Gynecological minimally invasive approach and medical therapy

Minimally invasive surgery (MIS) has numerous benefits including shorter length of hospital stay, faster return to normal activity, reduced rate of surgical site infections, less postoperative pain, less blood loss, and reduced incidence of venous thromboembolus, sepsis, and postoperative ileus, especially in women with high BMI (body mass index). In this moment, with COVID-19 infection hitting the world, reducing hospitalization has represented a great advantage.1-3 Minimally invasive surgery can be associated with longer operative times and longer operating room (OR) times.4 MIS has been shown to decrease overall complications when compared with open surgery:5 this is especially true for women with higher body mass index (BMI), which is independently associated with significantly higher rates of venous thromboembolus and wound infection in women who had laparotomy.2 Based on the well-documented advantages over abdominal hysterectomy, the American College of Obstetricians and Gynecologists recommends that minimally invasive approaches (vaginal or laparoscopic, including robot-assisted), should be performed anyway, whenever feasible.6 In this special issue of Minerva Obstetrics and Gynecology, the contributions dealing with the topics of urogynecology, with reference to minimally invasive cancer surgery, underlined that MIS and medical treatment must be preferred in patients when possible. In particular, Monti et al.7-9 dealt with the topic of urinary incontinence and the possible treatments for CIN; D’Oria et al.10 addressed the issue of non-invasive treatment of vulvovaginal atrophy in menopause; Bogani et al.11 approached the subject of minimally invasive surgery in cervical cancer; Casarin et al.12 dealt with minilaparoscopy in gynecology; D’Alterio et al.13 discussed the role of microbiome in the pathogenesis of endometriosis; Muzii et al.14 addressed the topic of endometriosisassociated infertility; and Milliken et al.15 dealt with the issue of surgery in vulval cancer. Our hope is that this special issue will improve clinical practice and help clinicians in their clinical activity in this pandemic period.