[Robot-assisted laparoscopic myomectomy: comparison with abdominal myomectomy]. / La myomectomie par cœlioscopie avec assistance robotique: comparaison avec la laparotomie.

OBJECTIVE: To compare morbidity of robot-assisted laparoscopic myomectomy versus those performed by laparotomy. PATIENTS AND METHODS: It reports a monocentric retrospective case matched analysis enrolling 22 patients (six laparotomic and 16 robot-assisted laparoscopic myomectomies), needing a surgical treatment for at least one myoma oversizing 6cm. RESULTS: Both patient groups were comparable regarding their age, their weight and myoma's size. There were more complications in the laparotomy group in comparison with the robotic group (66.7%, versus 0%; P=0.002). Average intraoperative blood losses were respectively 397±377mL versus 387±349mL (P=0.71) and length of stay 7.2±0.8 days versus 3.9±2.8 days (P<0.001). None of the robot-assisted laparoscopic myomectomy needed any conversion to laparotomy. CONCLUSION: Robot-assisted laparoscopic myomectomy seems to be feasible for heavy fibroids, with a lower morbidity in comparison with laparotomy. These results must be confirmed by several wider prospective studies.

[Robotic surgery in gynecologic oncology: Retrospective and comparative study with laparotomy and laparoscopy]. / Chirurgie robotique en cancérologie gynécologique: étude rétrospective comparative avec la laparotomie et la cœlioscopie traditionnelle.

OBJECTIVES: To compare robot-assisted laparoscopy with conventional laparoscopy and laparotomy in gynecologic oncology. PATIENTS AND METHODS: This is a monocentric retrospective study enrolling 92 patients who underwent a standard or radical hysterectomy (with parametrectomy) with or without pelvic lymphadenectomy between January 2008 and December 2010. All patients were diagnosed for a cervical or endometrial cancer. Laparotomy was performed for 33 patients, conventional laparoscopy for 20 patients, and robot-assisted laparoscopy for 39 patients. The main parameter was the length of hospital stay in the three groups. RESULTS: Length of hospital stay significantly decreased in the robotic group in comparison with the laparotomic group (median 5 and 8 days respectively, P<0.0001), but no differences were found between the robotic and laparoscopic groups (P=0.77). Intraoperative blood loss was lower in the robotic group. Intraoperative complications and lymph nodes removed were equal in the three groups. Regarding the data recorded, there were no significant differences between conventional and robotic laparoscopy. Hysterectomies performed after pelvic radiation, which were all made by laparotomy before the robot's arrival, were all performed with robotic laparoscopy since its arrival. CONCLUSION: Robotic surgery allows a reduced length of hospital stay and a lower blood loss in comparison with laparotomy, without any worse oncologic results. Robotic surgery changed our practice, especially hysterectomy after pelvic radiation, performed by laparotomy before.

[Use of carbetocin in prevention of uterine atony during cesarean section. Comparison with oxytocin]. / Utilisation de la carbétocine lors de la delivrance dirigée au cours des césariennes. Comparaison avec l'ocytocine.

OBJECTIVES: To compare the efficacy of carbetocin versus oxytocin, during delivery in patients undergoing a caesarian section. PATIENTS AND METHODS: A two phase observational study (before/after design) was conducted. Use of carbetocin was considered as a sentinel event. Data for 155 women who received carbetocin during a caesarian section were compared with 155 patients who received oxytocin. The main parameter evaluated was the need for haemostatic surgical techniques (vascular sutures, uterine compression sutures, emergent hysterectomy) during caesarian section. RESULTS: Both populations were comparable, particularly concerning risk factors of postpartum haemorrhage. In the carbetocin group, there was fewer compression sutures during caesarian section (0.6% versus 4.5%, P=0.06), as well as a significant decrease in postoperative intravenous iron administration (6.5% versus 14.5%, P=0.03). Vascular sutures, frequencies of prostaglandin intravenous injections, and blood transfusions during caesarian section were similar in both populations. There wasn't any emergent hysterectomy during the time of this study. DISCUSSION AND CONCLUSION: Prevention of uterine atony during a caesarian section with carbetocin seems to be as effective as oxytocin. Particularly, decreasing rate of surgical compression sutures with use of carbetocin is not significant, and prospective studies with more patients are necessary to confirm these results.

[Clinical diagnosis and evaluation of female urinary incontinence]. / Diagnostic et évaluation clinique de l'incontinence urinaire féminine.

OBJECTIVES: To establish recommendations on relevant methods for diagnosis and evaluation of female urinary incontinence (UI). MATERIAL AND METHODS: A literature review on Medline referenced papers between 1980 and 2009 was performed. Furthermore, the present recommendations derived form these of the SIFUD-PP published in 2001 and of the IUGA published in 2008. RESULTS: Patient interview allow to evocate the diagnosis of UI and to precise the type. The cough stress test is simple, reliable and reproducible for the diagnosis of stress urinary incontinence (SUI). An angle > 30 degrees during the Q-Tip test define uretral hypermobility. The voiding diary is a simple, non-invasive and cost-effective method which has to be proposed before urodynamics. The pad test allows an objective evaluation of UI severity. The use of at least one validated questionnaire for symptoms and quality of life is recommended. CONCLUSION: Clinical diagnosis and evaluation of female urinary incontinence is based on patient interview, cough stress test, clinical evaluation of uretral mobility (Q-Tip test), voiding diary, pad test and validated questionnaires for symptoms and quality of life.

[In vitro fertilization and smoking: use of urinary cotinine and expired air carbon monoxide measurements]. / Fécondation in vitro et tabac: intérêt de la cotininurie et de l'analyseur de monoxyde de carbone expiré.

OBJECTIVE: To study the correlation between expired air carbon (EACO) and urinary cotinine, and to determine the impact of tobacco smoking on in vitro fertilization (IVF) results. PATIENTS AND METHODS: We studied prospectively 221 patients in our ART center from October 2002 to October 2004: 51 active smokers, 85 passive smokers, and 85 non-smokers. Patients were classified into active, passive smokers, or non-smokers, based on a questionnaire. We measured urinary cotinine and EACO on the embryo transfer day and we recorded the IVF parameters. RESULTS: Two hundred and twenty-one patients were included. We observed a 17.2% reduction of estradiolemy (P=0.05), a 1.5% reduction of pregnancies (NS), a 7.8% reduction of infants born alive (NS), a 28.5% reduction of twin pregnancies (P=0.06), as well as a 10% increase of miscarriages (NS) in the active smokers in comparison with non-smokers (the same trends were observed between active and passive smokers). EACO and urinary cotinine were well correlated. There was a negative correlation between estradiolemy and urinary cotinine (R=-0.15, P=0.02). DISCUSSION AND CONCLUSION: Tobacco smoking intensity may be dilatory on IVF results. There is a high correlation between EACO and urinary cotinine. Other larger studies would probably obtain results more statistically significant.