Objectives With the objective of improving outcomes in oncological surgery, a new concept of surgical anatomy deduced from embryonic development, called ontogenetic anatomy and compartment theory of local tumor spread, is proposed by Michael Ho¨ckel from Germany. Hypothesis Compartment resection enables the preservation of functionally important tissues of different embryonic origin despite its close proximity to the tumor and incomplete resection of the compartment results in increase in local recurrences. This approach should maximize local tumor control and minimize treatment-related morbidity. Total Mesometrial Resection (TMMR) This new surgical technique has been developed and standardized over past 12 years for cervical cancer with a high local control rate without need for adjuvant radiotherapy.
Conclusion This Embryological based surgery holds a great promise for management of cervical cancer. However this novel surgery needs confirmation in multi institutional settings to translate research into practice for an excellent therapeutic index.
Compartment theory . Ontogenetic anatomy . Total mesometrial resection . Cervical cancerObjectives This article attempts to offer balanced insight into the use of transvaginal mesh for pelvic organ prolapse especially in the light of the negative publicity in recent times. The role of transvaginal mesh has been in the limelight for a number of reasons and it is important to address this issue in an objective, fair, and balanced manner. The conventional approach to prolapse surgery has undergone a paradigm shift and the principles of mesh replacement surgery sharply contrast with many traditionally held beliefs. This has created a new set of challenges that has revealed a sharp division of opinion among specialists and sub-specialists alike.
Conclusion The article is an attempt to explain how mesh surgery can be safely and efficiently performed in carefully selected cases and is based on the combined wisdom of some of the leading surgeons in the sub-specialty today.
Reconstructive pelvic floor surgery Use of mesh Pearls and pitfallsBreast and ovarian cancers are the most commonly encountered cancers in women, although only 5% or less of these arise from hereditary predisposition. Mutations in two of the cancer susceptibility genes, BRCA1 or BRCA2, explain breast and ovarian cancers in a majority of these hereditary cancers. With the advent of gene testing and dissemination of information over the public domains, clinicians are often confronted by patients about the options and benefits of these tests. Genetic counseling and risk estimation for breast or ovarian cancer along with BRCA mutation analysis has been initiated by our group at the Tata Memorial Hospital and ACTREC. The purpose of this review is to a) provide basic information about the mutations in BRCA1 and BRCA2 genes b) highlight the relevance of population based data on the occurrence of mutations in these genes c) evaluate various methods of genetic testing and d) discuss clinical aspects for the management of disease in mutation carriers.
The role of varicoceles in the etiology of male infertility continues to be controversial. Due to the numerous variables that impact the outcome of varicocele surgery, the results of various trials are often contrary. Recent studies at the molecular level have demonstrated that varicoceles can cause testicular nuclear DNA damage, apoptosis, and raised levels of reactive oxygen species. Clinical studies have shown that varicocele surgery can improve semen quality sufficient to downgrade the type of ART procedure required, can result in the appearance of sperm in the semen in some cases of non-obstructive azoospermia, and can reverse testicular growth retardation in cases of adolescent varicocele. Hence, despite contradictory clinical results, the best practice guidelines of many associations recommend varicocele surgery in men with sub-fertile semen, clinically evident varicoceles, and infertility. Ultrasonography to detect sub-clinical varicocles is not advocated. Medical therapy may help some men with mild to moderate varicoceles. Older technics of varicocele surgery by mass ligation or non-magnified dissection are associated with higher rates of recurrence, testicular artery damage, and hydrocele formation, as compared to microsurgical methods in which every vein is individually identified and ligated, while preserving the arteries and lymphatics. Laparoscopic ligation is no longer recommended.
