[Partial cystectomy for bladder endometriosis: Robotic assisted laparoscopy versus standard laparoscopy]. / Étude comparative : laparoscopie robot assistée versus cœlioscopie chez les patientes avec une endométriose vésicale.

OBJECTIVES: To compare robot-assisted laparoscopy (RL) and conventional laparoscopy (CL) in surgery for bladder endometriosis. METHODS: A retrospective study was conducted between January 2007 and December 2013, including patients with bladder endometriosis receiving at least a partial cystectomy by RL or CL. The primary endpoint was the presence of a radiological recurrence at bladder level. RESULTS: We included 15 patients in the RL group and 22 in the CL group. The median age was 29 years±7 years. The symptoms were similar in the 2 groups. Pre-surgical mapping of the lesions was carried out with MRI. Sixty percent of patients in the RL group vs 91% in the CL group had other associated endometriosis lesions, P=0.04. The median size of the bladder lesion was 30±8mm in the RL group vs 23±7mm in the CL group, P=0.03. The median operative time was 210 vs 225min, P=0.8. We did not find any significant difference in intraoperative and early and late postoperative complications between the 2 groups. The median length of stay was 5 days vs 6 days. The proportion of relapse was 20 vs 23%, P>0.05. Clinical improvement was similar between the groups, i.e. 93 vs 86%, P=0.6 and the pregnancy rate was 93 vs 86%, P=0.6. CONCLUSIONS: Robot-assisted laparoscopy in the surgical treatment of bladder endometriosis as compared to traditional laparoscopy does not seem to have an adverse effect neither on the risk of recurrence nor on the occurrence of intra- and postoperative complications.

[Current situation of the education in gynaecology-obstetrics in France]. / État des lieux de l'enseignement en gynécologie-obstétrique en France.

OBJECTIVES: To get an overview of the education offer for obstetrics trainees in France and to assess their satisfaction and requests regarding these classes and their access. MATERIAL AND METHODS: Two questionnaires were sent over the country between September 2013 and July 2014. The first one was intended to the person in charge of teaching in each university hospital. We asked about the organization of teaching classes and access to simulation workshops. The second one was intended to the local representative of interns of the French association of gynaecology and obstetrics trainees (AGOF). We searched for overall satisfaction and requests concerning these learning classes. RESULTS: Over 28 university hospitals, 19 teachers (67.9 %) and 25 students (89.3 %) responded. Various ways and means of teaching are used throughout the country. Use of simulation workshop has spread in many university hospitals but their types and numbers are still very different among the organizations. Students are globally satisfied by the type, volume and content of their teaching classes. Simulation workshops are really appreciated by trainees and they wish more of them were organized. CONCLUSION: There is a great disparity in the ways of teaching in France. Gathering resources between the different centres may allow trainees to access to the same theoretical education and simulation workshops all over the country.

[Early evaluation of the feasibility of robot-assisted laparoscopy in the surgical treatment of deep infiltrating endometriosis]. / Étude de faisabilité du traitement laparoscopique robot-assisté de lésions d'endométriose pelvienne profonde.

BACKGROUND: Preliminary study of the feasibility of robot-assisted laparoscopy for deep pelvic endometriosis nodule resection. PATIENTS AND METHODS: Between May 2009 and February 2010, we collected medical and surgical data about deep infiltrating endometriosis resections performed in our institution, using robot-assisted laparoscopy (DA VINCI Intuitive Surgical System(®)). RESULTS: Six patients were included: four partial bladder and two uterosacral ligament resections. The median age was 29.5 years (24-48). All patients reported chronic pelvic pain, associated with urinary tract symptoms in case of bladder endometriosis. Before surgery, lesion mapping was performed using magnetic resonance imaging for all, and mechanical bowel preparation or double-j stenting were prescribed, depending on the endometriosis location. Surgical procedures median time was 173 minutes (156-244), and median length of stay was 3 days (2-5). Complete resection was possible in all cases. There was no conversion in classical laparoscopy or laparotomy, and no intraoperative complication. Pathology diagnosis of surgical pieces concluded to endometriosis lesion in all cases. CONCLUSION: This study shows the feasibility of the robot-assisted laparoscopy in the resection of deep pelvic endometriosis, without increasing of surgical timing, blood loss or intraoperative complications.

[Vaginal mesh for pelvic organ prolapse repair]. / Place du matériel prothétique dans le traitement du prolapsus par voie vaginale.

The use of mesh for pelvic organ prolapse repair through the vaginal route has increased within the last decade. The main objective is to improve anatomical results (based on the superiority of sacropexy with meshes when compared to vaginal traditional surgery), with the advantages of the vaginal route. An increasing number of cohort series and randomized control trials have been published. There is level-1 evidence that the use of mesh for the treatment of cystocele through the vaginal route improves anatomical results when compared to traditional surgery. The rates of complications between these two techniques seem equivalent, even for de novo dyspareunia.