assessed the questionnaire reliability. Multivariable linear regression assessed the effect of variables on D-RECT outcome subscales. Results: One hundred nineteen Gynecological oncological fellows responded. The D-RECT questionnaire was extremely reliable for assessing the educational environment in Gynecological Oncology (subscales’ Cronbach [alpha], 0.82–0.96). Overall, trainees do not seem to receive adequate/effective constructive feedback during training. The overall educational climate (supervision, coaching/assessment, feedback, teamwork, interconsultant relationships, formal education, role of the tutor, patient handover, and overall consultant’s attitude) was significantly better (P = 0.001) in centers providing accredited training in comparison with centers without such accreditation. Multivariable regression indicated the main factors independently associated with a better educational climate were presence of an accredited training post and total years of training. Conclusions: This study emphasizes the need for better feedback mechanisms and the importance of accreditation of centers for training in Gynecological Oncology to ensure training within higher quality clinical learning climates.