[Periductal stromal tumor of the breast. A case report]. / Tumeur stromale périductale du sein. À propos d'un cas.

We report a case of a 50-year old post-menopausal woman who was admitted because of a lump in the upper external quadrant of her left breast. The definitive diagnosis of periductal stromal tumor was retained after histopathological examination. Periductal stromal tumor is a rare tumor with distinct morphological features. The clinical evolution and the prognosis are relatively similar to the phyllodes tumor.

Fertility after laparoscopic myomectomy of large intramural myomas: preliminary results.

Fertility outcome following laparoscopic myomectomy was evaluated. A prospective clinical study was carried out between October 1990 and October 1993 in 21 infertile patients who underwent laparoscopic myomectomy for a myoma measuring > or = 5 cm in diameter. The overall rate of intrauterine pregnancy was 33.3% (seven patients). Out of 12 patients with infertility factors associated with uterine myomas, three (25.0%) became pregnant, whereas four (44.4%) out of nine patients with no other associated infertility factor became pregnant. No uterine rupture was observed. Out of the seven pregnancies, four were spontaneous and began within 1 year of the operation. The other three were achieved after in-vitro fertilization in patients with associated infertility factors. In the four patients who gave birth by Caesarean section, no adhesions were found on the myomectomy scar. From these preliminary results, laparoscopic surgery for myomas seems to offer comparable results with those obtained by laparotomy.

Uterine rupture during pregnancy after laparoscopic myomectomy.

A 31 year old patient presenting with primary infertility underwent an operative laparoscopy for the treatment of bilateral hydrosalpinges, during which a myomectomy was also performed. The uterus was repaired using interrupted sutures. At follow-up laparoscopy seven weeks later, a uterine fistula was diagnosed and was oversewn using a single 'figure of eight' suture. One year later the patient became pregnant through in-vitro fertilization. At 34 weeks gestation, she required an emergency laparotomy for acute abdominal pain and the presence of fetal bradycardia. The operative findings revealed a uterine rupture at the site of the previous myomectomy scar. This was then enlarged with a scalpel and a live baby was delivered. The uterus was repaired in two layers. The postoperative period for both mother and baby was satisfactory. This complication raises the problem of the quality of uterine repair following laparoscopic myomectomy, together with the question of how to prevent this type of life-threatening situation.

Laparoscopic management of asymmetric Mayer-Rokitansky-Kuster-Hauser syndrome.

Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is a partial or complete absence (agenesis) of the uterus with an absent or hypoplastic vagina. Until now, the recommended treatment, when resection of a rudimentary horn was indicated, was laparotomy. We report a case of MRKH syndrome in which the patient benefited from laparoscopic surgery for bilateral resection of rudimentary horns. Laparoscopy is not only useful for diagnosis of uterine malformations but can also be valuable for any treatment required for this type of malformation, this being carried out during the same operative procedure, thus avoiding laparotomy for the patient. The creation of an artificial vagina is performed during a second operation.

[Laparoscopic surgery of large uterine fibromas. Operative technique and results]. / Traitement coeliochirurgical des volumineux fibromes utérins. Technique opératoire et résultats.

OBJECTIVE. To describe the technique of laparoscopic myomectomy for large myomas (5 cm and more) and to evaluate the results. RESULTS. Only myomas which are complicated (and/or resistant to properly conducted medical treatment) require surgical treatment. Between October 1, 1990 and October 31, 1994, we carried out 72 laparoscopic myomectomies for intramural myomas measuring 5 cm or more, in 71 patients. The operations lasted 130 +/- 60 min (range: 40-330 min). We converted to laparotomy for two cases (2.7%). We observed no serious per or postoperative complications. We never needed a repeat operation, whether by laparotomy or by laparoscopy. CONCLUSION. Despite these encouraging results, it must be remembered that the operation is lengthy and difficult and is reversed for laparoscopic surgeons perfectly familiar with endoscopic knot tying. Although it is a difficult technique, laparoscopic myomectomy is possible even for large myomas and those that are completely intramural. These results need to be assessed over the long term especially with respect to the risk of adhesions and the quality of the laparoscopic suture.

[Uterine myoma: modalities and indications for coelioscopic treatment]. / Les myomes utérins: modalités et indications du traitement coelioscopique.

Only complicated fibromas refractory to medical treatment should be treated surgically. Two types of operations can be proposed for interstitial and subserosal fibromas: myomectomy and hysterectomy. The indication, based on a through preoperative assessment, depends on the patient's age and the size, number and sites of the fibromas and associated lesions. Preliminary series confirm the feasibility of these two operations performed by laparoscopy, as a result of the progress in this modality over recent years. In the future, larger series will determine the respective place of each of these surgical procedures in relation to others surgical possibilities.

[Celiosurgery in gynecology. Indications, benefits and risks]. / La coeliochirurgie en gynécologie. Indications, bénéfices et risques.

Initially used exclusively for diagnosis, laparoscopy is now a surgical method in gynecology but also in many other specialties. In gynecology, the results of laparoscopic surgery are comparable to those obtained by laparotomy in many indications: ectopic pregnancy, ovarian cysts, endometriosis, tubo-peritoneal sterility... Because of the advantages of laparoscopic surgery over traditional surgical treatment by laparotomy, operative laparoscopy is, in these indications, now recognized to be the best choice of surgical treatment. The most important advantages of operative laparoscopy are the following: less esthetic drawbacks, minimal risk of parietal and infectious complications, lower risk of post operative adhesions, more comfortable post operative course and lower cost due to considerably shortened hospital stay and recovery period. The risk of complications is directly correlated to the surgeon's experience and the importance of the surgery performed.