[Perimenopausal discovery of endometriomas on ovarian abscess]. / Découverte périménopausique d'un endométriome sur abcès ovarien.

Ovarian abscess is a rare gynaecological diagnosis. The case reported is the one of an unexplained fever with a strong physical alteration during more than 14 days occurring around the menopause, at the age of 54. It has been discovered an ovarian tumour which was, infact, an infected endometrioma. The patient never complained from endometriosis during her reproductive life. She had no other risk factor for ovarian abscess.

Robotically assisted laparoscopic hysterectomy and adnexal surgery.

BACKGROUND: In this pilot study, we tested the feasibility and safety of using a robotic device to perform complex gynecologic surgery. METHODS: Ten female pigs underwent adnexal surgery (n = 5) or hysterectomy (n = 5) using the "Zeus" robotic device. The surgeon operates while sitting at the console away from the surgical table on which the robotic arms are fixed. Both procedures were performed solely with the robotic arms. After 1 week of observation the animals were sacrificed and the surgical site was explored. RESULTS: The procedure was completed successfully in all cases. No animal required conversion to laparotomy or nonrobotic laparoscopic assistance. The mean operative time (+/- SD) was 170 +/- 44 min for adnexal surgery and 200 +/- 57 min for hysterectomy. No complications occurred. No ureteral injuries were found on necropsy. CONCLUSION: Although designed for laparoscopic microsuturing, this robotic technology has the potential to be used for more complex gynecologic procedures.

Erythromycin for chlamydiasis in pregnant women. Assessing adherence to a standard multiday, multidose course.

OBJECTIVE: To assess patient adherence among pregnant women infected with Chlamydia trachomatis given a self-administered, 10-day course of erythromycin prescribed as 500-mg tablets to be taken four times a day for the full 10-day period of treatment. STUDY DESIGN: Study participants (n = 30) were given the standard, 10-day supply of 500-mg tablets of erythromycin and instructed to take one tablet four times daily for 10 days. Patients were blinded to the fact that the Medication Event Monitoring System was being used and that their adherence to this course of drug therapy was being monitored. RESULTS: A 100% cure rate was achieved. The average percentage of therapeutic coverage actually achieved by the study participants declined with the length of erythromycin therapy. Further, as the duration of treatment increased, the longest interval between two successive doses of erythromycin also increased. CONCLUSION: This study demonstrated the importance of assessing both the quantitative and temporal aspects of self-administered oral medication when assessing patient adherence. Moreover, since the length of the course of antibiotic therapy was shown to affect patient adherence, coupled with the 100% cure rate we observed, future research geared toward maximizing adherence while minimizing duration of treatment seems warranted.

Accuracy of preoperative diagnostic tools and outcome of hysteroscopic management of menstrual dysfunction.

STUDY OBJECTIVES: To review diagnoses, complications, and surgical findings in women treated for abnormal uterine bleeding by operative hysteroscopy, and to assess the accuracy of preoperative transvaginal ultrasound (TVS), saline-infusion sonography (SIS), diagnostic hysteroscopy, and endometrial biopsy. DESIGN: Retrospective study (Canadian task force classification II-2). SETTING: Tertiary care academic medical center. PATIENTS: Three hundred seventy-five women. Intervention. Operative hysteroscopy for abnormal uterine bleeding. MEASUREMENTS AND MAIN RESULTS: Main indications for hysteroscopy were postmenopausal bleeding (164 patients, 43.7%) and abnormal premenopausal uterine bleeding (211, 56.3%). Main pathology findings were endometrial polyps (172, 45.9%) and submucous myomas (105, 28%). Polyps had histologic abnormalities in 18 patients. Sensitivity of preoperative diagnostic tools for all intrauterine abnormalities and specifically for myomas and polyps was TVS 74% and 39%, SIS 96% and 96%, hysteroscopy 100% and 99%, and Pipelle biopsy 24% and 10%. The complication rate was 1.3%. Postmenopausal women felt significantly more improvement in symptoms (p = 0.02), and were more satisfied (p

Robotic-assisted laparoscopic microsurgical tubal anastomosis: a human pilot study.

OBJECTIVE: To evaluate the feasibility and safety of a robotic device to perform a laparoscopic tubal anastomosis. DESIGN: Prospective pilot study. SETTING: Tertiary care medical center. PATIENT(S): Ten patients with previous tubal ligations underwent laparoscopic tubal ligation reversal using a robotic suturing device. INTERVENTION(S): Tubal surgery was performed with a robotic system. A two-layered closure was used for all tubes. Four stitches of 8-0 polygalactin sutures were used for each layer. MAIN OUTCOME MEASURE(S): Tubal patency; secondary measures were pregnancy rates, complications, and operative time. RESULT(S): The procedure was completed successfully in all 10 patients. No patient required conversion to an open procedure. The mean time (+/-SD) required to complete the anastomosis of both tubes was 159 +/- 33.8 minutes. Chromotubation at the end of the procedure showed patency in all tubes anastomosed. A postoperative hysterosalpingogram 6 weeks after surgery demonstrated patency in 17 of the 19 (89%) tubes anastomosed. There have been five pregnancies so far. There were no complications. CONCLUSION(S): Robotic technology can be used safely to create laparoscopic microsurgical anastomoses with adequate patency rates. Robotic technology has the potential to make laparoscopic microsuturing easier.

Small bowel obstruction in a peritoneal defect after laparoscopic Burch procedure.

With expansion of laparoscopic surgery, the gynecologic surgeon faces a new set of complications not encountered in open surgery and completely related to the laparoscopic approach. A rare complication occurred after laparoscopic Burch colposuspension performed in a patient with genuine stress urinary incontinence. Although the fascial incision at the right lower quadrant cannula insertion site was closed, a loop of small bowel herniated through the nonclosed peritoneal defect and caused intestinal obstruction 9 days after surgery. For cannula insertion sites 10-mm and greater, we recommend suturing peritoneal defects at the time of fascial closure. (J Am Assoc Gynecol Laparosc 6(3):343-345, 1999)

Laparoscopic management of pelvic organ prolapse.

Until recently, most major gynecologic surgery was performed either vaginally or by laparotomy. In the last decade, surgeons have explored laparoscopic access for many gynecologic surgical disorders. Pelvic reconstructive surgery can be performed laparoscopically but demands a high skill level especially in suturing. Initial reports for laparoscopic bladder neck suspension for genuine stress urinary incontinence are encouraging but lack long term follow-up. The literature contains only a few case studies addressing pelvic support procedures. In this review we present our methods for laparoscopic management of different types of pelvic floor support defects. We view laparoscopy as a method of access rather than a procedure. We present laparoscopic techniques that do not modify the surgical procedures that have been validated by conventional surgery.

Full robotic assistance for laparoscopic tubal anastomosis: a case report.

Optical magnification and long instrumentation significantly increase surgical tremor, which makes laparoscopic microsuturing difficult. Therefore, laparoscopic tubal anastomosis has not gained wide acceptance among gynecologic surgeons. Robotic assistance facilitates this type of procedure by filtering tremor, reducing the surgeon's fatigue, and scaling the maneuvers. The authors have successfully completed a case of laparoscopic tubal reanastomosis using a "master-slave" robot to perform the standard microsuturing technique. A 33-year-old woman, gravida 2, para 2, requested reversal of her previous tubal ligature. A right isthmic-isthmic tubal anastomosis was performed laparoscopically, with faithful adherence to the authors' standard technique applied at laparotomy. Full robotic assistance was used to anastomose the tube. A chromotubation test showed anastomotic patency without leak. The patient recovered uneventfully after surgery and was discharged within 24 h after the procedure. Laparoscopic microsurgical tubal anastomosis with full robotic assistance is feasible and safe in humans.

Robotically assisted laparoscopic microsurgical uterine horn anastomosis.

OBJECTIVE: To evaluate the feasibility, safety, and sterility issues with regard to the use of a robotic device to perform uterine horn anastomosis in a live porcine model. DESIGN: Prospective animal study. SETTING: Landrace-Yorkshire pigs in a conventional laboratory setting. INTERVENTION(S): Six female pigs underwent laparoscopic bipolar electrocoagulation of the distal uterine horns. Two weeks later, the uterine horns were reanastomosed laparoscopically with use of a robotic system for microsuturing. Necropsy was performed 4 weeks later to assess postoperative adhesions and anastomosis patency. MAIN OUTCOME MEASURE(S): Tubal patency; secondary measures were operative time, complications, and surgeon fatigue. RESULT(S): The mean (+/-SD) total operative time per animal was 170+/-34 minutes including setting up and dismantling the robotic arms. The robot functioned well with only minor technical problems. All pigs survived both surgeries with no perioperative complications related to the use of the robot. Patency was confirmed after completing each anastomosis (12 anastomoses; 100% patency). Four weeks later, necropsy showed that eight anastomoses were still patent (67%). Only one pig had bilateral occlusion. Surgeon's fatigue was mild for each animal study. CONCLUSION(S): Robotic technology can be used safely in creating laparoscopic microsurgical anastomoses. The robot functioned properly in a sterile operating room environment. Adequate patency rates were achieved during the acute phase and at 4-week follow-up. Robotic technology has the potential to make laparoscopic microsuturing easier.

Robotically assisted laparoscopic tubal anastomosis in a porcine model: a pilot study.

As with standard microsurgical procedures performed at laparotomy, laparoscopic tubal anastomosis requires great dexterity. Handling fine suture materials under magnification to anastomose tubal segments with lumens less than 3 mm in diameter while working with your hands at a distance from the tissue makes these fine movements even more difficult. This is exacerbated by the tremor induced by the fatigue caused by a prolonged laparoscopic procedure and the need for precise control. We conducted a pilot study to evaluate the feasibility of performing laparoscopic tubal anastomosis with robotic assistance in a live porcine model. Two anastomoses were performed on one uterine horn via each of the following techniques: laparoscopy, laparoscopy with robotic assistance, and open microsurgery. Immediate necropsy demonstrated all the anastomoses to be patent. There were no intraoperative complications. Laparoscopic tubal anastomosis was associated with surgeon fatigue and neck, shoulder, and back pain. The surgeons were more comfortable performing the procedure with robotic assistance. The device functioned well and without incident. This acute animal study suggests that robotic assistance in laparoscopic tubal anastomoses is safe and feasible. It enhances surgeons' dexterity and precision while reducing fatigue. It is promising for future use in chronic experimental studies.

Vaginal bleeding in an infant secondary to sliding inguinal hernia.

BACKGROUND: Vaginal bleeding in infancy is rare and, to our knowledge, has not been reported in association with an inguinal hernia. CASE: A premature infant with a known reducible inguinal hernia developed vaginal bleeding at 8 months. Work-up revealed no coagulopathy and no endocrine abnormality. Physical examination and ultrasound found no anatomic lesion responsible for her bleeding. At surgery, she was found to have an indirect hernia in which the uterus, fallopian tube, and ovary were sliding components. Her vaginal bleeding ceased after herniorrhaphy. CONCLUSION: Vaginal bleeding in a child with an inguinal hernia may occur when the uterus is a sliding component of the hernia.