Assistant Professor in the Unit of Obstetrics and Gynecology, “Paolo Giaccone” Hospital, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo (Palermo, Italy).
Antonio Simone Laganà was born in Reggio Calabria (Italy) on 8th May 1986. He is Coordinator of the Special Interest Group for Endometriosis & Endometrial Disorders (SIGEED) of the European Society of Human Reproduction and Embryology (ESHRE).
Antonio Simone Laganà was trained in obstetric/gynecological ultrasound at the Altamedica Main Centre in Rome (Italy), got the Master in “Gynecological Minimally Invasive and Robotic Surgery” at the University of Pisa (Italy), the Ph.D. in “Medical and Surgical Biotechnologies” at the University of Messina (Italy), and developed an intensive training in minimally invasive gynecological surgery (high-volume advanced laparoscopy, hysteroscopy) at the Univerzitetni Klinični Center Ljubljana (Slovenia), during the Subspecialist Training Programme (Fellowship) in Reproductive Medicine (according to the criteria of the European Society of Human Reproduction and Embryology, ESHRE, and European Board and College of Gynecology and Obstetrics, EBCOG).
His research interests include endometriosis, reproductive immunology, infertility, gynaecological endocrinology, laparoscopy, and hysteroscopy. He is the author of more than 440 papers published in PubMed-indexed international peer-reviewed journals, and his presence is often requested as an invited speaker at international congresses. He is currently an editor of high-impact journals, including Scientific Reports, Journal of Minimally Invasive Gynecology, Journal of Ovarian Research, Gynecologic and Obstetric Investigation, and many others.
He is habilitated as Full Professor in Italy for Gynecology and Obstetrics.
Address: Messina (Italy)
Antonio Simone Laganà was born in Reggio Calabria (Italy) on 8th May 1986. He is Coordinator of the Special Interest Group for Endometriosis & Endometrial Disorders (SIGEED) of the European Society of Human Reproduction and Embryology (ESHRE).
Antonio Simone Laganà was trained in obstetric/gynecological ultrasound at the Altamedica Main Centre in Rome (Italy), got the Master in “Gynecological Minimally Invasive and Robotic Surgery” at the University of Pisa (Italy), the Ph.D. in “Medical and Surgical Biotechnologies” at the University of Messina (Italy), and developed an intensive training in minimally invasive gynecological surgery (high-volume advanced laparoscopy, hysteroscopy) at the Univerzitetni Klinični Center Ljubljana (Slovenia), during the Subspecialist Training Programme (Fellowship) in Reproductive Medicine (according to the criteria of the European Society of Human Reproduction and Embryology, ESHRE, and European Board and College of Gynecology and Obstetrics, EBCOG).
His research interests include endometriosis, reproductive immunology, infertility, gynaecological endocrinology, laparoscopy, and hysteroscopy. He is the author of more than 440 papers published in PubMed-indexed international peer-reviewed journals, and his presence is often requested as an invited speaker at international congresses. He is currently an editor of high-impact journals, including Scientific Reports, Journal of Minimally Invasive Gynecology, Journal of Ovarian Research, Gynecologic and Obstetric Investigation, and many others.
He is habilitated as Full Professor in Italy for Gynecology and Obstetrics.
Address: Messina (Italy)
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Papers by Antonio Simone Laganà
Case presentation. We reported clinical, diagnostic and therapeutical choices of a 44-year aged patient with a rare abnormally sized vulvar lipoma. A Diamond-shaped skin incision was performed and the neoformation was removed without capsule lesions. A vaginal plastic skin-reducing was performed to reduce redundant tissue. The deep planes of the lesion have been reconstructed to avoid leakage.
Conclusions. This kind of lipomas can be potentially diagnosed through clinical examination because of their specific characteristics. However, imaging is advisable to differentiate benign neoplasm from malignant one. Different approaches can be achieved for lipomas based on the size of lump, patient’s feelings and necessities and the operation goals; however, the complete surgical excision with the removal of capsules to prevent recurrence remains the treatment of choice for vulvar lipomas. Different surgical approaches aim to achieve better esthetical results, less scarring, and less colour discordance of the connected tissues post-surgery. Surgery is the gold standard for treatment of vulvar lesions. Currently, there is no evidence of long-term follow-up in the literature. We recommend an adequate counselling with the patient to understand their needs and encouraging them to seek medical advice and to tailor the treatment of such lesions.
Case presentation. We describe a case of silent spontaneous uterine rupture diagnosed during a planned cesarean section in a patient at 38+4 weeks’ gestation with two previous cesarean sections. The mother and newborn were discharged three days later in good health and without complications.
Conclusions. Worldwide, the frequency of cesarean deliveries has increased in recent decades and uterine rupture is a very rare catastrophic emergency that can have dramatic consequences. Our case report shows that uterine rupture can occur in pregnancy before labour without any signs or symptoms. Despite the uterine rupture with extrusion of the intact amniotic sac, there were no complications for the mother or the foetus. Timely diagnosis is crucial and future research should find more reproducible parameters to objectify the risk of silent uterine rupture and define the timing of delivery of previous cesarean sections requiring a new surgical delivery. All patients with previous cesarean sections should be counselled about the possibility of early delivery by cesarean section.
Design: This is a retrospective cohort study on prospectively collected data.
Setting: The study was conducted at tertiary care university hospital.
Participants: Participants were infertile women with histopathological diagnosis of endometriosis.
Methods: For 12 months (January 2018 to January 2019), women were deemed suitable and subsequently divided according to serum TSH levels above or below 2.5 mIU/L and compared to patients without endometriosis. Needed sample size was at least 41 patients for each cohort of women. Co-primary outcomes were the live birth rate (LBR), clinical pregnancy rate (CPR), and pregnancy loss rate (PLR).
Results: Overall, 226 women (45 with endometriosis and 181 controls without endometriosis) were included. Diagnoses of Hashimoto thyroiditis were significantly more frequent in women with rather than without endometriosis (14/45 [31.1%] vs. 27/181 [14.9%]; p = 0.012). Similarly, in women with endometriosis, Hashimoto diagnosis rates were higher with TSH ≥2.5 mIU/L compared to TSH <2.5 mIU/L (9/15 [60%] vs.5/30 [16.6%]; p = 0.001) so were the Hashimoto diagnosis rates in control group (women without endometriosis) with TSH ≥2.5 mIU/L compared to TSH <2.5 mIU/L (17/48 [35.4%] vs. 10/133 [7.5%], respectively; p = 0.001). Effect size analysis confirmed an increased risk of Hashimoto thyroiditis in women with endometriosis and TSH ≥2.5 mIU/L compared to women with endometriosis and TSH <2.5 mIU/L (risk ratio [RR] 3.60 [95% CI 1.46-8.86]) and in women with endometriosis and TSH ≥2.5 mIU/L compared to non-endometriotic euthyroid patients (RR 7.98 [95% CI 3.86-16.48]). Dysmenorrhea risk was higher in endometriotic euthyroid women compared to euthyroid patients with no endometriosis (RR 1.87 [95% CI 1.21-2.87]). The risk was still increased in euthyroid women with endometriosis relative to dysthyroid women with no endometriosis (RR 1.97 [95% CI 1.11-3.50]). There were no significant differences between the four groups for CPR, LBR, PLR and retrieved oocytes, immature oocytes, degenerated and unfertilized oocytes, cultured blastocysts, embryos and transferred embryos.
Limitations: Limitations of the study were retrospective design, limited sample size, and use of different ovarian stimulation protocol.
Conclusions: Thyroid autoimmunity seems more common in women with endometriosis and TSH over 2.5 mIU/L. However, there was no significant impact on in vitro fertilization and reproductive outcomes related to the coexistence of endometriosis, Hashimoto disease, and higher TSH levels. Due to limitations of the study, additional evidence is required to validate the abovementioned findings.
Design: Retrospective cross-sectional study (ClinicalTrial iD: NCT06184139), including only late-term pregnancies in healthy nulliparous women and single cephalic fetus with normal birthweight. Specify the type of study (randomized, prospective cohort, case-control, other) and include the number of study subjects (cases/controls), treatment type and duration, sampling procedures if applicable.
Participants/materials, setting, methods: One-hundred-and-four pregnant women underwent induction of labor with oral misoprostol for late-term pregnancy on the 290th day of gestation. Study population was divided in two groups based on age (<35 and ≥35 years) and obesity (BMI <30 and ≥30). Statistical analysis was performed using SPSS V.21.0 (IBM Corporation, Armonk, NY). The inclusion of 51 women from each of the two arms achieved 80% power with an alpha error of 0.05. Continuous variables were expressed as the mean and standard deviation (SD). Categorical variables are expressed as frequencies and percentages. Results No statistically significant differences were recorded between younger and older women. Obese women reported a longer time between the last dose of misoprostol and cervical dilation of 6 cm (p=0.01), a longer time between the last dose of misoprostol and delivery (p=0.04), and a higher rate of grade II vaginal lacerations (p=0.02). Limitations While this study contributes novel insights into cervical ripening and labor induction using oral misoprostol for late-term pregnancies, its scope is limited by the retrospective study design, inherently carrying biases compared to prospective approaches, and the limited sample size within the study cohort. Conclusions Maternal BMI is a factor negatively influencing the efficacy of oral misoprostol for induction of labor in late-term pregnancy.
Objectives: This article is aimed to summarize and discuss cutting-edge elements about the diagnosis and management of uterine fibroids and sarcomas.
Methods: This paper is a report of the lectures presented in an expert meeting about uterine fibroids and sarcomas held in Palermo in February 2023.
Outcome: Overall, the combination of novel molecular pathways may help combine biomarkers and expert ultrasound for the differential diagnosis of uterine fibroids and sarcomas. On the one hand, molecular and cellular maps of uterine fibroids and matched myometrium may enhance our understanding of tumor development compared to histologic analysis and whole tissue transcriptomics, and support the development of minimally invasive treatment strategies; on the other hand, ultrasound imaging allows in most of the cases a proper mapping the fibroids and to differentiate between benign and malignant lesions, which need appropriate management.
Conclusions and outlook: The choice of uterine fibroid management, including pharmacological approaches, surgical treatment, or other strategies, such as high-intensity focused ultrasound (HIFU), should be carefully considered, taking into account the characteristics of the patient and reproductive prognosis.
Methods: A comprehensive search of the literature was carried out on the following databases: MEDLINE, EMBASE, Global Health, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register), the Health Technology Assessment Database, and Web of Science. Only original studies that reported the oncologic and reproductive outcomes of patients with stage IA and G2EC tumors who underwent FST were considered eligible for inclusion in this systematic review (CRD42023484892). Studies describing only the FST for endometrial hyperplasia or G1 EC were excluded.
Results: Twenty-two papers that met the abovementioned inclusion criteria were included in the present systematic review. Preliminary analysis suggested encouraging oncologic and reproductive outcomes after FST.
Conclusions: The FST approach may represent a feasible and safe option for women of childbearing age diagnosed with G2EC. Despite these promising findings, cautious interpretation is warranted due to inherent limitations, including heterogeneity in study designs and potential biases. Further research with standardized methodologies and larger sample sizes is imperative for obtaining more robust conclusions.
Case presentation. We reported clinical, diagnostic and therapeutical choices of a 44-year aged patient with a rare abnormally sized vulvar lipoma. A Diamond-shaped skin incision was performed and the neoformation was removed without capsule lesions. A vaginal plastic skin-reducing was performed to reduce redundant tissue. The deep planes of the lesion have been reconstructed to avoid leakage.
Conclusions. This kind of lipomas can be potentially diagnosed through clinical examination because of their specific characteristics. However, imaging is advisable to differentiate benign neoplasm from malignant one. Different approaches can be achieved for lipomas based on the size of lump, patient’s feelings and necessities and the operation goals; however, the complete surgical excision with the removal of capsules to prevent recurrence remains the treatment of choice for vulvar lipomas. Different surgical approaches aim to achieve better esthetical results, less scarring, and less colour discordance of the connected tissues post-surgery. Surgery is the gold standard for treatment of vulvar lesions. Currently, there is no evidence of long-term follow-up in the literature. We recommend an adequate counselling with the patient to understand their needs and encouraging them to seek medical advice and to tailor the treatment of such lesions.
Case presentation. We describe a case of silent spontaneous uterine rupture diagnosed during a planned cesarean section in a patient at 38+4 weeks’ gestation with two previous cesarean sections. The mother and newborn were discharged three days later in good health and without complications.
Conclusions. Worldwide, the frequency of cesarean deliveries has increased in recent decades and uterine rupture is a very rare catastrophic emergency that can have dramatic consequences. Our case report shows that uterine rupture can occur in pregnancy before labour without any signs or symptoms. Despite the uterine rupture with extrusion of the intact amniotic sac, there were no complications for the mother or the foetus. Timely diagnosis is crucial and future research should find more reproducible parameters to objectify the risk of silent uterine rupture and define the timing of delivery of previous cesarean sections requiring a new surgical delivery. All patients with previous cesarean sections should be counselled about the possibility of early delivery by cesarean section.
Design: This is a retrospective cohort study on prospectively collected data.
Setting: The study was conducted at tertiary care university hospital.
Participants: Participants were infertile women with histopathological diagnosis of endometriosis.
Methods: For 12 months (January 2018 to January 2019), women were deemed suitable and subsequently divided according to serum TSH levels above or below 2.5 mIU/L and compared to patients without endometriosis. Needed sample size was at least 41 patients for each cohort of women. Co-primary outcomes were the live birth rate (LBR), clinical pregnancy rate (CPR), and pregnancy loss rate (PLR).
Results: Overall, 226 women (45 with endometriosis and 181 controls without endometriosis) were included. Diagnoses of Hashimoto thyroiditis were significantly more frequent in women with rather than without endometriosis (14/45 [31.1%] vs. 27/181 [14.9%]; p = 0.012). Similarly, in women with endometriosis, Hashimoto diagnosis rates were higher with TSH ≥2.5 mIU/L compared to TSH <2.5 mIU/L (9/15 [60%] vs.5/30 [16.6%]; p = 0.001) so were the Hashimoto diagnosis rates in control group (women without endometriosis) with TSH ≥2.5 mIU/L compared to TSH <2.5 mIU/L (17/48 [35.4%] vs. 10/133 [7.5%], respectively; p = 0.001). Effect size analysis confirmed an increased risk of Hashimoto thyroiditis in women with endometriosis and TSH ≥2.5 mIU/L compared to women with endometriosis and TSH <2.5 mIU/L (risk ratio [RR] 3.60 [95% CI 1.46-8.86]) and in women with endometriosis and TSH ≥2.5 mIU/L compared to non-endometriotic euthyroid patients (RR 7.98 [95% CI 3.86-16.48]). Dysmenorrhea risk was higher in endometriotic euthyroid women compared to euthyroid patients with no endometriosis (RR 1.87 [95% CI 1.21-2.87]). The risk was still increased in euthyroid women with endometriosis relative to dysthyroid women with no endometriosis (RR 1.97 [95% CI 1.11-3.50]). There were no significant differences between the four groups for CPR, LBR, PLR and retrieved oocytes, immature oocytes, degenerated and unfertilized oocytes, cultured blastocysts, embryos and transferred embryos.
Limitations: Limitations of the study were retrospective design, limited sample size, and use of different ovarian stimulation protocol.
Conclusions: Thyroid autoimmunity seems more common in women with endometriosis and TSH over 2.5 mIU/L. However, there was no significant impact on in vitro fertilization and reproductive outcomes related to the coexistence of endometriosis, Hashimoto disease, and higher TSH levels. Due to limitations of the study, additional evidence is required to validate the abovementioned findings.
Design: Retrospective cross-sectional study (ClinicalTrial iD: NCT06184139), including only late-term pregnancies in healthy nulliparous women and single cephalic fetus with normal birthweight. Specify the type of study (randomized, prospective cohort, case-control, other) and include the number of study subjects (cases/controls), treatment type and duration, sampling procedures if applicable.
Participants/materials, setting, methods: One-hundred-and-four pregnant women underwent induction of labor with oral misoprostol for late-term pregnancy on the 290th day of gestation. Study population was divided in two groups based on age (<35 and ≥35 years) and obesity (BMI <30 and ≥30). Statistical analysis was performed using SPSS V.21.0 (IBM Corporation, Armonk, NY). The inclusion of 51 women from each of the two arms achieved 80% power with an alpha error of 0.05. Continuous variables were expressed as the mean and standard deviation (SD). Categorical variables are expressed as frequencies and percentages. Results No statistically significant differences were recorded between younger and older women. Obese women reported a longer time between the last dose of misoprostol and cervical dilation of 6 cm (p=0.01), a longer time between the last dose of misoprostol and delivery (p=0.04), and a higher rate of grade II vaginal lacerations (p=0.02). Limitations While this study contributes novel insights into cervical ripening and labor induction using oral misoprostol for late-term pregnancies, its scope is limited by the retrospective study design, inherently carrying biases compared to prospective approaches, and the limited sample size within the study cohort. Conclusions Maternal BMI is a factor negatively influencing the efficacy of oral misoprostol for induction of labor in late-term pregnancy.
Objectives: This article is aimed to summarize and discuss cutting-edge elements about the diagnosis and management of uterine fibroids and sarcomas.
Methods: This paper is a report of the lectures presented in an expert meeting about uterine fibroids and sarcomas held in Palermo in February 2023.
Outcome: Overall, the combination of novel molecular pathways may help combine biomarkers and expert ultrasound for the differential diagnosis of uterine fibroids and sarcomas. On the one hand, molecular and cellular maps of uterine fibroids and matched myometrium may enhance our understanding of tumor development compared to histologic analysis and whole tissue transcriptomics, and support the development of minimally invasive treatment strategies; on the other hand, ultrasound imaging allows in most of the cases a proper mapping the fibroids and to differentiate between benign and malignant lesions, which need appropriate management.
Conclusions and outlook: The choice of uterine fibroid management, including pharmacological approaches, surgical treatment, or other strategies, such as high-intensity focused ultrasound (HIFU), should be carefully considered, taking into account the characteristics of the patient and reproductive prognosis.
Methods: A comprehensive search of the literature was carried out on the following databases: MEDLINE, EMBASE, Global Health, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register), the Health Technology Assessment Database, and Web of Science. Only original studies that reported the oncologic and reproductive outcomes of patients with stage IA and G2EC tumors who underwent FST were considered eligible for inclusion in this systematic review (CRD42023484892). Studies describing only the FST for endometrial hyperplasia or G1 EC were excluded.
Results: Twenty-two papers that met the abovementioned inclusion criteria were included in the present systematic review. Preliminary analysis suggested encouraging oncologic and reproductive outcomes after FST.
Conclusions: The FST approach may represent a feasible and safe option for women of childbearing age diagnosed with G2EC. Despite these promising findings, cautious interpretation is warranted due to inherent limitations, including heterogeneity in study designs and potential biases. Further research with standardized methodologies and larger sample sizes is imperative for obtaining more robust conclusions.
Setting: Endoscopy unit of an assisted fertility center.
Interventions: 3D transvaginal ultrasound and diagnostic hysteroscopy.
Conclusion: We identified three different subtypes of dysmorphic uterus. The T-shaped uterus, with thick lateral walls with normal uterine fundus and interostial distance; the Y-shaped uterus, with thick lateral walls, fundal septum or subseptum and reduced interostial distance; the I-shaped uterus, with very thick lateral walls (even above the isthmus) and severe reduction of the interostial distance.
Methods: This study measured the incidence of postoperative pulmonary complications in a cohort of 21 patients undergoing routine application of Jackson Pratt (JP) drainage as chest tube after diafragmatic resection.
Results: The incidence of postoperative pulmonary complications like pleural effusion, pneumothorax and subdiaphragmatic abscess in our group of patients were respectively 33%, 0% and 5%.
Conclusions: This study demonstrated a low rate of postoperative pulmonary complications with the routinely application of JP as chest tube with no additional discomfort for patients. Randomized controlled trials are required to test the role of routinely use of chest tube in preventing postoperative pulmonary complications in patients undergoing upper abdominal surgery.
Methods: Patients undergoing radical omentectomy in the setting of surgery for FIGO stage IIIC EOT between Jannuary 2014 and Jannuary 2017 were included. Patients with macroscopic involvement of the perigastric area were excluded. The perigastric area was evaluated by an expert pathologist. Nasogastric tube was held for 48 hours. After that it was observed the recovery of gastric function.
Results: Fifteen patients were included. All the patients underwent primary debulking surgery. Microscopic involvement of the perigastric omentum area was found in 37% of the cases. Five patients needed to put back the nasogastric tube for severe gastric sintoms.
Summary: In this study, evidence is given that radical omentectomy including the perigastric area and lesser omentum is a necessary component of complete cytoreductive surgery in FIGO stage IIIC EOT, whatever great number of severe gastroplegia is reported.
One of the highlights of this book is an exploration of Letrozole, a medication originally developed for treating breast cancer, but now showing promising results as an innovative treatment for male infertility. We explored Letrozole’s mode of action and the clinical data that supports its administration, giving readers a thorough grasp of how it can revolutionize the field of treating male infertility.
This book aims to apprise the readers about the various aspects of male infertility, approach to management of the condition and role of Letrozole in male infertility treatment, as well as clinical evidence-based discussions on the results of trials and research from across the globe. Our intent is to provide a solid foundation of knowledge that would help healthcare workers rely on, when dealing with cases of male infertility while still presenting the limitations.