[Salpingo-oophorectomy by laparoendoscopic single-site surgery for everybody]. / L'annexectomie par cœlio-chirurgie mono-trocart pour tous.

OBJECTIVES: To study the adnexectomy by laparoendoscopic single-site surgery with conventional laparoscopic instruments, we standardised the technique of salpingo-oophorectomy. PATIENTS AND METHODS: In this prospective study, all patients with adnexectomies from June 2010 to January 2014 were included. Laparoendoscopic single-site adnexectomy with conventional instruments is described step by step in order to make it available for the majority of gynecologic surgeons. Laparoconversions and complications are also noted. RESULTS: We realized 42 bilateral salpingo-oophorectomies, 16 single salpingo-oophorectomy. The average operative time was 45min (15-120) with negligible blood losses. There were no laparoconversions and very few complications. After 15-20 adnexectomies, the procedure took less and less time. DISCUSSION AND CONCLUSION: Adnexectomy by laparoendoscopic single-site surgery procedure with conventional laparoscopic instruments is easily reproducible with standardized steps and has many advantages.

[Margin status in ductal carcinoma in situ of the breast]. / Marge d'exérèse des cancers du sein intracanalaire.

For women with ductal carcinoma in situ, no residual disease after breast conserving surgery is one of the most important factors associated with local recurrence. Surgeons can rely on the pathologic examination of the margin and measure of margins width to indicate complete excision. Surgeon and pathologist have to do well and together to make margin can be assessed. Margin status is a prognostic factor for predicting residual disease. Margin width > 2 mm is associated with very few residual diseases. Margin status is also a prognostic factor for local recurrence. Local recurrence after margin width > 2-3 mm followed by radiotherapy is nearly equivalent to local recurrence after mastectomy. An evaluation based on margin status and other risk factors of recurrence (grade, necrosis, size and age like the Van Nuys Prognostic Index) can help clinicians to stratify patients into low-risk, intermediate risk and high-risk group of local recurrence. The validity of such index must be confirmed and margin width must be studied more precisely. Currently, breast conserving surgery with histological margin width > 2 mm followed by radiation therapy is necessary to obtain satisfactory local control. Such margin status with good aesthetic outcomes is not so easy to obtain with classic lumpectomy and oncologic breast surgery is a helpful technique.