Risk of de novo posterior vaginal prolapse after anterior laparoscopic sacrocolpopexy: Evaluation at one year.

INTRODUCTION AND HYPOTHESIS: Treatment of anterior vaginal and/or apical prolapse by sacrocolpopexy is most often performed by systematic placement of two non-resorbable meshes, anterior and posterior, whether or not there is an associated posterior vaginal prolapse. We believe that isolated correction of an anterior vaginal and/or apical prolapse in the absence of posterior vaginal prolapse is not associated with a higher rate of de novo posterior vaginal prolapse. METHOD: A prospective, observational, monocenter study performed in the Gynecology unit of the Conception UHC in Marseille from May 2011 to October 2014. Patients over 18 years of age exhibiting an anterior vaginal and/or apical prolapse of stage ≥ 2 of the POP-Q classification resulting in functional impairment with alteration of the quality of life, without an associated posterior vaginal prolapse were included and underwent a laparoscopic anterior sacrocolpopexy (ASP). They were seen again in consultation one year from the intervention. Validated quality of life questionnaires were completed pre- and one year postoperatively. RESULTS: 50 patients were included. The rate of de novo posterior vaginal prolapse was 8/50 (16 %). At one year, there was a significant improvement in terms of the SPDI-20 and SPIQ-7 (p < 0.0001) questionnaire, without significant improvement in the quality of sexual function (PISQ-12 questionnaire) (p = 0.073). CONCLUSION: The risk of de novo posterior vaginal prolapse at one year is low when an ASP is carried out.

Hysterectomy for benign disease: clinical practice guidelines from the French College of Obstetrics and Gynecology.

OBJECTIVE: The objective of the study was to draw up French College of Obstetrics and Gynecology (CNGOF) clinical practice guidelines based on the best available evidence concerning hysterectomy for benign disease. METHODS: Each recommendation for practice was allocated a grade, which depends on the level of evidence (clinical practice guidelines). RESULTS: Hysterectomy should be performed by a high-volume surgeon (>10 hysterectomy procedures per year) (gradeC). Stimulant laxatives taken as a rectal enema are not recommended prior to hysterectomy (gradeC). It is recommended to carry out vaginal disinfection using povidone-iodine solution prior to hysterectomy (grade B). Antibiotic prophylaxis is recommended during hysterectomy, regardless of the surgical approach (grade B). The vaginal or laparoscopic approach is recommended for hysterectomy for benign disease (grade B), even if the uterus is large and/or the patient is obese (gradeC). The choice between these two surgical approaches depends on other parameters, such as the surgeon's experience, the mode of anesthesia, and organizational constraints (duration of surgery and medical economic factors). Vaginal hysterectomy is not contraindicated in nulliparous women (gradeC) or in women with previous cesarean section (gradeC). No specific hemostatic technique is recommended with a view to avoiding urinary tract injury (gradeC). In the absence of ovarian disease and a personal or family history of breast/ovarian carcinoma, the ovaries should be preserved in pre-menopausal women (grade B). Subtotal hysterectomy is not recommended with a view to reducing the risk of peri- or postoperative complications (grade B). CONCLUSION: The application of these recommendations should minimize risks associated with hysterectomy.

Laparoscopic ovariectomy by single-port access for ovarian cryopreservation.

PURPOSE: The aim of this study is to assess the feasibility of ovariectomy by single-port access laparoscopy for cryopreservation. METHODS: Observational prospective monocentric study including patients referred for an ovariectomy for ovarian tissue cryopreservation underwent ovariectomy by single-port access laparoscopy. Feasibility, intra- and post-operative complications, and quality of the ovarian tissue collected were reported. RESULTS: Height patients were included. No conversion to standard laparoscopy or laparotomy was performed and no intra- or post-operative complications were reported. Median duration of surgery was 35 min (30-60). The quality of all the ovarian tissue collected was correct, and cryopreservation was possible for all patients. CONCLUSIONS: Ovariectomy for cryopreservation by laparoscopy with SPA seems feasible. The advantages of this technique are particularly interesting in these patients who require the least aggressive surgical technique possible and a rapid convalescence.

Supracervical hysterectomy by laparoendoscopic single site surgery.

OBJECTIVE: To evaluate the feasibility of laparoscopic supracervical hysterectomy (LSH) by single port access (SPA) with transcervical morcellation. STUDY DESIGN: Observational study conducted between September 2010 and March 2012 in two departments of Gynaecology. Forty women who required hysterectomy underwent LSH by SPA with transcervical morcellation. RESULTS: LSH by SPA with transcervical morcellation was completed successfully in 37/40 (93.5 %) patients. Mean operating time was 128 (±55) min and mean hospital stay was 3.5 (±1) days. The mean of uterus weight was 310 (±214) g. The mean estimated blood loss was 250 (±110) ml. Four women (10 %) required a second surgical intervention including two cases of endocervical bleeding. CONCLUSION: LSH by SPA with transcervical morcellation is a feasible procedure.

Accelerated senescence of cord blood endothelial progenitor cells in premature neonates is driven by SIRT1 decreased expression.

Epidemiological and experimental studies indicate that early vascular dysfunction occurs in low-birth-weight subjects, especially preterm (PT) infants. We recently reported impaired angiogenic activity of endothelial colony-forming cells (ECFCs) in this condition. We hypothesized that ECFC dysfunction in PT might result from premature senescence and investigated the underlying mechanisms. Compared with ECFCs from term neonates (n = 18), ECFCs isolated from PT (n = 29) display an accelerated senescence sustained by growth arrest and increased senescence-associated ß-galactosidase activity. Increased p16(INK4a) expression, in the absence of telomere shortening, indicates that premature PT-ECFC aging results from stress-induced senescence. SIRT1 level, a nicotinamide adenine dinucleotide-dependent deacetylase with anti-aging activities, is dramatically decreased in PT-ECFCs and correlated with gestational age. SIRT1 deficiency is subsequent to epigenetic silencing of its promoter. Transient SIRT1 overexpression or chemical induction by resveratrol treatment reverses senescence phenotype, and rescues in vitro PT-ECFC angiogenic defect in a SIRT1-dependent manner. SIRT1 overexpression also restores PT-ECFC capacity for neovessel formation in vivo. We thus demonstrate that decreased expression of SIRT1 drives accelerated senescence of PT-ECFCs, and acts as a critical determinant of the PT-ECFC angiogenic defect. These findings lay new grounds for understanding the increased cardiovascular risk in individuals born prematurely and open perspectives for therapeutic strategy.

Altered angiogenesis in low birth weight individuals: a role for anti-angiogenic circulating factors.

OBJECTIVE: Low birth weight (LBW) is a risk factor for hypertension at adulthood. Endothelial progenitor cells (EPCs) dysfunction has been characterized in LBW neonates. We hypothesized that changes in soluble, plasma pro- or anti-angiogenic factors are associated with EPCs dysfunction and impaired angiogenesis in LBW neonates. METHOD: Venous umbilical cord blood was collected from 42 normal, term neonates and 75 LBW neonates. Cord blood endothelial colony forming cells (ECFC) from control patients were cultured in the presence of 10% of serum obtained from both groups. RESULTS: The proliferation and the migration of ECFC were significantly reduced when cultured with 10% of serum of LBW neonates compared to serum of control neonates. Matrigel invasion assay was not significantly altered. Umbilical vein plasma VEGF concentration was significantly reduced in LBW neonates while that of sVEGFR and PF4 were significantly higher. Addition of VEGF corrected the inhibitory effect of LBW serum on normal ECFC proliferation. CONCLUSIONS: Serum obtained from LBW babies contains factors that exhibit an antiangiogenic effect on ECFC proliferation and migration. VEGF/sVEGF/PF4 pathway seems to be involved in the EPCs dysfunction in LBW neonates.

Salpingectomy for ectopic pregnancy by transumbilical single-site laparoscopy with the SILS system.

OBJECTIVE: To evaluate the feasibility in everyday practice and the advantages of salpingectomy for ectopic pregnancy by single-incision laparoscopic surgery with the SILS system. STUDY DESIGN: This single-center prospective observational study included 37 women requiring salpingectomy for ectopic pregnancy who underwent single-incision laparoscopic salpingectomy with the SILS system. Information about feasibility and intra- and post-operative data were collected. The data for these patients were compared with those of a control group of 40 women treated by standard laparoscopy. RESULTS: Thirty-six (97%) patients were treated successfully with the SILS system. After laparoscopic confirmation of the ectopic pregnancy, salpingectomy was performed with bipolar forceps and scissors. In one case, conversion to classic laparoscopy was performed because SILS was not feasible. Compared with the control group, operative time was longer (50 ± 35 vs 35 ± 30 min, p=0.001) but duration of hospitalization shorter with single-site laparoscopy (1.5 ± 1.5 vs 2.3 ± 1.5 days, p=0.02). CONCLUSIONS: Laparoscopic salpingectomy for ectopic pregnancy appears to be feasible in everyday practice by single-incision laparoscopic surgery with the SILS system and appears to reduce the duration of hospitalization. Larger series are necessary to confirm this conclusion.

A switch toward angiostatic gene expression impairs the angiogenic properties of endothelial progenitor cells in low birth weight preterm infants.

Low birth weight (LBW) is associated with increased risk of cardiovascular diseases at adulthood. Nevertheless, the impact of LBW on the endothelium is not clearly established. We investigate whether LBW alters the angiogenic properties of cord blood endothelial colony forming cells (LBW-ECFCs) in 25 preterm neonates compared with 25 term neonates (CT-ECFCs). We observed that LBW decreased the number of colonies formed by ECFCs and delayed the time of appearance of their clonal progeny. LBW dramatically reduced LBW-ECFC capacity to form sprouts and tubes, to migrate and to proliferate in vitro. The angiogenic defect of LBW-ECFCs was confirmed in vivo by their inability to form robust capillary networks in Matrigel plugs injected in nu/nu mice. Gene profile analysis of LBW-ECFCs demonstrated an increased expression of antiangiogenic genes. Among them, thrombospondin 1 (THBS1) was highly expressed at RNA and protein levels in LBW-ECFCs. Silencing THBS1 restored the angiogenic properties of LBW-ECFCs by increasing AKT phosphorylation. The imbalance toward an angiostatic state provide a mechanistic link between LBW and the impaired angiogenic properties of ECFCs and allows the identification of THBS1 as a novel player in LBW-ECFC defect, opening new perspectives for novel deprogramming agents.