Jean-Marie Wenger

Laparoscopic Supracervical Hysterectomy versus Laparoscopic-Assisted Vaginal Hysterectomy

STUDY OBJECTIVE To compare laparoscopic supracervical hysterectomy (LSH) with laparoscopic-assisted vaginal hysterectomy (LAVH) in terms of indications, pathology, length and weight of removed uteri, operative time, intraoperative blood loss, intra and postoperative complications, and later sexual function. DESIGN Cohort retrospective analysis of consecutive cases (Canadian Task Force classification II-3). SETTINGS Hutzel Hospital, Detroit Medical Center,Wayne State University, Detroit, Michigan; Vert-Pre Nouvelle Clinique, Geneva, Switzerland; and Benha University Hospitals, Egypt. PATIENTS Two hundred and fifty-nine women. INTERVENTIONS LSH and LAVH. MEASUREMENTS AND MAIN RESULTS Patients in both groups were matched regarding age, indications, and pathology of the removed uteri. Blood loss with the LSH procedure was significantly lower than it was with the LAVH procedure (mean 125 +/- 5 vs 149 +/- 7 mL, p =.001). Patients that underwent LSH had significantly shorter operating times (mean 120 +/- 3 vs 150 +/- 5 minutes, p =.007). The length of the removed uteri was 14.2 +/- 0.5 cm (range 5.2-18) in the LSH group versus 11.8 +/- 0.4 cm (range, 5.6-14) in the LAVH group. Weight of the removed uteri was 280 +/- 6 g (range, 65-750) in the LSH group compared with 235 +/- 8 g (range, 59-560) in the LAVH group. There was no difference between the groups in hospital length of stay. The number of complications was less in the LSH group (3/123, 2.4%) compared with 5/136 (3.7%) in the LAVH group. Sexual function after surgery was better in the LSH group. CONCLUSION After exclusion of preoperative cervical disease, LSH can be considered as a safer alternative to LAVH in patients that are candidates for laparoscopic hysterectomy.

Anatomic Distribution of Posterior Deeply Infiltrating Endometriosis on MRI After Vaginal and Rectal Gel Opacification

OBJECTIVE The challenges of imaging posterior deeply infiltrating endometriosis with MRI are to image a small anatomic area encompassing several thin fibromuscular anatomic structures such as uterosacral ligaments, and the vaginal and rectal walls; and to image endometriotic lesions, which are fibromuscular structures and have an MRI signal intensity very close to those of surrounding fibromuscular anatomic structures. CONCLUSION We show the capability and potential of MRI in diagnosing and staging of posterior deeply infiltrating endometriosis after vaginal and rectal gel opacification.

Treatment of genital prolapse by laparoscopic lateral suspension using mesh: a series of 73 patients.

STUDY OBJECTIVE To evaluate the efficacy of laparoscopic lateral suspension using mesh in patients with pelvic organ prolapse (POP). DESIGN A prospective cohort study (Canadian Task Force classification II-2). SETTING A tertiary referral center for operative laparoscopy. PATIENTS In all, 73 patients with POP were assessed in the preoperative and postoperative stages. The assessment included a description of their functional symptoms and the degree of their POP condition, established according to the Baden-Walker prolapse classification system. The patients were followed in the postoperative stage for a median of 19 (range 12-41) months. INTERVENTIONS Laparoscopic lateral suspension of pelvic organs using mesh carried out from January 2004 through September 2006. MEASUREMENTS AND MAIN RESULTS Satisfactory anatomic results were obtained in 64 (87.7%) patients. Neither major complications, nor postoperative pelvic infection were reported. None of the operations required laparotomy. CONCLUSION Laparoscopic lateral suspension using mesh effectively treats POP with low morbidity.

The adjuvant use of N-palmitoylethanolamine and transpolydatin in the treatment of endometriotic pain

OBJECTIVE To test the adjuvant use of the combination of N-palmitoylethanolamine and transpolydatin in the medical treatment of endometriotic pain. STUDY DESIGN We enrolled 47 patients admitted to the Outpatient Endometriosis Care Unit of Ferrara University from January 2011 to December 2011. They were divided into two groups according to the endometriosis site (group A: recto-vaginal septum; group B: ovary). One tablet, containing 400 mg of micronized N-palmitoylethanolamine plus 40 mg transpolydatin, was administered twice daily on a full stomach for 90 days. Each patient was requested to grade the severity of dysmenorrhea, chronic pelvic pain, dyspareunia and dyschezia using a 0-10 cm visual analogic scale prior to beginning treatment (T0), after 30 days (T1), 60 days (T2) and 90 days (T3). The continuous and categorical variables were compared, respectively, using Students t-test and the chi-square test. Analysis of variance for repeated measures was used to verify the reduction of endometriotic pain. RESULTS The intensity of endometriotic pain decreased significantly for both groups (p<0.0001). The efficacy of drug treatment was significant after 30 days. Pain intensity decreased equally in the two groups except for dysmenorrhea, which was reduced more rapidly in group B. CONCLUSIONS The combination of N-palmitoylethanolamine and transpolydatin reduced pain related to endometriosis irrespective of lesion site. It had a marked effect on chronic pelvic pain determined by deep endometriosis and on dysmenorrhea correlated to ovarian endometriosis.

Advances in neurosteroids: role in clinical practice

ABSTRACT The steroidogenic endocrine glands and local synthesis both contribute to the pool of steroids present in the central nervous system and peripheral nervous system. Although the synthesis of neurosteroids in the nervous system is now well established, the spectrum of respective functions in regulating neuronal and glial functions remains to be fully elucidated. From the concept of neurosteroids derives another treatment strategy: the use of pharmaceutical agents that increase the synthesis of endogenous neurosteroids within the nervous system. This approach has so far been hampered by lack of knowledge concerning the regulation of the biosynthetic pathways of neurosteroids and their relationship with sex steroids produced by the peripheral gland or with exogenous steroids. The present review summarizes some of the available clinical and experimental findings supporting the critical role of neurosteroids during fertile life and reproductive aging and their relationship with endogenous and exogenous sex steroids. The brain metabolism of synthetic progestins and the implications of DHEA treatment in postmenopausal women will also be discussed.

Endometriosis-Associated Abdominal Wall Cancer: A Poor Prognosis?

Objective Endometriosis-associated abdominal wall cancer (EAAWC) is rare, and few reports are available. This article provides a review of reports in the literature on the pathology, diagnosis, management, and outcome of patients with EAAWC. Method We performed a review of existing reports in the English language literature on cancer arising from abdominal wall endometriosis. MEDLINE and EMBASE searches were conducted for articles published from September 1986 to August 2014 using combinations of medical subject heading terms. Results We identified 26 articles reporting on EAAWC and added 1 patient who was treated at our institution. In all of these patients, EAAWC was described after uterine surgery (mostly cesarean section). The delay between the first surgery and the diagnosis of malignant disease was more than 20 years. Clear cell carcinoma was the most common histology, followed by endometrioid carcinoma. Death was described in 44% of women within a few months of diagnosis. Conclusions Endometriosis-associated abdominal wall cancer is rare and aggressive. It seems to be associated with cesarean section, and it shows poor prognosis. The mainstay of treatment remains extensive surgery and chemotherapy.

Hormonal causes of recurrent pregnancy loss (RPL)

Endocrine disorders play a major role in approximately 8% to 12% of recurrent pregnancy loss (RPL). Indeed, the local hormonal milieu is crucial in both embryo attachment and early pregnancy. Endocrine abnormalities, including thyroid disorders, luteal phase defects, polycystic ovary syndrome, hyperprolactinaemia and diabetes have to be evaluated in any case of RPL. Moreover, elevated androgen levels and some endocrinological aspects of endometriosis are also factors contributing to RPL. In the present article, we review the significance of endocrine disease on RPL.

Laparoendoscopic single-site supracervical hysterectomy with endocervical resection.

Laparoendoscopic single-site surgery is an attempt to enhance cosmetic benefits and reduce morbidity of minimally invasive surgery. Total laparoscopic hysterectomy through single-port access has been reported. Supracervical hysterectomy is an alternative to total hysterectomy but requires morcellation, which is challenging through a single umbilical incision. Herein we report and illustrate with a video supracervical hysterectomy performed via single-site laparoscopic surgery with transcervical morcellation after endocervical resection.

Pictorial review: rectosigmoid endometriosis on MRI with gel opacification after rectosigmoid colon cleansing

Posterior deeply infiltrating endometriosis (PDIE) is an invalidating disorder that may involve the rectosigmoid colon. MRI with gel opacification after rectosigmoid colon cleansing improves visualization of rectosigmoid endometriosis. Nonetheless, the depth of bowel wall infiltration is still difficult to assess. In this regard, the use of high-frequency echoendoscope may be needed. Recognition of rectosigmoid endometriosis is important to establish a correct diagnosis and provide counseling and appropriate therapy.

Robotic single-site combined cholecystectomy and hysterectomy: Advantages and limits

Highlights • Development of single-site port robotic devices represents a substantial evolution.• Combined cholecystectomy and total hysterectomy using the da Vinci Si single-port platform is feasible.• Technical development is required to improve single site combined surgery.