Operative laparoscopy is the gold standard in the treatment of endometriotic ovarian cysts.
Excisional surgery is the best technique to prevent recurrences and improve symptoms but it may result in ovarian reserve damage due to the removal of healthy ovarian cortex. The aim of this study was to assess the impact on ovarian reserve of the use of dual wavelengths laser system (DWLS) hemostasis after stripping technique of monolateral endometrioma, by dosing the anti-Mullerian hormone (AMH). This prospective study was conducted at the Institute of Obstetrics and Gynecology, University of Foggia, from December 2013 to January 2015. Fortyfive women underwent excision of monolateral endometriotic ovarian cyst by stripping without using a bipolar coagulation and performing hemostasis with a DWLS. The AMH serum levels were estimated before the surgery (T0), 4–6 weeks (T1) and 6–9 months (T2) after surgery. Our results suggest that an appropriate surgical technique with the use of laser hemostasis does not determine a significant reduction of ovarian reserve. Laser hemostasis could prevent follicular reserve loss after ovarian endometrioma surgery.

Herein the authors report the first case of prophylactic bilateral salpingo-ovariectomy (BSO) in single port access laparoscopy (SPAL) with use of diode laser in a patient with BRCA1 mutation. As fimbria could be considered the site of origin for many serous carcinomas in BRCA mutation carriers, many studies are carried out to evaluate the possibility of preventing ovarian carcinoma with BSO. SPAL is a development of endoscopic surgery which further reduces invasiveness of surgical procedures. Diode laser presents a recognized precision for tissue cutting and coagulation and its use could be highly advantageous in SPAL surgery and in particular in such situations avoiding fallopian tube histology distortion and consequently improve the prognosis of BRCA carriers.

Purpose To evaluate whether laparoscopic treatment with a diode laser is feasible, safe, and effective in symptomatic patients affected by deep endometriosis (DE).
Methods This retrospective study was performed using medical record data. The surgical reports, chronic pain scores, and quality of life (QoL) data were evaluated for 50 patients who had undergone laparoscopic surgery between November 2017 and March 2019 at two university hospitals (Monserrato (CA) and Foggia, Italy). Indications for surgery were chronic pelvic pain and/or infertility in patients who wished to conceive spontaneously. Endometriosis lesions/nodules were excised using
a diode laser (Leonardo®, Biolitec® DUAL 45) that can combine 980 and 1470 nm wavelengths transmitted through a 1000 μm conical optical fibre.
Results The median patient age was 32 years (range 21–44), with a body mass index (BMI) mean of 21.7 ± 2.9 kg/m2. The mean operation time was 147 min (range 106–190). No intraoperative or early complications (< 30 days) were reported.
All patients left the hospital, on average, within 3 days (range 2–9 days) after surgery. A significant improvement in pain was observed at the 3-, 6-, and 12-month follow-up (p < 0.01) in all patients. Moreover, patients reported a significant QoL improvement at the 12-month follow-up.
Conclusion The diode laser confirmed its feasibility and safety for treating endometriosis. During the shaving surgical procedure, the diode laser system ensures a safe and effective laparoscopic dissection of deep endometriotic lesions. Further comprehensive randomized trials are necessary to confirm these preliminary data in terms of efficacy, recurrence rates, and pregnancy outcomes.

Women who have a BRCA1mutation have a 39% to 46% risk of developing ovarian cancer by age 70, while women with a BRCA2 mutation
carry a 10% to 27% risk by age 70 (Kurman and Shih, 2008). Bilateral salpingo-ovariectomy (BSO) is suggested to BRCA mutation carriers
between the ages of 35 and 40, or when childbearing is complete (National Comprehensive Cancer Network, 2013). To reduce the surgical
adverse effect of early menopause in young patients many centers have investigated the possible role of bilateral salpingectomy and
delayed ovariectomy in preventing ovarian cancer (Anderson et al., 2013). Nevertheless, the effects of salpingectomy on ovarian functions
are still controversial but, in any case surgery should be performed avoiding any possible damage to ovarian vascularization. Single-port
access laparoscopic (SPAL) surgery has been introduced into the field of minimally invasive surgery and implemented in gynecologic procedures (Angioni et al., 2011, 2010). The main advantage of SPAL surgery is the excellent cosmetic outcome (Song et al., 2013). This approach requires only one umbilical incision; therefore, the surgical scar can be hidden within the umbilicus, making the surgery virtually scarless.
In addition to the potential cosmetic benefits, other theoretical advantages of SPAL surgery compared to conventional laparoscopy include less postoperative pain and a faster recovery (Mencaglia et al., 2013).
Recently, an exponential growth in the use of diode lasers has been observed in almost every area of pure and applied sciences; a wide variety of the semiconductors propelled the invention of a variety ofdiode lasers that opened several new way researches. Different types of lasers have been used over time, including Argon, CO2, Yag, diode 810 and others. The currently available 980 + 1470 Nm diode laser
may have certain advantages. A diode is an electronic laser consisting of 2 semiconductor materials with the size of a grain of sand. This
technology makes it possible for this laser to be the smallest available. A microprocessor-controlled systemregulates the flow of electrical current through the diode and generates the laser beam allowing cutting and coagulating with very low lateral thermal damage.
We report the first case of single port laparoscopywith use of a diode laser for bilateral salpingectomy in a patient with BRCA1 and BRCA2
mutation.

The most advantageous treatment for nonextensive endometriosis has long been the subject of debate. In recent years, the ability to detect atypical presentations has allowed the gynecological surgeon to treat this disease more readily. The treatment in the past has only been concerned with the singular treatment being applied at the time, not on the effects that previous treatments have had. The purpose of the current study was to see whether previous unsuccessful treatment modalities affected subsequent laser laparoscopy treatment of endometriosis.
Methods: Patients who were previously treated for their endometriosis (minimal and mild) underwent treatment of their disease by laser laparoscopy and the results were analyzed by χ2 (chi-square) analysis.
Results: Those patients previously treated with laser laparoscopy and laparotomy demonstrated poorer results than those previously treated with expectant, medical, or cautery. The sum of the original treatments plus the second treatment of laser laparoscopy was equal in all groups.
Conclusions: If endometriosis is diagnosed at the time of laparoscopy and is easily amenable to treatment, it behooves the physician to treat it at the time of surgery

Il setto uterino è una malformazione congenita dell’utero che può causare infertilità femminile. È una porzione anormale di tessuto che divide l’utero in due parti, impedendo talvolta l’impianto dell’embrione o causando aborti. Di solito viene trattato mediante resettoscopia in sala operatoria in anestesia spinale o generale e comporta la permanenza della paziente in ospedale.

Lo scopo di questo studio è stato quello di valutare l’efficacia della tecnica laser isteroscopica ambulatoriale (senza anestesia) nel determinare l’incremento del volume endocavitario. Dieci pazienti affette da utero setto  sono state sottoposte a controllo ecografico 3D transvaginale prima e 3 mesi dopo la metroplastica con laser.

E’ stato utilizzato il laser LEONARDO DUAL con la fibra MYOFIBER CA e, nel complesso, il volume endometriale mediano è significativamente maggiore dopo la chirurgia laser; infatti, il volume endocavitario a 3 mesi di follow-up è aumentato di 1,9 cm3. Nessuna delle pazienti ha riportato effetti avversi, e una paziente è attualmente incinta spontaneamente 9 mesi dopo la procedura laser.

Vantaggi:

• Efficacia
• Tecnica sicura e indolore
• Senza anestesia
• Ambulatoriale
• Nessun pernottamento in ospedale
• Risparmio dei costi di sala operatoria e di ospedalizzazione

A new two-step hysteroscopicmyomectomy carried out in the office setting and without anesthesia was
feasible for the excision of submucous myomas. The objective of this study was to assess whether removal of submucous myomas fromthe uterine cavity after hysteroscopic laser enucleation is necessary. Methods. Between June 2009 andApril 2013, all outpatients with symptomatic myomatosis (bleeding, pelvic pain, and infertility) assessed ultrasonographically were eligible to participate in a prospective study. All patients underwent office hysteroscopic enucleation of submucous myomas. Enucleated myomas were left in the uterine cavity. Neither anesthesia nor antibiotic prophylaxis was used. Results. Sixty-one women (mean age: 47.3 years) were
included. Regardless of hysteroscopic localization and grading, all myomas were enucleated. The mean (standard deviation, SD) diameter of the myoma as measured by the ultrasound scan was 22.6 (8.5) mm. In 29 cases (47.5%), the diameter of the resected myoma was >20mm and in 10 cases (16.4%) >30 mm. After a mean follow-up of 68.2 (16.5) days, none of the patients showed a residualmyoma inside the uterine cavity. Conclusions.The present results indicate that leaving laser-enucleated submucousmyoma in the uterine cavity is a feasible and safe therapeutic option.

Questo studio confronta la polipectomia isteroscopica ambulatoriale utilizzando il dispositivo bipolare Versapoint con l’uso del laser a diodi, valutando efficacia, sicurezza, durata della procedura e comfort della paziente. Gli autori analizzano gli esiti operatori, le complicazioni e i tassi di recidiva per stabilire se il laser a diodi offra vantaggi rispetto alla tecnica bipolare tradizionale.

Background: Uterine fibroids are the most common benign gynaecological tumours in women. When symptomatic, heavy menstrual bleeding is the principal manifestation of uterine fibroids. Nowadays, several conservative procedures have been utilized to discourage hysterectomy or myomectomy and great interest has been focused
on laser energy technology associated with mini-invasive approaches.
Diode lasers demonstrated many advantages in laparoscopic and hysteroscopic surgery. Methods: To evaluate the Dual
Wavelength Diode Laser System (DWLS) ablation techniques for treating fibroids, we devised an experimental system for characterizing the myolysis fibre ablation performance with a particular fibre designed to create a thermal ablation in the centre of the myoma.
All the myomas were used for the experiment after a total hysterectomy and their excision from the fresh uteri. The experiment setup was composed of two beaker containers filled with isotonic saline water,
temperature monitoring myoma surface and water bath, a diode laser fibre and a diode laser energy deposition system. Results: Good macroscopic results have been found for fibroids of about 60 cm3 ablated with a setting of 10 W of 980 nm + 10 W of 1470 nm and for samples of about 15 cm3 ablated with a setting of 5 W of 980 nm + 5 W of 1470 nm, where the volume of the ablated fibroids were 46.6% and 41.6%, respectively. Conclusion: This is the first ex vivo study with a new DWLS, which made it possible to understand which one of its settings could be recommended for the safest and best macroscopic results in myolysis.

Purpose This case series examined the safety and effectiveness of hysteroscopic myolysis using laser-induced interstitial
thermo-therapy (LITT) for treating heavy menstrual bleeding (HMB) in premenopausal women with FIGO type 1 or 2
uterine fibroids, not planning for future fertility. Additionally, a comprehensive review of innovative, minimally invasive,
incisionless myolysis techniques was conducted.
Methods Women with HMB, sonographically diagnosed with a single FIGO type 1 or 2 fibroid, underwent hysteroscopic
myolysis using the Leonardo
® diode laser. Effectiveness was assessed via transvaginal ultrasound measurement of myoma
size, volume and vascularization pre and post-procedure. Moreover, we also evaluated any improvements in symptoms using
the Pictorial Blood Loss Assessment Chart (PBAC score) scores.
Results The procedure resulted in significant HMB reductions and noticeable fibroid size, volume, and vascularization
decrease in all three patients, with no reported complications. The literature review revealed both advantages and limitations
of the minimally invasive, incisionless myolysis techniques.
Conclusions Hysteroscopic laser myolysis is a safe and effective therapeutic intervention for patients experiencing HMB,
diagnosed with FIGO type 1 or 2 fibroids, and not planning for future fertility. The procedure resulted in significant reductions
in menstrual blood loss and fibroid size. Despite the promising results, it is essential to note the limitations of this report,
including its case series design, a small number of patients, and a short follow-up period. Further research is necessary to
confirm these results.