Mikkel Seyer-Hansen

Pelvic organ function before and after laparoscopic bowel resection for rectosigmoid endometriosis: a prospective, observational study

To assess urinary, sexual, and bowel function before and after laparoscopic bowel resection for rectosigmoid endometriosis.

Diagnosis and treatment of rectovaginal endometriosis: an overview

Rectovaginal endometriosis can be a cause of severe pain, dyspareunia and intestinal problems. A thorough examination is needed and should include diagnostic imaging, such as transvaginal or transrectal ultrasound or magnetic resonance imaging. Medical therapies, such as oral contraceptives, progestins and levonorgestrel‐releasing intrauterine devices, all seem to reduce pain and should always be considered. Surgical treatment is challenging and implies a risk of severe complications. It is preferable to treat endometriotic lesions with superficial infiltration into the rectal wall by local laparoscopic excision, while segmental rectal resection is needed in the case of severe intestinal infiltration. This review describes available diagnostic tools, the possibilities for medical treatment and the alternative surgical approaches.

Does surgery for deep infiltrating bowel endometriosis improve fertility? A systematic review

Reduced fertility is a major concern in women with endometriosis. The influence of surgery of deep infiltrating endometriosis (DIE) affecting the bowel wall on fertility is controversial and the literature on this field is heterogeneous. In this review we addressed whether surgery for bowel DIE improves the spontaneous pregnancy rate, and the results of in vitro fertilization (IVF), and the potential risk of such surgery.

Transvaginal ultrasonography of rectosigmoid endometriosis: interobserver variation of lesion size

This study evaluates the interobserver variation of transvaginal ultrasonographic measurements of the size of deep infiltrating endometriosis lesions in the rectosigmoid wall performed by an experienced and a less experienced sonographer. Fifteen outpatient women were seen for a gynecologic examination and 24 women were seen with rectosigmoid endometriosis. Transvaginal ultrasonography was performed independently by two observers with a focus on the presence and size of rectosigmoid endometriosis. The senior observer had several years of experience, whereas the junior observer was a medical student with no prior experience in transvaginal ultrasonography. The findings of the two observers were identical concerning the identification of rectosigmoid endometriosis. The probability of differences in size within 30% of the mean was 0.81, 0.63 and 0.61 for length, width and depth, respectively. Our data suggest that fair skills in this technique can be acquired by inexperienced examiners within a short period of time.

Risk of bowel obstruction during in vitro fertilization treatment of patients with deep infiltrating endometriosis

Women with endometriosis often experience pain and infertility. Medical treatment interferes with the possibility of attaining pregnancy. For infertile women with endometriosis, surgery is a possible treatment, but with advanced disease there is an increased risk of serious complications. With only limited pain, women will often be referred for in vitro fertilization treatment instead. The disease is estrogen‐dependent and during in vitro fertilization treatment the women could theoretically experience worsening of their symptoms.

Bowel Endometriosis Syndrome: a new scoring system for pelvic organ dysfunction and quality of life

STUDY QUESTIONnIs it possible to develop a validated score that can identify women with Bowel Endometriosis Syndrome (BENS) and be used to monitor the effect of medical and surgical treatment?nnnSUMMARY ANSWERnThe BENS score can be used to identify women with BENS and to monitor the effect of medical and surgical treatment of women suffering from bowel endometriosis.nnnWHAT IS KNOWN ALREADYnEndometriosis is a heterogeneous disease with extensive variation in anatomical and clinical presentation, and symptoms do not always correspond to the disease burden. Current endometriosis scoring systems are mainly based on anatomical and surgical findings.nnnSTUDY DESIGN, SIZE, DURATIONnThe score was developed and validated from a cohort of 525 women with medically or surgically treated bowel endometriosis from Aarhus and Copenhagen University Hospitals, Denmark.nnnPARTICIPANTS/MATERIALS, SETTING AND METHODSnPatients filled in questionnaires on pelvic pain, quality of life (QoL) and urinary, sexual and bowel function. Items were selected for the final score using clinical and statistical criteria. The chosen variables were included in a multivariate analysis. Individual score values were designated items to form the BENS score, which was divided into no BENS, minor BENS and major BENS. Internal and external validations were performed.nnnMAIN RESULTS AND THE ROLE OF CHANCEnThe six most important items were pelvic pain, use of analgesics, dyschezia, straining to urinate, fecal urgency and satisfaction with sexual life. The range of the BENS score (0-28) was divided into 0-8 (no BENS), 9-16 (minor BENS) and 17-28 (major BENS). External validation showed a significant association between BENS score and QoL (P = 0.0001).nnnLIMITATIONS, REASONS FOR CAUTIONnThe BENS scoring system is limited by the fact that it was developed from a single endometriosis unit in Denmark, making it susceptible to social, cultural and demographic bias.nnnWIDER IMPLICATIONS OF THE FINDINGSnIt is the first endometriosis classification system to be based directly on the symptomatology of the patient. Validation in other languages will promote comparison of treatments and results across borders.nnnSTUDY FUNDING/COMPETING INTEREST(S)nNo external funding was either sought or obtained for this study. A.F. is an investigator for Bayer, outside this work.

Being a surgeon or doing surgery? A qualitative study of learning in the operating room

A key concern for surgical educators is to prepare students to perform in the operating room while ensuring patient safety. Recent years have seen a renewed discussion of medical education through practice theoretical and sociomaterial lenses. These lenses are introduced to understand and prepare the learner to perform in the given context. This paper takes its point of departure from practice theory by introducing a lens through which to understand learning environments in surgery.

Similar evolution of pain symptoms and quality of life in women with and without endometriosis undergoing assisted reproductive technology (ART)

Altogether 10% of all women of fertile age suffer from endometriosis, and up to 25% of these women require assisted reproductive technology (ART) to conceive. During ART the process of controlled ovarian stimulation causes high levels of estrogen, which in theory increases the risk of the progression of symptoms related to this estrogen‐dependent disorder. Because several case reports have described the worsening of endometriosis during ART we carried out this study to investigate whether controlled ovarian stimulation during ART aggravates symptoms in women with endometriosis in terms of pain and quality of life.

How Surgeons Conceptualize Talent: A Qualitative Study Using Sport Science as a Lens

OBJECTIVESnDebates prevail regarding the definition of surgical talent, and how individuals with the potential to become talented surgeons can be identified and developed. However, over the past 30 years, talent has been studied extensively in other domains. The objectives of this study is to explore notions of talent in surgery and sport in order to investigate if the field of surgical education can benefit from expanding its view on talented performances. Therefore, this study aims to use the sport literature as a lens when exploring how surgeons conceptualize and define talent.nnnDESIGNnSemi-structured interviews were conducted with a sample of 11 consultant surgeons from multiple specialties. We used constructivist grounded theory principles to explore talent in surgery. Ongoing data analysis refined the theoretical framework and iteratively informed data collection. Themes were identified iteratively using constant comparison.nnnSETTINGnThe setting included 8 separate hospitals across Canada and Denmark.nnnPARTICIPANTSnA total of 11 consultant surgeons from 6 different surgical subspecialties (urology, orthopedic surgery, colorectal surgery, general surgery, vascular surgery, head & neck surgery) were included.nnnRESULTSnWe identified three key elements for conceptualizing surgical talent: (1) Individual skills makes the surgical prospect good, (2) a mixture of skills gives the surgical prospect the potential to become talented, and (3) becoming talented may rely on the fit between person and environment.nnnCONCLUSIONnWe embarked on a study aimed at understanding talent in surgery. Talent is a difficult construct to agree on. Whether in medicine or sports, debates about talent will continue to persist, as we all perceive talent differently. While we heard different opinions, three key ideas summarize our participants discussions regarding surgical talent. These findings resonate with the holistic ecological approach from sport science and hence highlight the limits of a reductionist approach while favoring the individual-environment system as the minimal ontology for describing talented performances.