• Andre Levret (1703-1780): the eminent obstetrician of the 18th century and his innovative approach to the treatment of uterine polyps.

      Karamanou, M; Iavazzo, Christos; Saridaki, Z; Gritzalis, K; Androutsos, G; University Institute of History of Medicine, Faculty of Medicine, Claude Bernard Lyon 1 University, Lyon, France (2017-11-22)
    • Application of da Vinci(®) Robot in simple or radical hysterectomy: Tips and tricks.

      Iavazzo, Christos; Gkegkes, I; Department of Gynaecological Oncology, Christie Hospital, Manchester (2016)
      The first robotic simple hysterectomy was performed more than 10 years ago. These days, robotic-assisted hysterectomy is accepted as an alternative surgical approach and is applied both in benign and malignant surgical entities. The two important points that should be taken into account to optimize postoperative outcomes in the early period of a surgeon's training are how to achieve optimal oncological and functional results. Overcoming any technical challenge, as with any innovative surgical method, leads to an improved surgical operation timewise as well as for patients' safety. The standardization of the technique and recognition of critical anatomical landmarks are essential for optimal oncological and clinical outcomes on both simple and radical robotic-assisted hysterectomy. Based on our experience, our intention is to present user-friendly tips and tricks to optimize the application of a da Vinci® robot in simple or radical hysterectomies.
    • Avenzoar's (1091-1162) clinical description of cancer.

      Karamanou, M; Tsoucalas, G; Saridaki, Z; Iavazzo, Christos; Androutsos, G; Department of History of Medicine, Medical School, University of Athens, Athens, Greece (2015)
      In the 11(th) and 12(th) century the Western caliphate flourished, making Cordoba the capital of physicians and philosophers. During that period lived and practised the famous physician Ibn Zuhr or Avenzoar. In his monumental treatise Al Taysir, Avenzoar provided the first clinical description of a polypoid colorectal tumour as well as the case of a uterine cancer and a basal cell carcinoma. His medical work remained popular through middle ages, influencing the development of western medicine.
    • Balloon cell malignant melanoma of the urethra - a case report and literature review.

      Iavazzo, Christos; Gynaecological Oncology, The Christie NHS Foundation Trust, Manchester (2015)
    • Balloon cell urethral melanoma: differential diagnosis and management.

      McComiskey, Mark; Iavazzo, Christos; Datta, Meghna; Slade, Richard J; Winter-Roach, Brett; Lambe, Gerard F; Sangar, Vijay K; Smith, Michael; Gynaecological Oncology Department, Christie Hospital, Manchester M20 4BX, UK (2015)
      Introduction. Primary malignant melanoma of the urethra is a rare tumour (0.2% of all melanomas) that most commonly affects the meatus and distal urethra and is three times more common in women than men. Case. A 76-year-old lady presented with vaginal pain and discharge. On examination, a 4 cm mass was noted in the vagina and biopsy confirmed melanoma of a balloon type. Preoperative CT showed no distant metastases and an MRI scan of the pelvis demonstrated no associated lymphadenopathy. She underwent anterior exenterative surgery and vaginectomy also. Histology confirmed a urethral nodular malignant melanoma. Discussion. First-line treatment of melanoma is often surgical. Adjuvant treatment including chemotherapy, radiotherapy, or immunotherapy has also been reported. Even with aggressive management, malignant melanoma of the urogenital tract generally has a poor prognosis. Recurrence rates are high and the mean period between diagnosis and recurrence is 12.5 months. A 5-year survival rate of less than 20% has been reported in balloon cell melanomas along with nearly 20% developing local recurrence. Conclusion. To the best of our knowledge, this case is the first report of balloon cell melanoma arising in the urethra. The presentation and surgical management has been described and a literature review provided.
    • Clinicopathological analysis of primary ovarian carcinoid tumours at a quarternary referral centre

      Datta, Meghna; McComiskey, Mark; Iavazzo, Christos; Smith, Michael; Winter-Roach, Brett; Slade, Richard J; Ismail, Sezgin; Gynaecological oncology, Christie Hospital, Manchester (2015)
    • Comment to the letter: Prevention from port site metastasis.

      Iavazzo, Christos; Gkegkes, I; Gynaecological Oncology Department, Christie Hospital, Manchester (2015-04-26)
    • Contrast Enhanced Ultrasound (CEU) using microbubbles for sentinel lymph node biopsy in breast cancer: a systematic review.

      Gkegkes, I; Iavazzo, Christos; First Department of Surgery, General Hospital of Attica "KAT", Athens, Greece (2015)
      The concept of sentinel lymph node (SLN) is not new to medical practice especially in breast cancer patients. CEU microbubble technique is an innovative technique which is applied with the same purpose. It utilizes ultrasound contrast agents based on the use of dispersion with sulfur hexafluoride gas. The aim of this review is to examine the clinical evidence on the role of intradermally injected microbubbles as a technique of preoperative identification of SLNs in patients with breast cancer.
    • Cost assessment of robotics in gynecologic surgery: A systematic review.

      Iavazzo, Christos; Papadopoulou, E; Gkegkes, I; Robotic Gynaecology and Gynaecological Oncology Department, Christie Hospital, Manchester, UK. (2014-11)
      The application of robotics is an innovation in the field of gynecologic surgery. Our objective was to evaluate the currently available literature on the cost assessment of robotic surgery of various operations in the field of gynecologic surgery.
    • Early recurrence of early stage endometrioid endometrial carcinoma: Possible etiologic pathways and management options.

      Iavazzo, Christos; Gkegkes, I; Vrachnis, N; Gynaecological Oncology Department, Christie Hospital, Manchester, United Kingdom. (2014-04-18)
      The majority of endometrial cancers is early stage and of the endometrioid histological type, as the symptoms (mainly vaginal bleeding) of the disease lead to an early diagnosis. Close follow-up is nevertheless essential in such cancers staged early on, in which the rate of recurrence is relatively low. We retrieved the studies included in our narrative review after performing a systematic electronic search in the PubMed, Scopus and Cochrane databases. The incidence or recurrence of disease in such patients could be up to 2.6%, with the main sites of recurrence being the vaginal vault or metastases in distant parts of the body. Genetic factors such as p53 overexpression, inactivation of 14-3-3-sigma, KRAS amplification and KRAS mRNA expression, microsatellite instability and Lynch syndrome genes could be associated with such a recurrence. Black race is also correlated, as well as lymphovascular space involvement, lower uterine segment involvement and DNA aneuploidy. Longer hysteroscopy duration was not found to be associated. Close follow-up is suggested for early detection of recurrences, while surgical excision of isolated disease or exenteration of local disease as well as radiotherapy and chemotherapy are the main treatment options. This narrative review investigated the possible mechanisms of early recurrence in patients with endometrioid endometrial cancer as well as the further management of them.
    • Enhanced recovery programme in robotic hysterectomy.

      Iavazzo, Christos; Gkegkes, I; Post CCT Senior Clinical Fellow Gynaecological Oncology Department, Christie Hospital, Manchester (2015-09-09)
      The standard care for endometrial cancer includes total hysterectomy, bilateral salpingo-oophorectomy, peritoneal washings with or without bilateral pelvic and/or paraaortic lymph node dissection/sampling with or without omental biopsy or omentectomy. The aim of this narrative review is to present the advantages of robotic surgery in combination with the enhanced recovery programme to offer better care to patients with endometrial cancer. The authors argue that a well-organised service for robotic hysterectomy should be set up in all hospitals. As part of this, an enhanced recovery programme including the following elements should be implemented: patient education, preoperative carbohydrate drinks, spinal or local analgesia, goal-directed fluid therapy, early feeding and intensive early mobilisation. The enhanced recovery programme includes pre, intra and postoperative changes in patient management. A comprehensive enhanced recovery programme starting in the preoperative setting and extending through to the patient's discharge, combined with robotic approach, could lead to optimal care of patients with endometrial cancer.
    • Evaluating a service: post-treatment sexuality issues in gynaecological oncology patients.

      McComiskey, Mark; Iavazzo, Christos; Datta, Meghna; Savage, Helen; Slade, Richard J; Winter-Roach, Brett; Smith, Michael; Gynaecological Oncology, The Christie NHS Foundation Trust, Manchester (2015)
    • Fertility sparing approach as the standard of care in young patients with immature teratomas.

      Iavazzo, Christos; Vorgias, G; Iavazzo, P; Gkegkes, I; Department of Gynecological Oncology, Christie Hospital, Manchester (2017-03-01)
    • Fertility sparing management of premenopausal patients with dysgerminoma.

      Iavazzo, Christos; Vorgias, G; Iavazzo, P; Gkegkes, I; The Christie Hospital NHS FT, Manchester (2016)
    • Fertility sparing management of young patients with immature teratoma.

      Iavazzo, Christos; Vorgias, G; Iavazzo, P; Gkegkes, I; The Christie Hospital NHS FT, Manchester (2016)
    • Fertility sparing technique in patients with ovarian granulosa cell tumors.

      Iavazzo, Christos; Gkegkes, I; Gynaecological Oncology, The Christie NHS Foundation Trust, Manchester (2015)
    • Grigoris Lambrakis (1912-1963) - a Greek obstetrician and world renowned activist.

      Gkegkes, I; Karamanou, M; Iavazzo, P; Gkegke, X; Androutsos, G; Iavazzo, Christos; Gynaecological Oncology Department, Christie Hospital, Manchester (2016-08)
      Grigoris Lambrakis was a Greek politician, doctor, athlete, and faculty member of the Medical School of Athens University. As an athlete, Lambrakis held the Greek record for long jump for twenty-three years and he also won several gold medals in the Balkan Athletic Games. Lambrakis received an excellent medical education. As lecturer at the University of Athens, Lambrakis became a pioneer of Gynecological Endocrinology. His philanthropy was always evident during his medical career, but he also consistently attended international pacifist meetings and demonstrations. His medical work, and his performance as lecturer of Obstetrics and Gynaecology, have been neglected, if not overshadowed, by his political career. Lambrakis is recognized worldwide as a martyr for peace. The aim in this essay is to present his life, and especially to elucidate his medical achievements.
    • Hypodontia and ovarian cancer: a systematic review.

      Iavazzo, Christos; Papakiritsis, M; Gkegkes, I; J Turk Ger Gynecol Assoc (2016)
      Hypodontia can be defined as the non-formation of one or more teeth during the developmental period. Mutation in several genes related to tooth formation has previously been correlated with cancer. Regarding the ovarian cancer, there are few studies that associate the presence of hypodontia with ovarian cancer. A systematic literature search was performed in PubMed and Scopus. In total, 385 patients were included in this study. Control group was present in 3 out of 4 studies (340 patients). Hypodontia was present in 56 out of 290 patients (incidence of 19.3%). Only in 2 out of 4 studies, the number of missing teeth was mentioned (47 teeth), while the majority of them were either maxillary second premolars or maxillary lateral incisors. Unilateral distribution of the missing teeth was present in 28 out of 46 patients, while bilateral distribution of the missing teeth was present in 18 out of 46 patients. The presence of ovarian cancer in the family medical history occurred in 12 out of 33 patients. Only 1 out of 4 studies examined the presence of genes with mutations in the included patients. Based on our findings, the lack of clinical studies was the principal obstacle to clarify the possible predictive value of hypodontia in the early prediction of patients with higher risk of ovarian cancer.
    • Imiquimod in the extramammary Paget disease.

      Iavazzo, Christos; Karachalios, C; Iavazzo, P; Gkegkes, I; Gynaecological Oncology, The Christie NHS Foundation Trust, Manchester (2016)
    • Is fertility sparing surgery a treatment option for young patients with yolk sac tumor?

      Iavazzo, Christos; Vorgias, G; Iavazzo, PE; Minis, EE; Gkegkes, ID; Department of Gynecological Oncology, Christie Hospital, Manchester, UK (2018)
      Yolk sac tumor (YST) is the third most frequent ovarian germ cell type ovarian tumor. YST occurs primarily in young girls and in women at reproductive age and thus, the preservation of fertility is considered to be a crucial option if possible for these patients. Compared to previous years, the use of innovative chemotherapeutic regimens in the treatment of YSTs improved significantly the prognosis and outcomes of this rare type of neoplasia. As YSTs are chemosensitive, this fact favors fertility sparing surgical approach and less aggressive type of operations. We present a narrative review of the multispecialty fertility sparing surgical and medical approach of women with YST.