Background and Objectives: Advanced-stage epithelial ovarian cancer (EOC) is associated with poor prognosis, with complete macroscopic cytoreduction representing the strongest modifiable predictor of survival. Neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) is an alternative to primary debulking surgery (PDS) in patients with high tumor burden. However, its impact on surgical complexity remains debated. This study aimed to compare operative characteristics and survival outcomes between NACT + IDS and PDS using standardized scoring metrics in a real-world oncologic setting. Materials and Methods: We retrospectively analyzed 47 patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIIC-IV high-grade serous EOC treated between January 2018 and August 2022 at a single tertiary center. Twenty-five patients received platinum–taxane-based NACT followed by IDS, and twenty-two underwent upfront PDS with adjuvant chemotherapy. Surgical effort was quantified using the Surgical Complexity Score (SCS), and intra-abdominal tumor burden was assessed via the Peritoneal Cancer Index (PCI). Progression-free survival (PFS) and overall survival (OS) were estimated using Kaplan–Meier analysis. Hazard ratios (HRs) with 95% confidence intervals were derived from Cox proportional hazards models. Results: Complete cytoreduction (R0) was achieved in 76% of the NACT + IDS group and 68% of the PDS group. Mean surgical complexity and operative time were significantly lower following NACT (SCS 5.0 vs. 6.2, p = 0.04; 140 vs. 197 min, p = 0.001), without significant differences in blood loss, complication rates, or length of hospital stay. Median PFS was 25 months in the NACT + IDS group versus 21 months in the PDS group, and the difference was not statistically significant. Among patients with R0 resection, survival outcomes were comparable between treatment arms. Conclusions: NACT + IDS was associated with shorter and less complex surgeries in selected patients, but survival outcomes appeared similar when R0 was achieved. Data suggest that selective use of NACT in patients with extensive disease burden or limited general health status may be suitable, while confirming that complete cytoreduction remains the most critical prognostic factor, although these survival comparisons are exploratory given the retrospective design and limited sample size.

Background and Objectives: Hysterectomy is one of the most frequently performed gynecological surgical procedures worldwide. It is well established that the laparoscopic approach offers better outcomes for patients compared to abdominal hysterectomy. However, the technique for vaginal cuff closure during laparoscopic hysterectomy (TLH) remains insufficiently standardized in the international literature. Based on our results, we aim to demonstrate that closure of the vaginal cuff using a figure-of-eight suture is a sufficient, reproducible, time-efficient and safe method during total laparoscopic hysterectomy. Materials and Methods: Our retrospective observational study analyzed 173 patients who underwent a TLH from January 2016 to December 2021 at the University of Debrecen, Department of Obstetrics and Gynecology. Standardized surgical steps were applied in all cases (ligation of the uterine arteries at their origin, fenestration of the broad ligament above the ureter), and the vaginal cuff was closed laparoscopically with an absorbable suture, incorporating vesicovaginal fascia, vaginal mucosa and uterosacral ligaments. Patient demographics, operative data, and perioperative outcomes were extracted and analyzed. Results: TLH was successfully performed in 173 cases, and no conversion to open surgery was necessary. The mean age of the patients was 51.4 (23–86) years, the median body mass index (BMI) was 26.9 (16.9–45) kg/m², and the operative time was 92 (35–240) minutes. The mean uterine weight was 151 (16–440) g. The mean hemoglobin drop was 15.8 (0–44) g/L after the surgery. Regarding complications, ureteral injuries occurred in two cases (1.2%). One patient (0.6%) required relaparotomy due to rectosigmoid perforation. Postoperative complications included vaginal cuff dehiscence in two cases (1.2%), with one patient (0.6%) requiring resuturing, fever in six cases (3.5%), vaginal discharge in four cases (2.3%), and vaginal bleeding in one case (0.6%). Pulmonary embolism occurred in one patient (0.6%). Three patients (1.7%) required blood transfusion based on postoperative blood counts. Conclusions: Our results demonstrate an acceptable operative time and a low rate of postoperative complications, suggesting that closing of the vaginal cuff with a figure-of-eight suture is a sufficient and safe technique. This method can be reliably reproduced and incorporated into the standardized steps of total laparoscopic hysterectomy.