RESUMEN
STUDY QUESTION: Is increasing the intensity of high-intensity focused ultrasound (HIFU) by 30% in the treatment of rectal endometriosis a safe procedure? SUMMARY ANSWER: This study demonstrates the safety of a 30% increase in the intensity of HIFU in the treatment of rectal endometriosis, with no Clavien-Dindo Grade III complications overall, and namely no rectovaginal fistulae. WHAT IS KNOWN ALREADY: A feasibility study including 20 patients with rectal endometriosis demonstrated, with no severe complications, a significant improvement in digestive disorders, dysmenorrhoea, dyspareunia, and health status, although the volume of the endometriosis nodule did not appear to be reduced. STUDY DESIGN, SIZE, DURATION: A prospective multicentre cohort study was conducted between 2020 and 2022 with 60 patients with symptomatic rectal endometriosis. Following the failure of medical treatment, HIFU treatment was offered as an alternative to surgery. PARTICIPANTS/MATERIALS, SETTING, METHODS: As the main objective of this study was to examine safety, all adverse events observed during the 6 months of follow-up were analysed and graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) and Clavien-Dindo classifications. Secondary objectives included evaluating the evolution of symptoms using validated questionnaires: gynaecological and digestive pain symptoms with a visual analogue scale, health status with the Medical Outcomes Study 36-item Short Form (SF-36) questionnaire, average post-operative daily pain level, and analgesic medication required in the 10 days following treatment. MRI was also performed at Day 1 to detect early complications. Finally, we performed a blinded MRI review of the evolution of the nodule at 6 months post-treatment. MAIN RESULTS AND THE ROLE OF CHANCE: The procedure was performed under spinal anaesthesia for 30% of the patients. The median duration of treatment was 32 min. Fifty-five patients left the hospital on Day 1. MRI scans performed on Day 1 did not highlight any early-onset post-operative complication. Using the Clavien-Dindo classification, we listed 56.7% Grade I events, 3.4% Grade II events, and no events Grade III or higher. At 1, 3, and 6 months, all gynaecologic, digestive and general symptoms, as well as health status, had significantly improved. The evolution of the nodule was also significant (P < 0.001) with a 28% decrease in volume. LIMITATIONS, REASONS FOR CAUTION: The main objective was safety and not effectiveness. The study was not randomized and there was no control group. WIDER IMPLICATIONS OF THE FINDINGS: HIFU treatment for rectal endometriosis results in an improvement of symptoms with low morbidity; as such, for selected patients, it could be a valuable alternative to surgical approaches following the failure of medical treatment. STUDY FUNDING/COMPETING INTEREST(S): The study was funded by the company EDAP TMS. Professors Dubernard and Rousset are consultants for EDAP TMS. Dubernard received travel support from EDAP-TMS. Dr F. Chavrier received industrial grants from EDAP-TMS. He has developed a device for generating focused ultrasonic waves with reduced treatment time. This device has been patented by EDAP-TMS. Dr Lafon received industrial grants from EDAP-TMS; he declares that EDAP-TMS provided funding directly to INSERM to support a young researcher chair in therapeutic ultrasound, which is unrelated to the current study. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov identifier NCT04494568.
Asunto(s)
Endometriosis , Enfermedades del Recto , Humanos , Femenino , Endometriosis/terapia , Endometriosis/cirugía , Endometriosis/diagnóstico por imagen , Adulto , Estudios Prospectivos , Enfermedades del Recto/terapia , Francia , Resultado del Tratamiento , Ultrasonido Enfocado de Alta Intensidad de Ablación/métodos , Ultrasonido Enfocado de Alta Intensidad de Ablación/efectos adversos , Persona de Mediana Edad , Dismenorrea/terapia , Dispareunia/etiología , Dispareunia/terapiaRESUMEN
Endometriosis is a benign gynecologic affection that may lead to major surgeries, such as colorectal resections. Rectovaginal fistulas (RVF) are among the possible complications. When they occur, it is necessary to adapt the repair surgery as best as possible to limit their functional consequences. This video shows three different techniques for correcting RVF after rectal resection for endometriosis, with a combination of perineal surgery and laparoscopy: a mucosal flap, a transanal transection and single stapled anastomosis (TTSS) and a pull through. Supplementary file1 (MP4 469658 KB).
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Endometriosis , Laparoscopía , Fístula Rectovaginal , Humanos , Femenino , Fístula Rectovaginal/cirugía , Fístula Rectovaginal/etiología , Endometriosis/cirugía , Laparoscopía/métodos , Laparoscopía/efectos adversos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Proctectomía/efectos adversos , Proctectomía/métodos , Recto/cirugía , Anastomosis Quirúrgica/efectos adversos , Anastomosis Quirúrgica/métodos , Colgajos Quirúrgicos , Perineo/cirugía , AdultoRESUMEN
OBJECTIVE: This study aimed at assessing perioperative results of robot-assisted laparoscopy (RAL) in the context of deep infiltrating endometriosis (DIE). METHODS: This retrospective French multicentric study included all patients with DIE who underwent surgical treatment managed by RAL (Da Vinci® System). From November 2008 to June 2019, patients were included in a single European database, in Robotic Assisted Laparoscopic Gynecologic Surgery, with Society of European Robotic Gynecological Surgery collaboration. Patients had different DIE sites as follows: gynecological, urological, or digestive, or combinations of these. Surgical procedures and perioperative complications were evaluated. To assess complications, patients were divided into the following four groups according to surgical procedure and DIE site: gynecological only; gynecological and urological; gynecological and digestive; and gynecological, urological, and digestive. RESULTS: A total of 460 patients treated at one of eight health-care facilities from November 2008 to June 2019 were included. Median operative time was 245 min (IQR 186-320), surgeon console time was 138 ± 75 min and estimated blood loss was 70.0 mL ± 107 mL. Among this patient sample, 42.1% had a multidisciplinary surgical approach with a digestive or urology surgeon in addition to gynecology surgeon (25.5% and 16.6% of cases, respectively). Among those with intraoperative complications (n = 25, 5.4%) were primarily conversion to laparotomy (n = 6, 2.0%), transfusion (n = 2, 0.6%), and organ wounds (n = 8, 1.7%). Overall, 5.6% had severe postoperative complications (Clavien-Dindo classification ≥ Grade 3). CONCLUSION: This is among the largest published series addressing RAL for DIE. Interest in this procedure appears promising, with no observed increases in blood loss or in peri- or post-operative complications. DIE laparoscopic surgery can require complex surgical procedures performed by multidisciplinary surgical teams. Thus, it may be one of the best candidates for RAL within gynecology surgery.
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Endometriosis , Laparoscopía , Procedimientos Quirúrgicos Robotizados , Endometriosis/complicaciones , Endometriosis/cirugía , Femenino , Procedimientos Quirúrgicos Ginecológicos/efectos adversos , Procedimientos Quirúrgicos Ginecológicos/métodos , Humanos , Laparoscopía/efectos adversos , Laparoscopía/métodos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Estudios Retrospectivos , Procedimientos Quirúrgicos Robotizados/efectos adversos , Procedimientos Quirúrgicos Robotizados/métodos , Resultado del TratamientoRESUMEN
STUDY QUESTION: What is the prevalence of laparoscopically nonvisualized palpable satellite bowel nodules at or near the planned stapler site in women undergoing segmental bowel resection for endometriosis? SUMMARY ANSWER: Overall, 13 (25.5%) of 51 patients who underwent resection had nonvisualized palpable satellite lesions as small as 2 mm, including seven (14%) who had nonvisualized palpable lesions at or beyond the planned stapler site. WHAT IS KNOWN ALREADY: Both laparoscopy and laparotomy for bowel resection are standard of care in Europe and the USA. Reoperation rates after laparoscopic bowel procedures are 1-16%. Endometriotic lesions at the stapler margin of bowel resections are associated with increased repeat surgery. Nodules of 0.1 mm to 1 cm in size were not recognized during laparoscopic bowel surgery but were recognized on histological examination. Up to 20 nodules not visualized at laparoscopy have been recognized and excised at laparotomy. Tenderness is found at up to 27 mm from a recognized lesion. The size of a lesion does not always predict its symptoms or behavior. STUDY DESIGN, SIZE, DURATION: This single-arm, observational study focused on the presence of nonvisualized palpable satellite lesions of the bowel. Fifty-one patients scheduled for laparoscopic-assisted bowel resection for deep infiltrating endometriosis with suprapubic incision for placement of the stapler's anvil and removal of the specimen in the course of routine clinical care were included. There were no additional inclusion or exclusion criteria. PARTICIPANTS/MATERIALS, SETTING, METHODS: Laparoscopic-assisted segmental bowel resection for endometriosis was performed in a private referral center on women aged 24-49 years. MAIN RESULTS AND THE ROLE OF CHANCE: Forty-nine (96.1%) of the 51 patients underwent segmental resection of the sigmoid or rectum, and 14 (27.5%) underwent segmental resection of the ileum for large nodule(s) recognized on MRI. Twelve patients underwent both procedures. Eleven (22.4%) of the 49 patients with recognized sigmoid or rectal lesions and 5 (35.7%) of the 14 patients with recognized ileal lesions had nonvisualized, palpable, satellite lesions. All the large lesions and none of the satellite lesions had been recognized preoperatively on MRI. Five (10%) of 49 patients with lesions of the large bowel and 4 (28.6%) of the 14 patients with lesions of the ileum had nonvisualized palpable satellite lesions at or beyond the planned stapler site. Lesions as small as 2 mm were palpable. LIMITATIONS, REASONS FOR CAUTION: This is an observational study. It is not known if the small lesions of this study contributed to the symptoms or were progressive, stable or regressive. This study analyzed lesions in the bowel segment proximal to the primary large bowel lesion, but not in the distal segment as that would have required a change in standard of care surgical technique. This study protocol did not include shaving or disk resection or patients in whom no lesions were visualized. The use of additional techniques for recognition, such as hand-assisted laparoscopy or rectal probes, was not investigated. WIDER IMPLICATIONS OF THE FINDINGS: This study confirms that some nonvisualized satellite lesions as small as 2 mm are palpable and that an increased length of resection can be used to remove lesions recognized by palpation and to avoid lesions at and beyond the stapler site. This may decrease recurrent surgery in 1-16% of the women undergoing surgery for bowel endometriosis. Knowledge of the occurrence of these small lesions may also be particularly useful in plans for repeat surgery or for women with clinically significant bowel symptoms and no visible lesions at laparoscopy. Moreover, small lesions are considered to be important as there is no current technique to determine whether a large primary lesion, smaller lesions, an associated adjacent tissue reaction or a combination of those cause symptoms. STUDY FUNDING/COMPETING INTEREST(S): This CIRENDO cohort was supported by the G4 Group (the University Hospitals of Rouen, Lille, Amiens and Caen) and the ROUENDOMETRIOSE association. No specific funding was received for the study. H.R. reports receiving personal fees from Plasma Surgical Inc., Ethicon Endosurgery, Olympus and Nordic Pharma for presentations related to his experience with endometriosis surgery. D.C.M. reports being given access to Lumenis Surgical CO2 Lasers' lab at a meeting. None of the other authors have conflicts of interest to disclose. TRIAL REGISTRATION NUMBER: N/A.
Asunto(s)
Endometriosis , Laparoscopía , Enfermedades del Recto , Adulto , Endometriosis/diagnóstico por imagen , Endometriosis/cirugía , Europa (Continente) , Femenino , Humanos , Persona de Mediana Edad , Enfermedades del Recto/cirugía , Recto , Resultado del Tratamiento , Adulto JovenRESUMEN
The main autoimmune diseases responsible for obstetric complications are systemic lupus erythematosus and antiphospholipid syndrome. They are particularly associated with an increased risk of miscarriage, stillbirth, intrauterine growth restriction, prematurity and pre-eclampsia. Therapeutics to prevent its complications are mainly low dose aspirin and low molecular weight heparins. However, the introduction of these therapies will have to consider the benefit/risk ratio to manage pregnancy and especially delivery. Consistency of care provided by autoimmunity specialists and gynaecologist-obstetricians is extremely important and must be promoted through regular exchanges, fuelled by a mutual culture, through multidisciplinary consultation meetings.
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Síndrome Antifosfolípido , Lupus Eritematoso Sistémico , Obstetricia , Complicaciones del Embarazo , Síndrome Antifosfolípido/complicaciones , Síndrome Antifosfolípido/terapia , Femenino , Heparina de Bajo-Peso-Molecular/uso terapéutico , Humanos , Lupus Eritematoso Sistémico/tratamiento farmacológico , Lupus Eritematoso Sistémico/terapia , Embarazo , Complicaciones del Embarazo/terapiaRESUMEN
OBJECTIVE: The objective of our study is to present the activity volume and postoperative complications in a center exclusively destined to endometriosis surgery. METHODS: Retrospective mono-centric study analyzing data collected prospectively in patients surgically managed for endometriosis from September 2018 to August 2019. RESULTS: Four hundred and ninety-one patients underwent surgery for endometriosis during 12 consecutive months: 268 for colorectal localizations (54.6%), 51 for endometriosis of the urinary tract (10.4%), 17 for nodules of ileum and right colon (3.5%), 43 for nodules of parametriums (8.8%), 12 for nodules of sacral roots and sciatic nerves (2.4%), 7 for diaphragmatic localizations (1.4%). Among 268 patients with colorectal endometrioses, of which 48.1% concerned the low and mid rectum, shaving was performed in 102 cases, disc excision in 96 cases and colorectal resection in 100 cases. Stoma was performed in 13.1% of the cases. Patients could have 2 different procedures for multiple colorectal nodules. One hundred and ninety-nine ovarian endometriomas were managed by plasma energy ablation in 64.8%, sclerotherapy in 11.1%, cystectomy in 13.1%, oophorectomy in 11.1%. Major postoperative complications included 12 rectovaginal fistulas, while 18 other surgical procedures were carried out for various complications. In all, 38.1% of procedures involved a general surgeon and 5.3% an urologist. CONCLUSION: The creation of centers exclusively destined to endometriosis surgery allows the multidisciplinary management of a high number of patients, with an over-representation of severe forms and rare locations of the disease, followed by satisfactory complication rates.
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Endometriosis/cirugía , Comunicación Interdisciplinaria , Complicaciones Posoperatorias/epidemiología , Adulto , Enfermedades del Colon/cirugía , Femenino , Humanos , Enfermedades del Recto/cirugía , Estudios Retrospectivos , Enfermedades Urológicas/cirugíaRESUMEN
OBJECTIVE: The aim of the study was to assess the impact of the introduction of training workshops on the quality of prevention and management of Post-Partum Hemorrhage (PPH) in a type III university center. METHODS: A clinical audit was carried out in our type III university center before and after the introduction of training workshops on the prevention and management of PPH, in two periods between January 1st to December 31st 2011 and March 1st and August 1st, 2015. Training workshops were according to the recommendations for clinical practice of the National College of Gynecologists-Obstetricians French published in 2014, and included a theoretical portion and a simulation of low fidelity manikin. Data on the management of patients presenting with PPH after vaginal birth of a singleton were retrospectively collected consecutively from medical records. Data were collected using a standardized analytical grid. Between the two data collections, some improvement actions were implemented. RESULTS: After implementation of training workshops, the proportion of patients with active management of the third stage of labor (prophylactic uterotonic after delivery) has significantly improved (72% before, vs. 92% after, P=0.001); time to PPH diagnosis has been significantly higher notified (40% before, vs. 94% after, P<0.001), as well as the quantification of bleeding at diagnosis (46% before, vs. 72% after, P<0.003) and total bleeding (68% before, vs. 92%, P<0.001). PPH-specific monitoring sheet was found to be used significantly more frequently (3 before, vs. 30 after, P=0.00015). Additionally, the Physician Anesthesiologist has been contacted significantly more often (34% before, vs. 53% after, P=0.002). CONCLUSION: Our study highlights a significant improvement in professional practices between 2011 and 2015 on PPH prevention and management in our type III university center.
Asunto(s)
Obstetricia/educación , Hemorragia Posparto/terapia , Adulto , Auditoría Clínica , Femenino , Hospitales Universitarios , Humanos , Trabajo de Parto , Masaje , Obstetricia/métodos , Hemorragia Posparto/diagnóstico , Hemorragia Posparto/prevención & control , Embarazo , Estudios Retrospectivos , ÚteroRESUMEN
First-line diagnostic investigations for endometriosis are physical examination and pelvic ultrasound. The second-line investigations are: targeted pelvic examination performed by an expert clinician, transvaginal ultrasound performed by an expert physician sonographer (radiologist or gynaecologist), and pelvic MRI. Management of endometriosis is recommended when the disease has a functional impact. Recommended first-line hormonal therapies for the management of endometriosis-related pain are combined hormonal contraceptives (CHCs) or the 52mg levonorgestrel-releasing intrauterine system (IUS). There is no evidence base on which to recommend systematic preoperative hormonal therapy solely to prevent surgical complications or facilitate surgery. After surgery for endometriosis, a CHC or 52mg levonorgestrel-releasing IUS is recommended as first-line treatment when pregnancy is not desired. In the event of failure of the initial treatment, recurrence, or multiorgan involvement, a multidisciplinary team meeting is recommended, involving physicians, surgeons and other professionals. A laparoscopic approach is recommended for surgical treatment of endometriosis. HRT can be offered to postmenopausal women who have undergone surgical treatment for endometriosis. Antigonadotrophic hormonal therapy is not recommended for patients with endometriosis and infertility to increase the chances of spontaneous pregnancy, including postoperatively. Fertility preservation options must be discussed with patients undergoing surgery for ovarian endometriomas.
Asunto(s)
Endometriosis/tratamiento farmacológico , Ginecología , Obstetricia , Guías de Práctica Clínica como Asunto , Sociedades Médicas , Endometriosis/diagnóstico , Endometriosis/cirugía , Femenino , Francia , Ginecología/normas , Humanos , Obstetricia/normas , Guías de Práctica Clínica como Asunto/normas , Sociedades Médicas/normasRESUMEN
The article presents French guidelines for surgical management of endometriosis. Surgical treatment is recommended for mild to moderate endometriosis, as it decreases pelvic painful complaints and increases the likelihood of postoperative conception in infertile patients (A). Surgery may be proposed in symptomatic patients with ovarian endometriomas which diameter exceeds 20mm. Cystectomy allows for better postoperative pregnancy rates when compared to ablation using bipolar current, as well as for lower recurrences rates when compared to ablation using bipolar current or CO2 laser. Ablation of ovarian endometriomas using bipolar current is not recommended (B). Surgery may be employed in patients with deep endometriosis infiltrating the colon and the rectum, with good impact on painful complaints and postoperative conception. In these patients, laparoscopic route increases the likelihood of postoperative spontaneous conception when compared to open route. When compared to conservative rectal procedures (shaving or disc excision), segmental colorectal resection increases the risk of postoperative stenosis, requiring additional endoscopic or surgical procedures. In large deep endometriosis infiltrating the rectum (>20mm length of bowel infiltration), conservative rectal procedures do not improve postoperative digestive function when compared to segmental resection. In patients with bowel anastomosis, placing anti-adhesion agents on contact with bowel suture is not recommended, due to higher risk of bowel fistula (C). Various other recommendations are proposed in the text, however, they are based on studies with low level of evidence.
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Endometriosis/cirugía , Adulto , Enfermedades del Colon/etiología , Enfermedades del Colon/cirugía , Cistectomía , Endometriosis/complicaciones , Femenino , Humanos , Histerectomía , Laparoscopía , Enfermedades del Recto/etiología , Enfermedades del Recto/cirugía , Enfermedades Urológicas/etiología , Enfermedades Urológicas/cirugíaRESUMEN
According to some studies, extragenital endometriosis represents 5% of the localisations. Its prevalence seems to be underestimated. The extra pelvic localisation can make the diagnosis more difficult. Nevertheless, the recurrent and catamenial symptomatology can evoke this pathology. Surgery seems to be the unique efficient treatment for parietal lesions. Pain linked to nervous lesions (peripheric and sacral roots) seems to be underestimated and difficult to diagnose because of various localisations. Neurolysis seems to have encouraging results. Diaphragmatic lesions are often discovered either incidentally during laparoscopy, or by pulmonary symptomatology as recurrent catamenial pneumothorax or cyclic thoracic pain. Surgical treatment seems as well to be efficient.
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Abdomen/cirugía , Diafragma/cirugía , Endometriosis/terapia , Enfermedades del Sistema Nervioso Periférico/terapia , Enfermedades Torácicas/cirugía , Endometriosis/complicaciones , Endometriosis/diagnóstico , Femenino , Humanos , Laparoscopía , Enfermedades del Sistema Nervioso Periférico/etiología , Enfermedades Torácicas/etiologíaRESUMEN
Minimal and mild endometriosis (stage 1 and 2 AFSR) can lead to chronic pelvic pain and infertility but can also exist in asymptomatic patients. The prevalence of asymptomatic patients with minimal and mild endometriosis is not clear but typical endometriosis lesions are found in about 5 to 10% of asymptomatic women and more than 50% of painful and/or infertile women. Laparoscopic treatment of minimal and mild endometriotic lesions is justified in case of pelvic pain because their destruction decrease significatively the pain compared with diagnostic laparoscopy alone. In this context, ablation and excision give identical results in terms of pain reduction. Moreover, literature shows no interest in uterine nerve ablation in case of dysmenorrhea due to minimal and mild endometriosis. Then, it is recommended to treat these lesions during a laparoscopy realised as part of pelvic pain. On the other hand, it is not recommended to treat asymptomatic patients. With regard to treatment of minimal and mild endometriosis in infertile patients, only two studies can be selected and both show that laparoscopy with excision or ablation and ablation of adhesions is superior to diagnostic laparoscopy alone in terms of pregnancy rate. However, it is not recommended to treat these lesions when they are asymptomatic because there is no evidence that they can progress with symptomatic disease. There is no study assessing the interest to treat these lesions when they are found fortuitously. Adhesion barrier utilisation permits to reduce post-operative adhesions, however literature failed to demonstrate the clinical profit in terms of reduction of the risk of pain or infertility.
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Endometriosis/cirugía , Infertilidad Femenina/cirugía , Laparoscopía , Dolor Pélvico/cirugía , Endometriosis/complicaciones , Femenino , Humanos , Infertilidad Femenina/etiología , Dolor Pélvico/etiología , Adherencias Tisulares/prevención & controlRESUMEN
First-line investigations to diagnose endometriosis are clinical examination and pelvic ultrasound. Second-line investigations include pelvic examination performed by a referent clinician, transvaginal ultrasound performed by a referent echographist, and pelvic MRI. It is recommended to treat endometriosis when it is symptomatic. First-line hormonal treatments recommended for the management of painful endometriosis are combined with hormonal contraceptives or levonorgestrel 52mg IUD. There is no evidence to recommend systematic preoperative hormonal therapy for the unique purpose of preventing the risk of surgical complications or facilitating surgery. After endometriosis surgery, combined hormonal contraceptives or levonorgestrel SIU 52mg are recommended as first-line therapy in the absence of desire of pregnancy. In case of initial treatment failure, recurrence, or multiple organ involvement by endometriosis, medico-surgical and multidisciplinary discussion is recommended. The laparoscopic approach is recommended for the surgical treatment of endometriosis. HRT may be offered in postmenopausal women operated for endometriosis. In case of infertility related to endometriosis, it is not recommended to prescribe anti-gonadotropic hormone therapy to increase the rate of spontaneous pregnancy, including postoperatively. The possibilities of fertility preservation should be discussed with the patient in case of surgery for ovarian endometrioma.
Asunto(s)
Endometriosis/diagnóstico , Endometriosis/terapia , Terapias Complementarias , Anticonceptivos Hormonales Orales , Diagnóstico por Imagen , Femenino , Examen Ginecologíco , Humanos , Infertilidad Femenina/etiología , Infertilidad Femenina/terapia , Educación del Paciente como Asunto , Dolor Pélvico/tratamiento farmacológico , Dolor Pélvico/etiologíaRESUMEN
Postpartum hemorrhage (PPH) is one of the most common causes of mortality in obstetrics worldwide. The accuracy of estimated blood loss is a priority in determining appropriate treatment. Will the additional use of a visual aid improve physicians' accuracy in estimating blood loss compared to the use of a collector bag and baby scale alone? Simulation training sessions created three vaginal delivery scenarios for participants to estimate volumes of blood loss: firstly, using only a collector bag and a baby weight scale and secondly, adding a visual aid depicting known volumes of blood. The primary endpoint was to determine if participants could accurately evaluate blood loss within a 20% error margin. The addition of the visual estimator resulted in overestimation of blood loss. The rates of participants' estimations were significantly more accurate when using the collector bag with the baby weight scale without the addition of the visual aid; 85.5% versus 33.3% (p < 0.01) for 350 mL, 88.4% versus 50.7% (p < 0.01) for 1100 mL and 88.4% versus 78.3% (p < 0.01) for 2500 mL, respectively. Additional use of a visual aid with a collector bag does not seem to be useful in improving the accuracy in the estimation of blood loss.
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Recursos Audiovisuales , Hemorragia Posparto/diagnóstico , Manejo de Especímenes , Adulto , Parto Obstétrico , Educación de Pregrado en Medicina , Femenino , Humanos , Recién Nacido , Masculino , Embarazo , Estudios Prospectivos , Manejo de Especímenes/instrumentación , Manejo de Especímenes/métodos , Adulto JovenRESUMEN
The use of low-dose aspirin in pregnancy should remain a highly targeted indication since its long-term safety has not been established and should be restricted to women at high risk of vascular complications. Indications for which the benefit of aspirin has been shown are women with a history of preeclampsia responsible for a premature birth before 34 weeks, those having at least two history of preeclampsia, those with an antiphospholipid syndrome and those with lupus associated with positive antiphospholipid antibodies or renal failure. In all other cases, the level of evidence of the benefit of aspirin is insufficient to recommend its routine prescription.
Asunto(s)
Aspirina/efectos adversos , Aspirina/uso terapéutico , Complicaciones Cardiovasculares del Embarazo/tratamiento farmacológico , Anomalías Inducidas por Medicamentos/etiología , Síndrome Antifosfolípido/complicaciones , Síndrome Antifosfolípido/tratamiento farmacológico , Femenino , Humanos , Preeclampsia/tratamiento farmacológico , Embarazo , Nacimiento Prematuro/prevención & control , Factores de RiesgoRESUMEN
Modern surgery tends to the improvement of minimally invasive strategies. Laparoscopy, rooted in practices for years, supplanted laparotomy in many directions. Regarding the extraction of large uterus, morcellation is currently the only way to externalize surgical specimens (myomas, uterine), without increasing the skin opening while allowing to reduce postoperative complications compared to laparotomy. However, in 2014, the Food and Drug Administration (FDA) discourages the use of uterine morcellation because of oncological risk. This recommendation has been challenged by a part of the profession. Our review has sought to identify the evidence for and against the use of morcellation. We also tried to quantify surgical risk and the current means of prevention. The incidence of uterine sarcomas is still poorly identified and preoperative diagnostic facilities remain inadequate. The small number of retrospective studies currently available could not enable any recommendation. The evaluation of morcellation devices and the improvement of preoperative diagnosis modalities (imaging, preoperative biopsy) are to continue to minimize the oncological risk.
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Histerectomía/métodos , Laparoscopía/métodos , Morcelación/efectos adversos , Neoplasias Uterinas , Femenino , Humanos , Complicaciones Posoperatorias/prevención & control , Factores de Riesgo , Sarcoma/patología , Miomectomía Uterina/métodos , Neoplasias Uterinas/diagnóstico por imagen , Neoplasias Uterinas/patología , Neoplasias Uterinas/prevención & control , Útero/patologíaRESUMEN
OBJECTIVES: To compare robot-assisted laparoscopy (RL) and conventional laparoscopy (CL) in surgery for bladder endometriosis. METHODS: A retrospective study was conducted between January 2007 and December 2013, including patients with bladder endometriosis receiving at least a partial cystectomy by RL or CL. The primary endpoint was the presence of a radiological recurrence at bladder level. RESULTS: We included 15 patients in the RL group and 22 in the CL group. The median age was 29 years±7 years. The symptoms were similar in the 2 groups. Pre-surgical mapping of the lesions was carried out with MRI. Sixty percent of patients in the RL group vs 91% in the CL group had other associated endometriosis lesions, P=0.04. The median size of the bladder lesion was 30±8mm in the RL group vs 23±7mm in the CL group, P=0.03. The median operative time was 210 vs 225min, P=0.8. We did not find any significant difference in intraoperative and early and late postoperative complications between the 2 groups. The median length of stay was 5 days vs 6 days. The proportion of relapse was 20 vs 23%, P>0.05. Clinical improvement was similar between the groups, i.e. 93 vs 86%, P=0.6 and the pregnancy rate was 93 vs 86%, P=0.6. CONCLUSIONS: Robot-assisted laparoscopy in the surgical treatment of bladder endometriosis as compared to traditional laparoscopy does not seem to have an adverse effect neither on the risk of recurrence nor on the occurrence of intra- and postoperative complications.
Asunto(s)
Cistectomía/métodos , Endometriosis/cirugía , Laparoscopía/métodos , Procedimientos Quirúrgicos Robotizados/métodos , Enfermedades de la Vejiga Urinaria/cirugía , Adulto , Femenino , Humanos , Complicaciones Posoperatorias , Recurrencia , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
OBJECTIVE: Analysis of litigation in gynecological surgery in the French university hospital of Lille. METHODS: It is a longitudinal and retrospective study. We collected all cases of complaints between November 1997 and August 2015 concerning the department of gynecological surgery, university hospital of Lille. Medical data were obtained using electronic medical record and hospital's legal unit gave data about the complaints. RESULTS: Forty cases were identified during the reporting period. Thirty-three records concerned medical injuries and seven cases failing to provide information or lack of communication. Eleven complaints were reviewed by the French "commission de conciliation et d'indemnisation". Five cases were brought to administrative court. Finally, Lille high court examined two records. Most of complaints concerned perforation during endoscopic procedures, nosocomial infections and forgotten foreign bodies. It was not observed any increasing number of complaints during the whole period. It was noticed a decreasing number of legal action in favor of "commission de conciliation et d'indemnisation". CONCLUSION: This study evaluated specifically litigation in gynecological surgery. It is necessary to conduct this type of study so as to improve medical care and to provide information for practitioner about consequences of their exercise.
Asunto(s)
Procedimientos Quirúrgicos Ginecológicos/legislación & jurisprudencia , Hospitales Universitarios/legislación & jurisprudencia , Femenino , Francia , Humanos , Laparoscopía/legislación & jurisprudencia , Estudios Longitudinales , Calidad de la Atención de Salud , Estudios RetrospectivosRESUMEN
Endometriosis is a frequent benign pathology that is found in 10-15% of women and in 20% of infertile women. It has an impact on fertility, but also in everyday life. If medical treatment fails, surgical treatment can be offered to the patient. To provide adequate treatment and give clearer information to patients, it seems essential to achieve an optimal preoperative imaging assessment. Thus, the aim of this work is to define the information expected by the surgeon and the indications of each imaging test for each compartment of the pelvis, allowing an ideal surgical management of pelvic endometriosis. We will not discuss imaging techniques' principles and we will not develop the indications and surgical techniques.