Laparoendoscopic single-site surgery for management of ovarian endometriomas.

BACKGROUND AND OBJECTIVES: To compare our initial experience in laparoscopic surgery for ovarian endometriomas performed through an umbilical incision using a single 3-channel port and flexible laparoscopic instrumentation versus traditional laparoscopy. METHODS: This study was conducted in 3 tertiary care referral centers. Since September 2009, we have performed laparoendoscopic single-site surgery in 24 patients diagnosed with ovarian endometriomas. A control group of patients with similar diagnoses who underwent traditional operative laparoscopy during the same period was included (n = 28). In the laparoendoscopic single-site surgery group, a multichannel port was inserted into the peritoneum through a 1.5- to 2.0-cm umbilical incision. RESULTS: Patients in the laparoendoscopic single-site surgery group were significantly older (P = .04) and had a higher body mass index (P = .005). Both groups were comparable regarding history of abdominal surgery, lateral pelvic side wall involvement, and cul-de-sac involvement. After we controlled for age and body mass index, the size of the resected endometriomas, duration of surgery, and amount of operative blood loss were comparable in both groups. When required, an additional 5-mm port was inserted in the right or left lower quadrant in the laparoendoscopic single-site surgery group to allow the use of a third instrument for additional tissue retraction or manipulation (10 of 24 patients, 41.6%). However, adhesiolysis was performed more frequently in the conventional laparoscopy group. The duration of hospital stay was <24 hours in both groups. No intraoperative complications were encountered. All incisions healed and were cosmetically satisfactory. CONCLUSION: The laparoendoscopic single-site surgery technique is a reasonable initial approach for the treatment of endometriomas. In our experience, an additional side port is usually needed to treat pelvic side wall and cul-de-sac endometriosis that often accompanies endometriomas.

Endometriosis-induced alterations in mouse metaphase II oocyte microtubules and chromosomal alignment: a possible cause of infertility.

OBJECTIVE: To examine the effect of peritoneal fluid (PF) of patients with endometriosis on the cytoskeleton of metaphase II oocytes and correlate the results with the stage of endometriosis and the duration of infertility. DESIGN: Prospective-controlled study. SETTING: Center for reproductive medicine at a tertiary-care hospital. PATIENT(S): Women with endometriosis (n=23) and tubal ligation/reversal (n=15). INTERVENTION(S): Peritoneal fluid obtained from 38 women (23 with endometriosis and 15 tubal ligation/reversal) after laparoscopy. Four hundred metaphase II oocytes were used: 165 frozen metaphase II oocytes were incubated in the PF of patients with endometriosis, 135 oocytes incubated in the PF of nonendometriosis patients (control subjects) and 100 oocytes incubated in human tubal fluid (HTF) media. MAIN OUTCOME MEASURE(S): Spindle abnormalities (microtubule and chromosomal) were evaluated by confocal imaging. RESULT(S): In the endometriosis group, the cytoskeleton had a higher frequency of abnormal meiotic spindle and chromosomal misalignment (score ≥3), indicating severe damage compared with the control groups. The proportions of abnormalities in microtubule and chromosome alterations in endometriosis (67.9% and 63.6%, respectively) were significantly higher than for oocytes incubated with PF of the nonendometriosis group (24.4% and 14.8%) as well as the HTF group (13% and 13%). Oocyte cytoskeleton damage positively correlated with the duration of infertility and the stage of endometriosis. CONCLUSION(S): Alteration of oocyte cytoskeleton might be one of the causes of poor oocyte quality in patients with endometriosis.

Lipid peroxidation and antioxidant status in preeclampsia: a systematic review.

BACKGROUND: Preeclampsia is characterized by increased lipid peroxidation and diminished antioxidant capacity; however, there is no consensus as to the extent of these conditions. OBJECTIVE: To assess the association of lipid peroxidation and antioxidant status with preeclampsia quantitatively using meta-analysis. DESIGN: Systematic review and meta-analysis. SEARCH STRATEGY: Studies were identified by performing an extensive search using BIOSIS (1986-2007), EMBASE (1986-2007), Medline (1986-2007), and the Cochrane database. DATA ANALYSIS: Standardized mean differences (SMD) with 95% confidence intervals (CI) were used in the meta-analysis and sources of heterogeneity were examined. MAIN RESULTS: In the included studies, the overall SMD was a 1.21 nmol/mL increase in serum malondialdehyde in preeclampsia cases compared to controls (95% CI: 0.76, 1.66). Overall, total serum thiobarbituric acid-reactive substances SMD were 1.62 nmol/mL greater in cases than in controls (95% CI: 0.27, 2.96). The overall estimate SMD for serum vitamin E was 1.12 nmol/mL less in cases than controls (95% CI: -1.77, -0.48) and vitamin C SMD overall estimate was -0.53 (95%CI: -1.03, -0.02), significantly lower in cases compared with controls. The overall SMD for erythrocyte superoxide dismutase was -2.37 (95% CI: -4.76, 0.03), a marginally significant decrease in cases versus controls. CONCLUSIONS: Established preeclampsia is associated with increased concentrations of oxidative stress markers including lipid peroxidation products, and a reduction in antioxidant concentrations. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this educational activity, the participant should be better able to describe the pattern of oxidative stress markers associated with preeclampsia, and interpret the available literature as it relates to oxidative stress and preeclampsia.

The impact of peritoneal fluid from healthy women and from women with endometriosis on sperm DNA and its relationship to the sperm deformity index.

OBJECTIVE: To study the effect of peritoneal fluid (PF) from healthy women and from women with endometriosis on sperm DNA and its relationship to sperm morphology as assessed by the sperm deformity index (SDI). DESIGN: Experimental study. SETTING: Research laboratory at an academic hospital. PATIENT(S): Healthy women undergoing laparoscopic tubal ligation and women with endometriosis. INTERVENTION(S): Aliquots of prepared sperm from 10 healthy donors were incubated with PF from healthy women undergoing laparoscopic tubal ligation (treatment 1, n = 10), with PF from patients with endometriosis (treatment 2, n = 10), and with human tubal fluid media with 10% bovine serum albumin (control, n = 10). MAIN OUTCOME MEASURE(S): Sperm DNA fragmentation was assessed by terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling assay and SDI. RESULT(S): There was a significant increase in sperm DNA damage at 24 hours compared with at 1.5 and 3 hours. The SDI scores significantly correlated with sperm DNA damage after 1.5 and 24 hours of incubation in all aliquots. Percentage normal morphology did not correlate with DNA damage. CONCLUSION(S): In vitro exposure of sperm to PF from patients with endometriosis is associated with significantly increased DNA damage. There is evidence of interdependence between the sperm morphology as assessed by SDI scores and DNA damage. The significant increase in sperm DNA damage observed after 24 hours of incubation may be clinically relevant.

L-carnitine supplementation reduces oocyte cytoskeleton damage and embryo apoptosis induced by incubation in peritoneal fluid from patients with endometriosis.

OBJECTIVE: To investigate the protective effect of L-carnitine (LC) against deleterious substances present in the peritoneal fluid (PF) of patients with endometriosis, which may affect the oocyte cytoskeleton and embryogenesis. DESIGN: Experimental study. SETTING: Research embryology laboratory at an academic hospital. PATIENT(S): Frozen metaphase II mouse oocytes and embryos. INTERVENTION(S): One hundred metaphase II mouse oocytes were divided into five groups and incubated: PF from endometriosis patients; PF from endometriosis patients + LC; PF from tubal ligation patients (patient control); LC only; and human tubal fluid (HTF) alone. A total of 180 eight-cell mouse embryos were divided into: endometriosis only; tubal ligation only; endometriosis + LC; LC alone; and HTF alone. MAIN OUTCOME MEASURE(S): Protective effect of LC on oocytes and embryos. RESULT(S): Incubation of the oocytes and the embryos with PF from patients with endometriosis statistically significantly damaged the oocyte microtubules and chromosomes and increased embryo apoptosis compared with controls. Incubation with LC (0.6 mg/mL) statistically significantly improved microtubule and chromosome structure and decreased the level of embryo apoptosis. CONCLUSION(S): We propose the use of LC as a supplement in patients with endometriosis, a novel approach that may help improve in vitro fertilization outcome in these patients.