Myomectomies by endo-uterine resection.

Endo-uterine resection is a true surgical act, well defined and atraumatic. To perform elective and complete one-stage hysteroscopic myomectomies, sparing normal myometrium, is not easy. Endometrial ablations provoking synaechie and adenomyosis should not be added to myomectomies. Complications of hysteroscopic surgery may be threatening and must be prevented.

[Reccurent abortions: unpublished syndrome suggesting the explanation of fetal death]. / Avortements à répétition: un syndrome inédit suggérant l'explication de la mort foetale.

A report is given of 8 cases of recurrent "idiopathic" abortions sharing in common the following features, unreported so far: (1) high uterine arterial impedance; (2) decrease in endometrial thickness, in spite of normal hormonal and endometrial cycle at biopsy; (3) a history of previous curettages. Such a syndrome could be consistent with the existence of a narrow peripheral symphysis of the uterine cavity, unaffecting its shape at hysterography.

[Infiltrating cancer of the bladder. Is concomitant radiochemotherapy an alternative to cystectomy?]. / Cancer infiltrant de la vessie. La radio-chimiothérapie concomitante peut-elle être une alternative a la cystectomie?

Infiltrating bladder cancer is an extremely severe condition causing death within 5 years due to metastatic extension in one-half of the patients whatever the treatment. It is well known that radiotherapy is successful in treating some patients while partial exeresis (open surgery or laparoscopic surgery) is effective in others. Current chemotherapy protocols (usually well-tolerated) increase the efficacy of radiotherapy but it is surprising that over the last 10 years, total cystectomy has become the first line treatment proposed for patients with infiltrating bladder cancer. The operation is a major procedure leading to an important morbidity and mortality. Since 1988, we have decided not to rely on total cystectomy for such patients, but rather to use a treatment protocol associating endoscopic exercise of the tumour and radiochemotherapy. Our results allow confirmation that this protocol can provide curative treatment in certain cases without removing the entire bladder. We thus suggest that systematic amputation of the bladder for cancer is an obsolete procedure and raise the question as to the usefulness of total cystectomy in this disease?

Single-stage total hysteroscopic myomectomies: indications, techniques, and results.

OBJECTIVE: To assess the risks and benefits of myomectomies performed by endouterine resection. DESIGN: A retrospective analysis of 284 patients, with histologically proven submucous myomas, operated on between April 1984 and April 1993. Outcomes were analyzed by Kaplan-Meier statistics. SETTING: Author's private practice in University Medical Center. PATIENTS: The age ranged from 25 to 70 years. INTERVENTIONS: All the interventions but one were performed entirely at one setting. Myomas ranged in diameter from 10 to 65 mm. MAIN OUTCOME MEASURES: Clinical symptoms and hysteroscopic appearance. RESULTS: Good anatomical and functional results were achieved in 95.6% of cases during the first 6 postoperative months, persisting in 94.6% at 1 year, in 89.7% at 2 years, in 87.8% at 3 years, in 83.0% at 4 years, in 76.3% at 5 years, in 73.2% at 6 years, and remained stable at 67.6% by > or = 7 years. The only notable complication was one perforation, which was repaired immediately. Endouterine resection did not improve the outcome in patients with primary infertility but was of benefit in cases of secondary infertility. CONCLUSIONS: Myomectomy by endouterine resection is a difficult but safe and worthwhile conservative intervention.

Endoscopic intrauterine resection: principles and technique.

The adaptation of urologic resection techniques in the uterine cavity has made it possible to perform endouterine surgery. This technique also permits a complete histological analysis of all the resected tissues. In the opinion of the Authors this systemic intrauterine resection leads to a complete transformation of gynecologic surgery, since it permits a considerable reduction of the hospitalization and recovery period.

Methodical intrauterine resection.

A technique using a fine intrauterine resectoscope with mobile electrical loop and continuous flow providing a thoroughly clear vision in all circumstances was used to resect 61 submucous leiomyomas. This technique allows complete resection of intrauterine benign tumours such as submucous leiomyoma sessile type partially embedded in the myometrium, old and wide marginal synechiae, or uterine septa. Under direct visual control it allows one to perform deep biopsies leading to precise histologic diagnoses with determination of possible myometrial penetration. The advantages of this technique, which may be performed eventually on outpatients with paracervical block, are: precise hemostasis; complete and controlled uterine evacuation, avoiding postoperative infections; precise histologic diagnosis; suppression of a good percentage of hysterectomies and open myomectomies; simplicity of follow-up; brevity of hospitalization and convalescence, which are sometimes nil; and conservation, or even restoration, of fertility.

[Transcervical intrauterine resection. A surgical technique that is safely controlled and non-traumatic]. / Résection endo-utérine transcervicale. Une technique chirurgicale de sécurité réglée et atraumatique.

The author describes a safe narrow intra-uterine resectoscope which allows complete treatment of benign lesions inside the uterus. A continuous flow of liquid washes away all haemorrhage from the cavity of the uterus and allows a continuous good view. The author reports his three years experience which includes biopsies from eighteen zones of haemorrhage and the successful treatment of 92 submucous fibroids, 81 fibroid polyps, 57 endometrial polyps, 33 cases of synechiae, 8 cases of retained placental products and 7 of septa in the uterus. He says that it is extremely important to have complete histological analyses of all "chips" that are removed by this technique, which is similar to the technique employed for trans-urethral resection of the prostate gland. Histological examination helped to make the diagnosis of 9 cancers which would have been missed had laser been used. Other advantages of this new technique, which requires special training for gynaecologists already mastering open surgery, are the shortness of the time needed to stay in hospital and for convalescence. Furthermore, the uterus is conserved, as is the strength of the uterine wall and this allows normal deliveries to take place.