1
|
Ruffolo AF, Lallemant M, Aurore D, Kerbage Y, Rubod C, Cosson M. Self-care of vaginal pessary for pelvic organ prolapse: a systematic review and meta-analysis. Arch Gynecol Obstet 2024:10.1007/s00404-024-07506-1. [PMID: 38634900 DOI: 10.1007/s00404-024-07506-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 04/02/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION There is no evidence about the efficacy of self-care of vaginal pessary in women with symptomatic pelvic organ prolapse (POP). The aim of this systematic review and meta-analysis is to assess the adherence to pessary treatment among women who engage in self-management of their pessary. METHODS We performed a systematic review and meta-analysis, according to PRISMA 2020 guidelines, and selected seven publications for inclusion in the analysis. RESULTS Pooled continuation rate of self-cared vaginal pessary was the 76% (95%CI: 66-85%) with a I2-test of 93.3% (p < 0.001). Pooled conversion to POP surgery was the 12% (95%CI: 1-23%) with a I2-test of 96% (p < 0.001). Continuation rate was not statistically different between women who were treated by self-care and non-self-care management of vaginal pessary (RR 1.11, 95%CI 0.96-1.27; p = 0.15), with a related I2-test of 37% (p = 0.21). CONCLUSION Self-care vaginal pessary management presented a high continuation rate in women affected by pelvic organ prolapse at a long follow-up. The rate of conversion to surgical management of POP was low. No significant difference in continuation rate were highlighted between women who adopted the self-care or the clinical-based management of pessary.
Collapse
Affiliation(s)
| | - Marine Lallemant
- Department of Gynecology, Jeanne de Flandre University Hospital, 59000, Lille, France
| | - Deseure Aurore
- Department of Gynecology, Jeanne de Flandre University Hospital, 59000, Lille, France
| | - Yohan Kerbage
- Department of Gynecology, Jeanne de Flandre University Hospital, 59000, Lille, France
| | - Chrystèle Rubod
- Department of Gynecology, Jeanne de Flandre University Hospital, 59000, Lille, France
| | - Michel Cosson
- Department of Gynecology, Jeanne de Flandre University Hospital, 59000, Lille, France
| |
Collapse
|
2
|
Rubod C, de Prémare C, Kerbage Y, Kyheng M, Plouvier P, Chossegros C, Robin G. Does surgery for colorectal endometriosis prior to IVF±ICSI have an impact on cumulative live birth rates? Reprod Biomed Online 2024; 48:103649. [PMID: 38335899 DOI: 10.1016/j.rbmo.2023.103649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 10/23/2023] [Accepted: 10/26/2023] [Indexed: 02/12/2024]
Abstract
RESEARCH QUESTION Does colorectal endometriosis surgery prior to IVF ± intracytoplasmic sperm injection (ICSI) impact cumulative live birth rates? DESIGN This retrospective, monocentric study (Lille University Hospital) was conducted between 1 January 2007 and 31 December 2018. Two groups of patients from the JFIV database were included: a group undergoing IVF±ICSI alone (120 patients, 215 oocyte retrievals), and a group undergoing surgery and then IVF±ICSI (69 patients, 109 oocyte retrievals). The mode of management was decided after a multidisciplinary team meeting. Different criteria such as age (cut-off 35 years), anti-Müllerian hormone concentration (cut off 2 ng/ml), imaging results and the patient's symptomatology were considered: the most symptomatic patients underwent surgery prior to IVF±ICSI. The cumulative clinical pregnancy and live birth rates obtained after four IVF attempts were estimated and compared between the two groups using competing risk survival methods. RESULTS The cumulative live birth rates after four IVF attempts in the two groups were not statistically significantly different (50.8% in the IVF±ICSI group versus 52.2% in the surgery followed by IVF±ICSI group, P = 0.43). The results for the cumulative clinical pregnancy rates were the same (56.7% in the IVF±ICSI group versus 58% in the surgery followed by IVF±ICSI group, P = 0.47). CONCLUSION The study shows that cumulative live birth and pregnancy rates were similar in infertile patients with colorectal endometriosis who underwent IVF±ICSI either with or without prior colorectal endometriosis surgery.
Collapse
Affiliation(s)
- Chrystèle Rubod
- Service de chirurgie gynécologique, CHU Lille, Lille, France.; Univ. Lille, CHU Lille, Lille, France
| | | | - Yohan Kerbage
- Service de chirurgie gynécologique, CHU Lille, Lille, France
| | - Maeva Kyheng
- Service de Biostatistiques, CHU Lille, Lille, France
| | - Pauline Plouvier
- Service d'Assistance Médicale à la Procréation et Préservation de la Fertilité, CHU Lille, Lille, France
| | | | - Geoffroy Robin
- Univ. Lille, CHU Lille, Lille, France.; Service d'Assistance Médicale à la Procréation et Préservation de la Fertilité, CHU Lille, Lille, France
| |
Collapse
|
3
|
Lallemant M, Shimojyo AA, Mayeur O, Ramanah R, Rubod C, Kerbage Y, Cosson M. Mobility analysis of a posterior sacrospinous fixation using a finite element model of the pelvic system. PLoS One 2024; 19:e0299012. [PMID: 38512958 PMCID: PMC10956756 DOI: 10.1371/journal.pone.0299012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 02/04/2024] [Indexed: 03/23/2024] Open
Abstract
INTRODUCTION AND HYPOTHESIS In order to improve the knowledge POP physiopathology and POP repair, a generic biomechanical model of the female pelvic system has been developed. In the literature, no study has currently evaluated apical prolapse repair by posterior sacrospinous ligament fixation using a generic model nor a patient-specific model that personalize the management of POP and predict surgical outcomes based on the patient's pre-operative Magnetic Resonance Imaging. The aim of our study was to analyze the influence of a right and/or left sacrospinous ligament fixation and the distance between the anchorage area and the ischial spine on the pelvic organ mobility using a generic and a patient-specific Finite Element model (FEM) of the female pelvic system during posterior sacrospinous ligament fixation (SSF). METHODS Firstly, we used a generic 3D FEM of the female pelvic system previously made by our team that allowed us to simulate the mobility of the pelvic system. To create a patient-specific 3D FEM of the female pelvic system, we used a preoperative dynamic pelvic MRI of a 68 years old woman with a symptomatic stage III apical prolapse and cystocele. With these 2 models, a SSF was simulated. A right and/or left SSF and different distances between the anchorage area and the ischial spine (1 cm, 2 cm and 3 cm.) were compared. Outcomes measures were the pelvic organ displacement using the pubococcygeal line during maximal strain: Ba point for the most posterior and inferior aspect of the bladder base, C point the cervix's or the vaginal apex and Bp point for the anterior aspect of the anorectal junction. RESULTS Overall, pelvic organ mobility decreased regardless of surgical technique and model. According to the generic model, C point was displaced by 14.1 mm and 11.5 mm, Ba point by 12.7 mm, and 12 mm and Bp point by 10.6 mm and 9.9 mm after left and bilateral posterior SSF, respectively. C point was displaced by 15.4 mm and 11.6 mm and Ba point by 12.5 mm and 13.1mm when the suture on the sacrospinous ligament was performed at 1 cm and 3 cm from the ischial spine respectively (bilateral posterior SSF configuration). According to the patient-specific model, the displacement of Ba point could not be analyzed because of a significative and asymmetric organ displacement of the bladder. C point was displaced by 4.74 mm and 2.12 mm, and Bp point by 5.30 mm and 3.24 mm after left and bilateral posterior SSF respectively. C point was displaced by 4.80 mm and 4.85 mm and Bp point by 5.35 mm and 5.38 mm when the suture on the left sacrospinous ligament was performed at 1 cm and 3 cm from the ischial spine, respectively. CONCLUSION According to the generic model from our study, the apex appeared to be less mobile in bilateral SSF. The anchorage area on the sacrospinous ligament seems to have little effect on the pelvic organ mobilities. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04551859.
Collapse
Affiliation(s)
- Marine Lallemant
- Service de Gynécologie Obstétrique, Pôle Mère-Femme, Centre Hospitalier Universitaire Jean Minjoz, Besançon, France
- Université Lille, CNRS, Centrale Lille, UMR 9013—LaMcube—Laboratoire de Mécanique, Multiphysique, Multiéchelle, F-59000, Lille, France
| | - Andres Arteaga Shimojyo
- Université Lille, CNRS, Centrale Lille, UMR 9013—LaMcube—Laboratoire de Mécanique, Multiphysique, Multiéchelle, F-59000, Lille, France
| | - Olivier Mayeur
- Université Lille, CNRS, Centrale Lille, UMR 9013—LaMcube—Laboratoire de Mécanique, Multiphysique, Multiéchelle, F-59000, Lille, France
| | - Rajeev Ramanah
- Service de Gynécologie Obstétrique, Pôle Mère-Femme, Centre Hospitalier Universitaire Jean Minjoz, Besançon, France
- Laboratoire de Nanomédecine, Imagerie et Thérapeutiques, INSERM E4 4662, Université de Franche-Comté, Besançon, France
| | - Chrystèle Rubod
- Université Lille, CNRS, Centrale Lille, UMR 9013—LaMcube—Laboratoire de Mécanique, Multiphysique, Multiéchelle, F-59000, Lille, France
- CHU Lille, Service de Chirurgie Gynécologique, F-59000, Lille, France
- Faculté de médecine, Université Lille Nord de France, F-59000, Lille, France
| | - Yohan Kerbage
- Université Lille, CNRS, Centrale Lille, UMR 9013—LaMcube—Laboratoire de Mécanique, Multiphysique, Multiéchelle, F-59000, Lille, France
- CHU Lille, Service de Chirurgie Gynécologique, F-59000, Lille, France
- Faculté de médecine, Université Lille Nord de France, F-59000, Lille, France
| | - Michel Cosson
- Université Lille, CNRS, Centrale Lille, UMR 9013—LaMcube—Laboratoire de Mécanique, Multiphysique, Multiéchelle, F-59000, Lille, France
- CHU Lille, Service de Chirurgie Gynécologique, F-59000, Lille, France
- Faculté de médecine, Université Lille Nord de France, F-59000, Lille, France
| |
Collapse
|
4
|
Loyau S, Bauters A, Trillot N, Garcia C, Cougoul P, Pol H, Paris C, Robin G, Rubod C, Payrastre B, Jandrot-Perrus M, Voisin S, Dupont A. Association between endometriosis, infertility and autoimmune antiplatelet glycoprotein VI antibodies in two patients. Platelets 2023; 34:2226756. [PMID: 37350057 DOI: 10.1080/09537104.2023.2226756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
The association between endometriosis and autoimmune diseases is well known, however no acquired platelet function defect has been described so far. We describe the case of two patients with endometriosis associated with an antiplatelet glycoprotein VI (anti-GPVI) antibody. The two women with deep pelvic endometriosis associated with secondary infertility presented a mild bleeding tendency, a deficient platelet aggregation response to collagen, convulxin or CRP and a severe GPVI deficiency. Immunoblot revealed a combined FcRγ deficiency but no indication of GPVI cleavage. In the first case, platelet count was normal and an anti-GPVI IgG was detected in plasma. A first corticosteroids administration normalized in vitro platelet functions but further administrations were unsuccessful. Three IVF attempts failed. Conservative laparoscopic surgery was carried out after antifibrinolytic treatment without bleeding. The second case presented with a history of moderate thrombocytopenia and a weak anti-GPVI in the context of infertility and autoimmune disease, the Sjögren syndrome resolved after corticosteroids and hydroxychloroquine treatment. Acquired GPVI deficiencies are rare. It would be useful to determine whether the association with endometriosis is coincidental or not by more systematic investigations. It does not seem that in these patients, GPVI deficiency is associated with an increased risk of bleeding.
Collapse
Affiliation(s)
- Stéphane Loyau
- Université de Paris, Inserm UMR-S1148, Laboratory for Vascular Translational Science (LVTS), CHU Xavier Bichat, Paris, France
| | - Anne Bauters
- CHU Lille, Institut d'Hématologie-Transfusion, Lille, France
| | | | - Cédric Garcia
- Centre Hospitalier Universitaire de Toulouse, Laboratoire d'Hématologie, Toulouse, France
- Inserm UMR1297 and Université Toulouse 3, Institut des Maladies Métaboliques et Cardiovasculaires, Toulouse, France
| | - Pierre Cougoul
- Institut Universitaire du cancer de Toulouse, Médecine interne, Toulouse, France
| | - Hélène Pol
- Pole gynécologie obstétrique, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Camille Paris
- CHU Lille, Institut d'Hématologie-Transfusion, Lille, France
| | - Geoffroy Robin
- CHU Lille, Service d'Assistance Médicale à la Procréation et Préservation de la Fertilité et Unité Fonctionnelle de Gynécologie Endocrinienne, Service de Gynécologie Médicale, Orthogénie et Sexologie, Hôpital Jeanne de Flandre, Lille, France
| | - Chrystèle Rubod
- Service de chirurgie gynécologique, CHU Lille, Lille, France
| | - Bernard Payrastre
- Centre Hospitalier Universitaire de Toulouse, Laboratoire d'Hématologie, Toulouse, France
- Inserm UMR1297 and Université Toulouse 3, Institut des Maladies Métaboliques et Cardiovasculaires, Toulouse, France
| | - Martine Jandrot-Perrus
- Université de Paris, Inserm UMR-S1148, Laboratory for Vascular Translational Science (LVTS), CHU Xavier Bichat, Paris, France
| | - Sophie Voisin
- Centre Hospitalier Universitaire de Toulouse, Laboratoire d'Hématologie, Toulouse, France
- Inserm UMR1297 and Université Toulouse 3, Institut des Maladies Métaboliques et Cardiovasculaires, Toulouse, France
| | | |
Collapse
|
5
|
Kheirbek N, Delporte V, El Hajj H, Martin C, Delplanque S, Kerbage Y, Rubod C, Cosson M, Giraudet G. Comparing vNOTES Hysterectomy with Laparoscopic Hysterectomy for Large Uteri. J Minim Invasive Gynecol 2023; 30:877-883. [PMID: 37422053 DOI: 10.1016/j.jmig.2023.06.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/23/2023] [Accepted: 06/26/2023] [Indexed: 07/10/2023]
Abstract
STUDY OBJECTIVE Our study aimed to compare conventional laparoscopic hysterectomies (LHs) with vaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomies performed for patients with large uteri (weight >280 g) at our institution, which underwent a change in practice from conventional LH to vNOTES for large uteri. DESIGN Retrospective cohort. SETTING French tertiary university hospital. PATIENTS Two cohorts: the last 54 patients who underwent vNOTES hysterectomy and the last 52 patients who underwent conventional LH for large uteri. INTERVENTION Baseline characteristics and surgical outcomes were assessed, including uterine weight, mode of delivery for previous pregnancies, history of abdominal surgery, indication for hysterectomy, associated procedures, operative time (OT), complications, volume of intraoperative bleeding, and length of postoperative hospital stay. MEASUREMENTS AND MAIN RESULTS Both groups were comparable, with a mean uterine weight of 586.4 ± 289.2 g in the laparoscopy group compared with 686.7 ± 374.6 g in the vNOTES group. There was a significant decrease in the OT in the vNOTES group with a median of 99 minutes (66.5-138.5 minutes) compared with 171 minutes (131-208 minutes) in the laparoscopy group, p <.001. The length of hospital stay was also decreased in the vNOTES group with a median of 0.5 nights compared with 2 nights in the laparoscopy group, p <.001. More patients were managed in an ambulatory setting in the vNOTES group (50% vs 3.7%, p <.001). Our study did not find any significant difference in terms of bleeding or the number of conversions to another surgical approach. The frequency of intraoperative and postoperative complications was very low. CONCLUSION Compared with the laparoscopic approach, vNOTES hysterectomy for large uteri (>280 g) is associated with decreased OT, a shorter hospital stay, and increased performance in the ambulatory setting.
Collapse
Affiliation(s)
- Nour Kheirbek
- Department of Gynecologic Surgery (Drs. Kheirbek, Delporte, Delplanque, Kerbage, Rubod, Cosson, and Giraudet), Lille University Hospital, Lille, France.
| | - Victoire Delporte
- Department of Gynecologic Surgery (Drs. Kheirbek, Delporte, Delplanque, Kerbage, Rubod, Cosson, and Giraudet), Lille University Hospital, Lille, France
| | - Houssein El Hajj
- Department of Gynecologic Oncology and Senology, Curie Institute, Saint Cloud, France (Drs. El Hajj)
| | - Claire Martin
- Department of Biostatistics (Dr. Martin), Lille University and Lille University Hospital, ULR 2694 - METRICS: evaluation of health technologies and medical practices, Lille, France
| | - Sophie Delplanque
- Department of Gynecologic Surgery (Drs. Kheirbek, Delporte, Delplanque, Kerbage, Rubod, Cosson, and Giraudet), Lille University Hospital, Lille, France
| | - Yohan Kerbage
- Department of Gynecologic Surgery (Drs. Kheirbek, Delporte, Delplanque, Kerbage, Rubod, Cosson, and Giraudet), Lille University Hospital, Lille, France; University of Lille, Henri Warembourg, Lille, France (Drs. Kerbage, Rubod, and Cosson)
| | - Chrystèle Rubod
- Department of Gynecologic Surgery (Drs. Kheirbek, Delporte, Delplanque, Kerbage, Rubod, Cosson, and Giraudet), Lille University Hospital, Lille, France; University of Lille, Henri Warembourg, Lille, France (Drs. Kerbage, Rubod, and Cosson)
| | - Michel Cosson
- Department of Gynecologic Surgery (Drs. Kheirbek, Delporte, Delplanque, Kerbage, Rubod, Cosson, and Giraudet), Lille University Hospital, Lille, France; University of Lille, Henri Warembourg, Lille, France (Drs. Kerbage, Rubod, and Cosson)
| | - Geraldine Giraudet
- Department of Gynecologic Surgery (Drs. Kheirbek, Delporte, Delplanque, Kerbage, Rubod, Cosson, and Giraudet), Lille University Hospital, Lille, France
| |
Collapse
|
6
|
Crochet P, Mousty E, Le Lous M, Chauleur C, Berveiller P, Ceccaldi PF, Deffieux X, Hanssens S, Gauthier T, Le Ray C, Legendre G, Rabischong B, Winer N, Tsatsaris V, Ghesquiere L, Rubod C. [Simulation training for French obstetrics and gynecology residents: A national survey in 2022]. Gynecol Obstet Fertil Senol 2023; 51:393-399. [PMID: 37295716 DOI: 10.1016/j.gofs.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 05/15/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To evaluate the use of simulation among French Obstetrics and Gynecology residency programs. METHODS A survey was conducted with all 28 French residency program directors. The questionnaire covered equipment and human resources, training programs, types of simulation tools and time spent. RESULTS Of the cities hosting a residency program, 93% (26/28) responded regarding equipment and human resources, and 75% (21/28) responded regarding training program details. All respondents declared having at least one structure dedicated to simulation. A formal training program was reported by 81% (21/26) of cities. This training program was mandatory in 73% of the cases. There was a median number of seven senior trainers involved, three of whom had received a specific training in medical education. Most of declared simulation activities concerned technical skills in obstetrics and surgery. Simulations to practice breaking bad news were offered by 62% (13/21) of cities. The median number of half-days spent annually on simulation training was 55 (IQR: 38-83). CONCLUSION Simulation training is now widely available among French residency programs. There remains heterogeneity between centers regarding equipment, time spent and content of simulation curricula. The French College of Teachers of Gynecology and Obstetrics has proposed a roadmap for the content of simulation-based training based on the results of this survey. An inventory of all existing "train the trainers" simulation programs in France is also provided.
Collapse
Affiliation(s)
- P Crochet
- Service de gynécologie-obstétrique, université de Rouen, CHU Charles-Nicolle, Rouen, France; Univ Rouen Normandie, INSERM, NORDIC UMR 1239 - Team Adrenal and Gonadal Pathophysiology (AGoPath), 76000 Rouen, France.
| | - E Mousty
- Service de gynécologie-obstétrique, université de Montpellier-Nîmes, CHU de Nîmes, Nîmes, France.
| | - M Le Lous
- Service de gynécologie-obstétrique, hôpital Sud, université de Rennes, CHU de Rennes, Rennes, France.
| | - C Chauleur
- Inserm, U 1059, service de gynécologie-obstétrique, université Jean-Monnet, CHU de Saint-Étienne, 42023 Saint-Étienne, France.
| | - P Berveiller
- Service de gynécologie-obstétrique, CHI de Poissy St-Germain, 78300 Poissy, France.
| | - P-F Ceccaldi
- Université Paris Cité, Paris, France; Service de gynécologie-obstétrique, hôpital Beaujon, Assistance publique-Hôpitaux de Paris, Clichy, France.
| | - X Deffieux
- Service de gynécologie-obstétrique, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France.
| | - S Hanssens
- Department of neonatology, Jeanne-de-Flandre hospital, université de Lille, CHU de Lille, Lille, France.
| | - T Gauthier
- Service de gynécologie-obstétrique, hôpital mère-enfant, CHU de Limoges, 87000 Limoges, France.
| | - C Le Ray
- Maternité Port-Royal, Groupe hospitalier Paris Centre, FHU Prema, université Paris Cité, AP-HP, 75014 Paris, France.
| | - G Legendre
- Département de médecine, service de gynécologie-obstétrique, faculté de santé, Angers, France.
| | - B Rabischong
- Department of gynecological surgery, CHU Estaing, Clermont-Ferrand, France.
| | - N Winer
- Service de gynécologie-obstétrique, NUN INRAE PhAN, UMR 1280, CHU de Nantes, 44000 Nantes, France.
| | - V Tsatsaris
- Maternité Port-Royal, Groupe hospitalier Paris Centre, FHU Prema, université Paris Cité, AP-HP, 75014 Paris, France.
| | - L Ghesquiere
- Department of neonatology, Jeanne-de-Flandre hospital, université de Lille, CHU de Lille, Lille, France.
| | - C Rubod
- Department of neonatology, Jeanne-de-Flandre hospital, université de Lille, CHU de Lille, Lille, France.
| |
Collapse
|
7
|
Ballit A, Hivert M, Rubod C, Dao TT. Fast soft-tissue deformations coupled with mixed reality toward the next-generation childbirth training simulator. Med Biol Eng Comput 2023:10.1007/s11517-023-02864-5. [PMID: 37382859 DOI: 10.1007/s11517-023-02864-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 06/07/2023] [Indexed: 06/30/2023]
Abstract
High-quality gynecologist and midwife training is particularly relevant to limit medical complications and reduce maternal and fetal morbimortalities. Physical and virtual training simulators have been developed. However, physical simulators offer a simplified model and limited visualization of the childbirth process, while virtual simulators still lack a realistic interactive system and are generally limited to imposed predefined gestures. Objective performance assessment based on the simulation numerical outcomes is still not at hand. In the present work, we developed a virtual childbirth simulator based on the Mixed-Reality (MR) technology coupled with HyperMSM (Hyperelastic Mass-Spring Model) formulation for real-time soft-tissue deformations, providing intuitive user interaction with the virtual physical model and a quantitative assessment to enhance the trainee's gestures. Microsoft HoloLens 2 was used and the MR simulator was developed including a complete holographic obstetric model. A maternal pelvis system model of a pregnant woman (including the pelvis bone, the pelvic floor muscles, the birth canal, the uterus, and the fetus) was generated, and HyperMSM formulation was applied to simulate the soft tissue deformations. To induce realistic reactions to free gestures, the virtual replicas of the user's detected hands were introduced into the physical simulation and were associated with a contact model between the hands and the HyperMSM models. The gesture of pulling any part of the virtual models with two hands was also implemented. Two labor scenarios were implemented within the MR childbirth simulator: physiological labor and forceps-assisted labor. A scoring system for the performance assessment was included based on real-time biofeedback. As results, our developed MR simulation application was developed in real-time with a refresh rate of 30-50 FPS on the HoloLens device. HyperMSM model was validated using FE outcomes: high correlation coefficients of [0.97-0.99] and weighted root mean square relative errors of 9.8% and 8.3% were obtained for the soft tissue displacement and energy density respectively. Experimental tests showed that the implemented free-user interaction system allows to apply the correct maneuvers (in particular the "Viennese" maneuvers) during the labor process, and is capable to induce a truthful reaction of the model. Obtained results confirm also the possibility of using our simulation's outcomes to objectively evaluate the trainee's performance with a reduction of 39% for the perineal strain energy density and 5.6 mm for the vertical vaginal diameter when the "Viennese" technique is applied. This present study provides, for the first time, an interactive childbirth simulator with an MR immersive experience with direct free-hand interaction, real-time soft-tissue deformation feedback, and an objective performance assessment based on numerical outcomes. This offers a new perspective for enhancing next-generation training-based obstetric teaching. The used models of the maternal pelvic system and the fetus will be enhanced, and more delivery scenarios (e.g. instrumental delivery, breech delivery, shoulder dystocia) will be designed and integrated. The third stage of labor will be also investigated to include the delivery of the placenta, and the clamping and cutting of the umbilical cord.
Collapse
Affiliation(s)
- Abbass Ballit
- Univ. Lille, CNRS, Centrale Lille, UMR 9013-LaMcube-Laboratoire de Mécanique, Multiphysique, Multiéchelle, Lille, F-59000, France
| | - Mathieu Hivert
- Université Lille Nord de France, Faculté de Médecine, F-59000, Lille, France
- CHU Lille, Service de Chirurgie Gynécologique, F-59000, Lille, France
| | - Chrystèle Rubod
- Univ. Lille, CNRS, Centrale Lille, UMR 9013-LaMcube-Laboratoire de Mécanique, Multiphysique, Multiéchelle, Lille, F-59000, France
- Université Lille Nord de France, Faculté de Médecine, F-59000, Lille, France
- CHU Lille, Service de Chirurgie Gynécologique, F-59000, Lille, France
| | - Tien-Tuan Dao
- Univ. Lille, CNRS, Centrale Lille, UMR 9013-LaMcube-Laboratoire de Mécanique, Multiphysique, Multiéchelle, Lille, F-59000, France.
| |
Collapse
|
8
|
Bouchez MC, Delporte V, Delplanque S, Leroy M, Vandendriessche D, Rubod C, Cosson M, Giraudet G. vNOTES Hysterectomy: What about Obese Patients? J Minim Invasive Gynecol 2023:S1553-4650(23)00112-7. [PMID: 36966918 DOI: 10.1016/j.jmig.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 03/15/2023] [Accepted: 03/19/2023] [Indexed: 04/17/2023]
Abstract
STUDY OBJECTIVE To compare the surgical outcomes of hysterectomy by vaginal natural orifice transluminal endoscopic surgery (vNOTES) for patients with body mass index (BMI) <30 and BMI ≥30. DESIGN A retrospective cohort study. SETTING A French teaching hospital. PATIENTS All patients who underwent a vNOTES hysterectomy from February 2020 to January 2022 were included (N = 200). The vNOTES approach was chosen for all patients requiring a hysterectomy, unless the procedure was for endometriosis or cancer (except grade 1 endometrioid adenocarcinoma). INTERVENTIONS Patients were categorized into 2 groups based on their BMI (<30 or ≥30 kg/m2). The population characteristics, surgical outcomes, and hospitalization outcomes were compared. The main outcome was the intraoperative conversion rate. Secondary end points were blood loss, operative time, perioperative and postoperative complications, and same-day surgery management. MEASUREMENTS AND MAIN RESULTS A total of 146 patients were included in the BMI <30 group, and 54 patients in the BMI ≥30 group. There was no statistical difference between obese and nonobese patients concerning intraoperative conversion (p = .150), with 4 cases occurring in the BMI <30 group (2.74%) and 4 occurring in the BMI ≥30 group (7.41%). Operative times were longer in obese patients (115.93 min [±55.28] vs 79.78 min [±40.38], p <.001). There was no significant difference in blood loss (p = .337) or perioperative and postoperative complications (p = .346 and p = .612, respectively). The ability to complete the surgery as a same-day procedure was no different between obese and nonobese patients (p = .150). CONCLUSION The results concerning intraoperative conversion and perioperative and postoperative complications show that vNOTES hysterectomies seem to be feasible for obese patients. When same-day surgery was decided before surgery, no more obese than nonobese patients were converted to conventional hospitalization. Further studies are needed to confirm these observations.
Collapse
Affiliation(s)
- Marie-Charlotte Bouchez
- Department of Gynecologic Surgery, Jeanne de Flandre Hospital (Drs. Bouchez, Delporte, Delplanque, Vandendriessche, Rubod, Cosson, and Giraudet), CHU Lille, Lille, France.
| | - Victoire Delporte
- Department of Gynecologic Surgery, Jeanne de Flandre Hospital (Drs. Bouchez, Delporte, Delplanque, Vandendriessche, Rubod, Cosson, and Giraudet), CHU Lille, Lille, France
| | - Sophie Delplanque
- Department of Gynecologic Surgery, Jeanne de Flandre Hospital (Drs. Bouchez, Delporte, Delplanque, Vandendriessche, Rubod, Cosson, and Giraudet), CHU Lille, Lille, France
| | - Maxime Leroy
- Biostatistics Department (Ms. Leroy), CHU Lille, Lille, France
| | - David Vandendriessche
- Department of Gynecologic Surgery, Jeanne de Flandre Hospital (Drs. Bouchez, Delporte, Delplanque, Vandendriessche, Rubod, Cosson, and Giraudet), CHU Lille, Lille, France
| | - Chrystèle Rubod
- Department of Gynecologic Surgery, Jeanne de Flandre Hospital (Drs. Bouchez, Delporte, Delplanque, Vandendriessche, Rubod, Cosson, and Giraudet), CHU Lille, Lille, France
| | - Michel Cosson
- Department of Gynecologic Surgery, Jeanne de Flandre Hospital (Drs. Bouchez, Delporte, Delplanque, Vandendriessche, Rubod, Cosson, and Giraudet), CHU Lille, Lille, France
| | - Géraldine Giraudet
- Department of Gynecologic Surgery, Jeanne de Flandre Hospital (Drs. Bouchez, Delporte, Delplanque, Vandendriessche, Rubod, Cosson, and Giraudet), CHU Lille, Lille, France
| |
Collapse
|
9
|
Lallemant M, Clermont-Hama Y, Giraudet G, Rubod C, Delplanque S, Kerbage Y, Cosson M. Long-Term Outcomes after Pelvic Organ Prolapse Repair in Young Women. J Clin Med 2022; 11:jcm11206112. [PMID: 36294437 PMCID: PMC9605202 DOI: 10.3390/jcm11206112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/12/2022] [Accepted: 10/15/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of the study was to describe the long-term outcomes of Pelvis Organ Prolapse (POP) repair in women under 40 years old. A retrospective chart review of all POP repairs performed in women ≤40 years old between January 1997 and December 2015 in the Gynecologic Surgery Department of Lille University Hospital was performed. Inclusion criteria were all women ≤40 years old who underwent a POP repair with a stage ≥2 POP according to the Baden and Walker classification. The study population was separated into three groups: a sacrohysteropexy group, a vaginal native tissue repair (NTR) group, and a transvaginal mesh surgery (VMS) group. The primary outcome was reoperation procedures for a symptomatic recurrent POP. Secondary outcomes were other complications. During the study period, 43 women ≤ 40 years old who underwent a POP repair were included and separated into three groups: 28 patients (68%), 8 patients (19%), and 7 patients (16%) in the sacrohysteropexy, VMS, and NTR groups respectively. The mean followup time was 83 ± 52 months. POP recurrence, reoperated or not, was essentially diagnosed in the VMS group (87.5%) and the NTR group (50%). POP recurrence repairs were performed for nine patients (21%): 7%, 62.5%, and 25% in the sacrohysteropexy, VMS, and NTR groups, respectively. Global reoperation concerned 10 patients (23%) whatever the type of POP surgery, mainly patients from the VMS group (75%) and from the NTR group (25%). It occurred in only 7% of patients from the sacrohysteropexy group. Two patients (4%) presented a vaginal exposure of the mesh (in the VMS group). De novo stress urinary incontinence was encountered by nine patients (21%): 29% and 12.5% in the sacrohysteropexy and NTR groups, respectively. Despite the risk of recurrence, POP repair should be proposed to young women in order to restore their quality of life. Vaginal native tissue repair or sacrohysteropexy should be performed after explaining to women the advantages and disadvantages of each procedure.
Collapse
|
10
|
Siebert D, Giraudet G, Collinet P, Gonzalez Estevez M, Cosson M, Rubod C. Risk factors for immediate failure of outpatient surgery in gynecologic surgery. Int J Gynaecol Obstet 2022; 159:592-599. [PMID: 35426951 DOI: 10.1002/ijgo.14220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/29/2022] [Accepted: 04/04/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To describe the risk factors for immediate failure of gynecologic outpatient surgery. The secondary objective was to describe the risk factors for rehospitalization within 30 days after surgery. METHODS This is a single-center retrospective cohort study conducted on all patients operated on in outpatient surgery in gynecology at the Lille University Hospital. The primary outcome was defined as any unanticipated admission to the inpatient postoperative care unit on the day of the operation. The secondary outcome was defined as any rehospitalization within 30 days following the intervention. Our statistical analysis included 916 patients operated on between January and July 2019. RESULTS In our study, 84 patients (9.2%) had an immediate failure of outpatient surgery. The most frequent etiologies were surgical (58.3%). In multivariate analysis with logistic regression, the following variables were associated with an increased risk of immediate failure of outpatient surgery: urogynecologic surgery (P < 0.001), complex laparoscopy (P = 0.004), endometriosis surgery (P < 0.001), and a duration of intervention longer than 1 hour (P < 0.001). CONCLUSION We find an increased risk of immediate failure of gynecologic outpatient surgery depending on the type of surgery as well as for surgeries lasting more than 1 hour.
Collapse
Affiliation(s)
- David Siebert
- Lille University Hospital, Gynecologic Surgery Department, Lille, France
| | - Géraldine Giraudet
- Lille University Hospital, Gynecologic Surgery Department, Lille, France
| | - Pierre Collinet
- Lille University Hospital, Gynecologic Surgery Department, Lille, France.,Lille University Hospital, Faculty of Medicine, Lille, France
| | - Max Gonzalez Estevez
- Lille University Hospital, Anesthesia in Gynecology and Obstetrics Department, Lille, France
| | - Michel Cosson
- Lille University Hospital, Gynecologic Surgery Department, Lille, France.,Lille University Hospital, Faculty of Medicine, Lille, France
| | - Chrystèle Rubod
- Lille University Hospital, Gynecologic Surgery Department, Lille, France.,Lille University Hospital, Faculty of Medicine, Lille, France
| |
Collapse
|
11
|
Kerbage Y, Dericquebourg S, Collinet P, Verpillat P, Giraudet G, Rubod C. Cystic adenomyoma surgery. J Gynecol Obstet Hum Reprod 2022; 51:102313. [PMID: 35031510 DOI: 10.1016/j.jogoh.2022.102313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 01/05/2022] [Accepted: 01/10/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Cystic adenomyoma is a lesion located within the myometrium. It is lined with endometrium and has hemorrhagic content. This rare entity has been described as a focal form of adenomyosis. However, it is poorly understood, and the management of symptomatic patients is not codified. Our objective is to evaluate the effectiveness of treatment with planned surgery for cystic adenomyoma on symptoms and fertility in a retrospective series of patients. STUDY DESIGN This is a retrospective study between January 2011 and January 2018 in a university hospital of patients that had surgery for cystic adenomyoma with uterine preservation. RESULTS Pre-operative, per-operative, and post-operative data were recorded. Of the 18 patients included, 3 were lost to follow-up; 15 underwent laparoscopic surgery and 3 operative hysteroscopies. Complications during and after surgery were rare, involving only 3 patients, and of low severity. One patient saw no improvement in pain after surgery and 2 patients saw only partial improvement in their pain; 7 patients achieved at least one pregnancy with favorable outcome after surgery. CONCLUSION Based on this series, we argue that conservative surgical treatment for cystic adenomyoma generally improves pain and fertility without causing morbidity.
Collapse
Affiliation(s)
- Yohan Kerbage
- Service de Chirurgie Gynécologique, CHU Lille, 1 Avenue Oscar Lambret, Lille F-59000, France; CHU Lille, University Lille, Lille F-59000, France.
| | - Sarah Dericquebourg
- Service de Chirurgie Gynécologique, CHU Lille, 1 Avenue Oscar Lambret, Lille F-59000, France
| | - Pierre Collinet
- Service de Chirurgie Gynécologique, CHU Lille, 1 Avenue Oscar Lambret, Lille F-59000, France; CHU Lille, University Lille, Lille F-59000, France
| | | | - Géraldine Giraudet
- Service de Chirurgie Gynécologique, CHU Lille, 1 Avenue Oscar Lambret, Lille F-59000, France
| | - Chrystèle Rubod
- Service de Chirurgie Gynécologique, CHU Lille, 1 Avenue Oscar Lambret, Lille F-59000, France; CHU Lille, University Lille, Lille F-59000, France
| |
Collapse
|
12
|
Kerbage Y, Loridan A, Jean dit Gauthier E, Cosson M, Giraudet G, Rubod C. Evaluation of the contribution of a multimedia tool in the monitoring of low-risk pregnancy: Qualitative study carried out with general practitioners in France. J Gynecol Obstet Hum Reprod 2022; 51:102319. [DOI: 10.1016/j.jogoh.2022.102319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 10/19/2022]
|
13
|
Robin C, Uk A, Decanter C, Behal H, Collinet P, Rubod C, Barbotin AL, Robin G. Impact of endometriosis on oocyte morphology in IVF-ICSI: retrospective study of a cohort of more than 6000 mature oocytes. Reprod Biol Endocrinol 2021; 19:160. [PMID: 34656130 PMCID: PMC8522159 DOI: 10.1186/s12958-021-00798-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/11/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Infertility associated with endometriosis can be explained by several non-exclusive mechanisms. The oocyte plays a crucial role in determining embryonic competence and this is particularly relevant for in vitro fertilization (IVF) outcomes. According to some authors, the morphology of oocytes could also be a non-invasive marker of oocyte quality. The aim of this study was to evaluate the relationship between endometriosis and oocyte morphology after controlled ovarian stimulation for intracytoplasmic sperm injection (ICSI) on a large oocyte cohort. METHODS Single-center comparative retrospective study in the academic In Vitro Fertilization (IVF) unit of the Lille University Hospital. A total of 596 women treated for IVF-ICSI with ejaculated spermatozoa for sperm alterations were included. They were classified as endometriosis (n = 175) or control groups (n = 401). The morphological evaluation of 2,016 mature oocytes from 348 cycles of patients with endometriosis was compared with that of 4,073 mature oocytes from 576 control cycles. The main outcome measures were Average Oocyte Quality Index (AOQI) and metaphase II oocyte morphological scoring system (MOMS). Comparison of groups was carried out by a mixed linear model and by a generalized estimation equation model with a "patient" random effect to consider that a patient might have several attempts. RESULTS No difference in AOQI and MOMS scores was found between endometriosis and control women (adjusted p = 0.084 and 0.053, respectively). In case of endometriosis, there were significantly fewer metaphase II oocytes retrieved, embryos obtained, grade 1 embryos and number of cumulative clinical pregnancies compared to controls. In the endometriosis group, endometriosis surgery was associated with a reduced number of mature oocytes retrieved, and the presence of endometrioma(s) was associated with some abnormal oocyte shapes. Nevertheless, no difference concerning the AOQI and MOMS scores was found in these subgroups. CONCLUSION Endometriosis does not have a negative impact on oocytes' morphology in IVF-ICSI. TRIAL REGISTRATION On December 16, 2019, the Institutional Review Board of the Lille University Hospital gave unrestricted approval for the anonymous use of all patients' clinical, hormonal and ultrasound records (reference DEC20150715-0002).
Collapse
Affiliation(s)
- Camille Robin
- Service de Gynécologie Endocrinienne Et Médecine de La Reproduction, CHU Lille, Assistance Médicale À La Procréation Et Préservation de La Fertilité, Hôpital Jeanne de Flandre, Service dAvenue Eugène Avinée, 59000, Lille, France.
| | - Audrey Uk
- Institut de Biologie de La Reproduction-Spermiologie-CECOS, Hôpital Jeanne de Flandre, Centre Hospitalier Et Universitaire, 59000, Lille, France
| | - Christine Decanter
- Service de Gynécologie Endocrinienne Et Médecine de La Reproduction, CHU Lille, Assistance Médicale À La Procréation Et Préservation de La Fertilité, Hôpital Jeanne de Flandre, Service dAvenue Eugène Avinée, 59000, Lille, France
- EA 4308 Gamètogenèse Et Qualité du Gamète, Faculté de Médecine Et CHU de Lille, F-59000, Lille, France
| | - Hélène Behal
- EA 2694, Santé Publique : Épidémiologie Et Qualité Des Soins, Univ. Lille, CHU Lille, Unité de Biostatistiques, F-59000, Lille, France
| | - Pierre Collinet
- Service de Chirurgie Gynécologique, Hôpital Jeanne de Flandre, Centre Hospitalier Et Universitaire, 59000, Lille, France
- Faculté de Médecine, Université de Lille, 59045, Lille, France
| | - Chrystèle Rubod
- Service de Chirurgie Gynécologique, Hôpital Jeanne de Flandre, Centre Hospitalier Et Universitaire, 59000, Lille, France
- Faculté de Médecine, Université de Lille, 59045, Lille, France
| | - Anne-Laure Barbotin
- Institut de Biologie de La Reproduction-Spermiologie-CECOS, Hôpital Jeanne de Flandre, Centre Hospitalier Et Universitaire, 59000, Lille, France
- EA 4308 Gamètogenèse Et Qualité du Gamète, Faculté de Médecine Et CHU de Lille, F-59000, Lille, France
- Faculté de Médecine, Université de Lille, 59045, Lille, France
| | - Geoffroy Robin
- Service de Gynécologie Endocrinienne Et Médecine de La Reproduction, CHU Lille, Assistance Médicale À La Procréation Et Préservation de La Fertilité, Hôpital Jeanne de Flandre, Service dAvenue Eugène Avinée, 59000, Lille, France
- EA 4308 Gamètogenèse Et Qualité du Gamète, Faculté de Médecine Et CHU de Lille, F-59000, Lille, France
- Faculté de Médecine, Université de Lille, 59045, Lille, France
| |
Collapse
|
14
|
Gehenne L, Parent A, Christophe V, Rubod C. [Living with endometriosis, sexual experiences of patients and their partners: A French qualitative study]. ACTA ACUST UNITED AC 2021; 50:69-74. [PMID: 34656789 DOI: 10.1016/j.gofs.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Indexed: 11/29/2022]
Abstract
AIM Endometriosis is a disabling gynecological pathology. Couples who face it frequently encounter sexual difficulties related to dyspareunia. This study aims to understand the sexual experiences of endometriosis patients and their partners. METHODS A total of 13 patients and 13 partners were interviewed prior to surgery. Semi-structured interviews were conducted separately and explored their sexual experiences. The interviews were transcribed verbatim and analyzed using content analysis. RESULTS Both members of the couple reported pain during intercourses; decreased sexual desire; adaptation during sexual intercourses; communication about sexuality, which can be either open or a source of conflict, and the search for explanations for endometriosis. As for the emotional sphere, patients report anticipatory anxiety while partners report frustration and hope. CONCLUSION These couples are in difficulty regarding sexuality, it is necessary to take care of both members of the couple and to encourage communication between them.
Collapse
Affiliation(s)
- L Gehenne
- Psychiatrie de liaison et oncologie médicale, hôpital Fontan, CHU de Lille, rue Paul-Nayrac, Lille, France; Université Lille, CNRS, UMR 9193 - SCALab - sciences cognitives et sciences affectives, 59000 Lille, France.
| | - A Parent
- Psychiatrie de liaison et oncologie médicale, hôpital Fontan, CHU de Lille, rue Paul-Nayrac, Lille, France
| | - V Christophe
- Université Lille, CNRS, UMR 9193 - SCALab - sciences cognitives et sciences affectives, 59000 Lille, France
| | - C Rubod
- Service de chirurgie gynécologique, CHU de Lille, 59000 Lille, France; Faculté de médecine, université de Lille, 59000 Lille, France
| |
Collapse
|
15
|
Morch A, Doucède G, Lecomte-Grosbras P, Brieu M, Rubod C, Cosson M. Pelvic organ prolapse meshes: Can they preserve the physiological behavior? J Mech Behav Biomed Mater 2021; 120:104569. [PMID: 34058600 DOI: 10.1016/j.jmbbm.2021.104569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 11/24/2020] [Accepted: 05/02/2021] [Indexed: 10/21/2022]
Abstract
Implants for the cure of female genital prolapse still show numerous complications cases that sometimes have dramatic consequences. These implants must be improved to provide physiological support and restore the normal functionalities of the pelvic area. Besides the trend towards lighter meshes, a better understanding of the in vivo role and impact of the mesh implantation is required. This work investigates the mechanical impact of meshes after implantation with regards to the behavior of the native tissues. Three meshes were studied to assess their mechanical and biological impact on the native tissues. An animal study was conducted on rats. Four groups (n = 17/group) underwent surgery. Rats were implanted on the abdominal wall with one of the three polypropylene knitted mesh (one mesh/group). The last group served as control and underwent the same surgery without any mesh implantation. Post-operative complications, contraction, mechanical rigidities, and residual deformation after cyclic loading were collected. Non-parametric statistical comparisons were performed (Kruskal-Wallis) to observe potential differences between implanted and control groups. Mechanical characterization showed that one of the three meshes did not alter the mechanical behavior of the native tissues. On the contrary, the two others drastically increased the rigidities and were also associated with clinical complications. All of the meshes seem to reduce the geometrical lengthening of the biological tissues that comes with repetitive loads. Mechanical aspects might play a key role in the compatibility of the mesh in vivo. One of the three materials that were implanted during an animal study seems to provide better support and adapt more properly to the physiological behavior of the native tissues.
Collapse
Affiliation(s)
- Annie Morch
- Univ. Lille, CNRS, Centrale Lille, UMR 9013- LaMcube - Laboratoire de Mécanique, Multiphysique, Multi-échelle, F-59000, Lille, France
| | - Guillaume Doucède
- Service de Chirurgie gynécologique - CHU Lille, F-59000, Lille, France; Université de Lille - Faculté de Lille, F-59000, Lille, France
| | - Pauline Lecomte-Grosbras
- Univ. Lille, CNRS, Centrale Lille, UMR 9013- LaMcube - Laboratoire de Mécanique, Multiphysique, Multi-échelle, F-59000, Lille, France
| | - Mathias Brieu
- Univ. Lille, CNRS, Centrale Lille, UMR 9013- LaMcube - Laboratoire de Mécanique, Multiphysique, Multi-échelle, F-59000, Lille, France; California State University - Los Angeles, College Engineering - Computer Science, and Technology, Dept. Mechanical Engineering, United States
| | - Chrystèle Rubod
- Univ. Lille, CNRS, Centrale Lille, UMR 9013- LaMcube - Laboratoire de Mécanique, Multiphysique, Multi-échelle, F-59000, Lille, France; Service de Chirurgie gynécologique - CHU Lille, F-59000, Lille, France; Université de Lille - Faculté de Lille, F-59000, Lille, France
| | - Michel Cosson
- Univ. Lille, CNRS, Centrale Lille, UMR 9013- LaMcube - Laboratoire de Mécanique, Multiphysique, Multi-échelle, F-59000, Lille, France; Service de Chirurgie gynécologique - CHU Lille, F-59000, Lille, France; Université de Lille - Faculté de Lille, F-59000, Lille, France.
| |
Collapse
|
16
|
Cohen A, Doucède G, Clouqueur E, Debarge V, Behal H, Rubod C, Hanssens S. [Use of the SBAR tool: Assessment of the value of a short training course on the quality of communication between caregivers in the short and long term]. ACTA ACUST UNITED AC 2021; 49:823-829. [PMID: 33933673 DOI: 10.1016/j.gofs.2021.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Communication breakdown is one of the main causes of adverse events in clinical routine. The main objective of this study was to assess whether a short training course on medical communication based on the situation-background-assessment-recommendation (SBAR) tool improved the quality of communication in clinical practice. METHODS Interventional study, conducted at the Jeanne de Flandre maternity unit (Lille University Hospital, France) between January 2017 and December 2019. The training sessions lasted 1 hour and consisted of a theoretical part, based on the SBAR tool, and of a practical part (video-stimulated recall and role-play case scenarios). The main outcome measure was the evaluation of the quality of the telephone calls made by a caregiver to the on-call doctor, using a questionnaire completed before (Q1) and remotely from training (Q2). RESULTS One hundred and twenty health professionals were trained (n=120). Following the trainings, there was an improvement in communication in the short term, whether in terms of relevance (64.9 vs. 52.6, P<0.001) or conciseness of the message (36.9 vs. 32.2, P<0.001), but also in terms of long-term in a real clinical situation (Q2: 3.9 vs. Q1: 3.0, P<0.001). Finally, 81% of participants were satisfied with the training. CONCLUSIONS Short training sessions on communication based on the SBAR tool appeared to improve participants' knowledge and skills in the short-term, but also in the longer term in a real clinical situation.
Collapse
Affiliation(s)
- A Cohen
- Département d'obstétrique, CHU de Lille, 59000 Lille, France.
| | - G Doucède
- Clinique Saint-George, 134, avenue des Arènes de Cimiez, 06000 Nice, France
| | - E Clouqueur
- Centre hospitalier de Tourcoing, 155, rue du Président Coty, 59200 Tourcoing, France
| | - V Debarge
- Département d'obstétrique, CHU de Lille, 59000 Lille, France; Faculté de médecine Henri-Warembourg, 59000 Lille, France
| | - H Behal
- ULR 2694 - METRICS : évaluation des technologies de santé et des pratiques médicales, CHU de Lille, University Lille, 59000 Lille, France
| | - C Rubod
- Département d'obstétrique, CHU de Lille, 59000 Lille, France; Faculté de médecine Henri-Warembourg, 59000 Lille, France
| | - S Hanssens
- Faculté de médecine Henri-Warembourg, 59000 Lille, France
| |
Collapse
|
17
|
Verpillat P, Fourquet T, Kamus É, Collinet P, Jacques AS, Capelle C, Bugeaud M, Puech P, Rubod C. Images pièges et difficultés diagnostiques dans le cadre d’un bilan d’endométriose pelvienne : intérêt de la confrontation radioclinique. Imagerie de la Femme 2021. [DOI: 10.1016/j.femme.2020.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
18
|
de Lapparent C, Verpillat P, Gandon A, Kamus E, Fourquet T, Jacques AS, Capelle C, Collinet P, Rubod C, Puech P. [Contribution of the pre-operative Mri-coloscan couple in the surgical planning of deep digestive pelvic endometriosis]. ACTA ACUST UNITED AC 2021; 49:913-922. [PMID: 33639282 DOI: 10.1016/j.gofs.2021.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The digestive involvement of endometriosis accounts for up to 20-25% of deep localisations. Precise mapping of digestive lesions is essential in order to plan surgery and specialized teams. The aim of this study is to assess the contribution of the MRI-coloscan couple in the preoperative assessment of digestive endometriosis. METHODS We analyzed 45 files of patients referred for suspected digestive endometriosis. They had all undergone a preoperative MRI and coloscan associated with surgery throughout the year. We first compared the data collected in imaging, and then compared the synthesis of this data with the surgical procedure performed. RESULTS 35 patients required digestive surgery. 24 of 45 files were concordant in MRI and coloscanner. Data from MRI alone matched with surgery in 69% of cases, against 84% for the coloscan. The synthesis allowed a concordance of 89%. 25 segmental resections, 2 discoid and 16 shaving were performed. The use of coloscan made up for nine extra cases: the detection of four additional cases of multifocality, a single undiagnosed case of a deep lesion, and allowed to specify the depth of the involvement in four cases. On the contrary, the MRI was correct compared to the CT in four cases. The presence of a digestive surgeon was necessary in 53% of cases. CONCLUSION In the era of imaging staging, it would seem interesting to turn towards a subclassification of the digestive involvement of endometriosis in order to decide which surgery to perform. In our experience, the coloscan is a useful complement of MR, especially to assess the depth of involvement and the multifocality.
Collapse
Affiliation(s)
- C de Lapparent
- University Lille, CHU Lille, Service d'imagerie génito-urinaire et de la femme, 59000 Lille, France.
| | - P Verpillat
- University Lille, CHU Lille, Service d'imagerie génito-urinaire et de la femme, 59000 Lille, France
| | - A Gandon
- University Lille, CHU Lille, Service de chirurgie générale et digestive, 59000 Lille, France
| | - E Kamus
- University Lille, CHU Lille, Service d'imagerie génito-urinaire et de la femme, 59000 Lille, France
| | - T Fourquet
- University Lille, CHU Lille, Service d'imagerie génito-urinaire et de la femme, 59000 Lille, France
| | - A-S Jacques
- University Lille, CHU Lille, Service d'imagerie génito-urinaire et de la femme, 59000 Lille, France
| | - C Capelle
- University Lille, CHU Lille, Service d'imagerie génito-urinaire et de la femme, 59000 Lille, France
| | - P Collinet
- University Lille, CHU Lille, Service de chirurgie gynécologique, 59000 Lille, France; University Lille, Inserm, CHU Lille, U1189 - ONCO-THAI - Assisted Laser Therapy and Immunotherapy for Oncology, 59000 Lille, France
| | - C Rubod
- University Lille, CHU Lille, Service de chirurgie gynécologique, 59000 Lille, France
| | - P Puech
- University Lille, CHU Lille, Service d'imagerie génito-urinaire et de la femme, 59000 Lille, France; University Lille, Inserm, CHU Lille, U1189 - ONCO-THAI - Assisted Laser Therapy and Immunotherapy for Oncology, 59000 Lille, France
| |
Collapse
|
19
|
Kerbage Y, Rouillès J, Estrade JP, Collinet P, Huchon C, Villefranque V, Rubod C. Surgical training through simulation dedicated to French Ob-gyn residents. Evaluation and satisfaction. J Gynecol Obstet Hum Reprod 2021; 50:102076. [PMID: 33515852 DOI: 10.1016/j.jogoh.2021.102076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/15/2021] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE In order to be able to develop surgical training of residents through simulation, we carried out a descriptive study, evaluating the satisfaction of participating residents and the benefit of the workshops offered during the 4 th Junior Master Class, free annual training organized in 2017 in Lille University Hospital. It is dedicated to ob-gyn residents in France, overseas departments and territories. MATERIAL AND METHODS During two days, plenary sessions and practical workshops on animal models or simulators were organized in laparoscopy, diagnostic and operative hysteroscopy, vaginal surgery and robotic surgery. A questionnaire was given anonymously to each student, collecting on the one hand their surgical curriculum, on the other hand, the evaluations of the theoretical contribution and the quality of the interventions and materials offered during the plenary sessions. The last part was subdivided into a questionnaire specific to each workshop. RESULTS The 48 residents who voluntarily followed this training were overwhelmingly satisfied with the quality of the training offered. The practical benefits outweighed the theoretical benefits. These workshops improved their practical skills from 63 % to 84 % depending on the workshops offered. In addition, 100 % of students would recommend this training to other residents and consider it useful for their future practice. CONCLUSION These very satisfactory results encourage us to organize new surgical training. Simulation is the key point for an appropriate surgical learning.
Collapse
Affiliation(s)
- Yohan Kerbage
- CHU Lille, Service de chirurgie gynécologique F-59000 Lille, France; Univ. Lille, CHU Lille, F-59000 Lille, France.
| | - Julie Rouillès
- CHU Lille, Service de chirurgie gynécologique F-59000 Lille, France
| | - Jean Philippe Estrade
- CHU Lille, Service de chirurgie gynécologique F-59000 Lille, France; Univ. Lille, CHU Lille, F-59000 Lille, France; Clinique Bouchard-Elsan, Chirurgie gynécologique, Marseille, France; Service de chirurgie gynécologique- Université de Paris, Hôpital Lariboisière, Paris, France; Maternité, Hôpital Simone Veil, 14 rue de Saint Prix, Eaubonne, France
| | - Pierre Collinet
- CHU Lille, Service de chirurgie gynécologique F-59000 Lille, France; Univ. Lille, CHU Lille, F-59000 Lille, France
| | - Cyrille Huchon
- Service de chirurgie gynécologique- Université de Paris, Hôpital Lariboisière, Paris, France
| | | | - Chrystèle Rubod
- CHU Lille, Service de chirurgie gynécologique F-59000 Lille, France; Univ. Lille, CHU Lille, F-59000 Lille, France
| |
Collapse
|
20
|
Cathelain A, Jourdain M, Cordonnier C, Catteau-Jonard S, Sebbane D, Copin MC, Berlingo L, Rubod C, Garabedian C. Career aspirations among specialty residents in France: a cross-sectional gender-based comparison. BMC Med Educ 2021; 21:63. [PMID: 33468117 PMCID: PMC7816478 DOI: 10.1186/s12909-021-02494-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 01/10/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Most studies evaluating career aspirations among gender are performed in Anglo-Saxon countries. Two recent French studies looked at the career choice of residents in obstetrics & gynecology. It seemed useful to us to broaden this questioning to other specialties, by proposing a study to all residents in the same Faculty. The objective of our study was to describe residents' career aspirations and possible barriers according to gender. METHODS Declarative cross-sectional survey, using questionnaires sent by email to the specialty residents of the Faculty of Medicine of Lille (France). An analysis by specialty group (i.e., medicine, surgery, obstetrics & gynecology, and anesthesia & resuscitation) and a comparison of the results according to gender were performed. RESULTS Of the 1384 specialty residents currently in training, 462 answered the questionnaire (33.38%), among whom 289 women and 173 men (average age = 27.08 ± 0.091 years). Seventeen women (5.9%) were currently considering a university hospital career versus 37 men (21.4%) (p = 0.001). Gender analysis made it possible to identify obstacles to engaging in a university career: lacking a female model, more frequent doubting the ability to undertake this type of career among women (61.6%) than men (35.3%) (p < 0.001), and gender discrimination felt in the workplace for 51.6% of women (versus 7.5% of men, p < 0.001). Subgroup analysis showed specificities related to each specialty. CONCLUSIONS Few residents plan to embark upon a university hospital career, let alone female residents. There are considerations specific to each specialty and marked gender differences regarding career aspirations. Many features have been identified as obstacles to access to university hospital positions for women. It is important to develop strategies to remove these barriers and enable women to pursue such university careers. TRIAL REGISTRATION Not applicable (no intervention).
Collapse
Affiliation(s)
- A Cathelain
- CHU Lille, Department of Obstetrics & Gynecology, Lille University Hospital, Avenue Eugène Avinée, F-59000, Lille, France.
| | - M Jourdain
- INSERM, CHU Lille, U1190, Transrational diabetes research, Intensive Medicine and Resuscitation Department, F-59000, Lille, France
| | - C Cordonnier
- Department of Neurology, CHU Lille, Inserm U1171, Degenerative and Vascular Cognitive Disorders, Lille University Hospital, Lille, France
| | - S Catteau-Jonard
- CHU Lille, Department Endocrine Gynecology and Reproductive Medicine, Lille University Hospital, F-59000, Lille, France
| | - D Sebbane
- CHU Lille, Department of psyciatry, F-59000, Lille, France
- ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, INSERM, Paris, France
| | - M C Copin
- CHU Lille, Pathology Institute, Lille University Hospital Center, F-59000, Lille, France
| | - L Berlingo
- Maternity, Pitié Salpêtrière Hospital, Assistance Publique des Hôpitaux de Paris, Sorbonne University, Paris, France
| | - C Rubod
- CHU Lille, Department of Obstetrics & Gynecology, Lille University Hospital, Avenue Eugène Avinée, F-59000, Lille, France
| | - C Garabedian
- CHU Lille, Department of Obstetrics & Gynecology, Lille University Hospital, Avenue Eugène Avinée, F-59000, Lille, France
| |
Collapse
|
21
|
Hamoud Y, Cosson M, Collinet P, Phalippou J, Rubod C, Giraudet G. Easy way to perform a labia minora reduction. J Gynecol Obstet Hum Reprod 2020; 50:101884. [PMID: 32745640 DOI: 10.1016/j.jogoh.2020.101884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 07/24/2020] [Accepted: 07/26/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Labia minora reduction is a surgery in the rise. Surgeons are left with a large choice of described techniques yet there is a paucity of visual data to guide surgeons through this procedure. Also, many gynecologic surgeons are reluctant to perform this operation emphasizing potential complications. TECHNIQUE We present a step by step visual support of a wedge resection technique. EXPERIENCE This technique of labia minora reduction is safe and carries a great satisfaction rate among patients. CONCLUSION We believe that a visual description of a simple and quick technique will help standardized patient care and achieve good outcomes.
Collapse
Affiliation(s)
- Yasmine Hamoud
- CHU Lille, Department of Gynecology, F-59000, Lille, France.
| | - M Cosson
- CHU Lille, Department of Gynecology, F-59000, Lille, France
| | - P Collinet
- CHU Lille, Department of Gynecology, F-59000, Lille, France
| | - J Phalippou
- CHU Lille, Department of Gynecology, F-59000, Lille, France
| | - C Rubod
- CHU Lille, Department of Gynecology, F-59000, Lille, France
| | | |
Collapse
|
22
|
Leleu A, Cathelain A, Rubod C, Vandendriessche D, Cosson M, Giraudet G. Symptom related to Essure® and evolution after removal: Outcomes of retrospective cohort. J Gynecol Obstet Hum Reprod 2020; 50:101836. [PMID: 32590111 DOI: 10.1016/j.jogoh.2020.101836] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 05/25/2020] [Accepted: 06/12/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The number of requests for Essure removal has grown continually over recent years. The objective is to describe the symptoms reported after Essure sterilization, methods of removal and results. MATERIAL AND METHODS Retrospective and single-centre cohort (Regional university hospital of Lille, France) was conducted. All women, having consulted from December 2016 to February 2019 for symptoms related to Essure insertion, were included. All the symptoms were noted. A second group was created that included patients who underwent Essure removal to evaluate the benefits of surgery on these symptoms. RESULTS The study included 98 patients. Most frequent symptoms were musculoskeletal pain (75 %), asthenia (63 %) and pelvic pain (55 %). Fifty-nine patients (60 %) underwent surgery. Surgery appeared beneficial with reduction of symptoms in 60 % of these patients, complete resolution in 33 % and no reduction of symptoms in 7%. Many symptoms were relieved by surgery with an overall decline of 96 % in menorrhagia, 94 % in metrorrhagia and 93 % in dyspareunia. However, other symptoms were not relieved by surgery like 100 % of sleep disorders, 70 % of abdominal pain cases and 57 % of memory impairment cases. CONCLUSION Symptoms related to Essure insertion are numerous. Although surgery appears beneficial, some adverse effects remain. Therefore, a preoperative aetiologic assessment and information about risk of surgery failure are important.
Collapse
Affiliation(s)
- A Leleu
- CHU Lille, Gynaecological Surgery Department, F-59000, Lille, France
| | - A Cathelain
- CHU Lille, Gynaecological Surgery Department, F-59000, Lille, France
| | - C Rubod
- CHU Lille, Gynaecological Surgery Department, F-59000, Lille, France; University of Lille, F-59000, Lille, France
| | - D Vandendriessche
- CHU Lille, Gynaecological Surgery Department, F-59000, Lille, France
| | - M Cosson
- CHU Lille, Gynaecological Surgery Department, F-59000, Lille, France; University of Lille, F-59000, Lille, France
| | - G Giraudet
- CHU Lille, Gynaecological Surgery Department, F-59000, Lille, France.
| |
Collapse
|
23
|
Pécout M, Jean Dit Gautier E, Doucède G, Collinet P, Rubod C. Pelvic endometriosis: Refer to the surgeon at the right moment: Pelvic endometriosis: When refer to the surgeon? J Gynecol Obstet Hum Reprod 2020; 49:101701. [PMID: 32028037 DOI: 10.1016/j.jogoh.2020.101701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 01/16/2020] [Accepted: 01/24/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND As endometriosis is not a single condition but different morphological types, it is easy to conceive that its management allow for a diversity of approaches. The objective of this literature review is about a simplified pathway through care for patients with endometriosis, and to target the right time for surgical treatment. METHODS Through a literature and references review, the different surgical care arrangements according to attainment, to symptoms and to the patients demands and expectations are reviewed. RESULTS An existing literature and recommendations synthesis has been done, and it was found that an optimum medical or surgical care rely on a multidisciplinary approach. Asymptomatic patients should not have surgery, and the medical treatment precede surgical treatment in numerous indications. In case of a surgical need, the right moment is determined by the recommendations, as noted in this article. Different aspects are necessary, the symptomatology, the intend to be pregnant and the recurrence of lesions in particular, but also the use of medically assisted reproduction or not. CONCLUSION In order to optimize the surgical treatment of patients with endometriosis, it is advisable to not refer these patients to the surgeon not too soon and not too late, furthermore if he's an expert. In all cases the treatment is multidisciplinary, and the most difficult cases are referred to multidisciplinary consultative reunion. The surgical treatment relies on "centre of expertise's" existence for some specific forms of deep endometriosis. The surgical treatment is a question of both pathology and timing. BRIEF SUMMARY In order to optimize the surgical treatment of endometriosis, it is advisable to refer patients to the surgeon at the right moment.
Collapse
Affiliation(s)
- Marie Pécout
- Gynaecology Surgery Department, CHU Lille, F-59000, Lille, France.
| | - Estelle Jean Dit Gautier
- Gynaecology Surgery Department, CHU Lille, F-59000, Lille, France; Lille University, Faculty of Medicine, F-59000, Lille, France.
| | - Guillaume Doucède
- Gynaecology Surgery Department, CHU Lille, F-59000, Lille, France; Lille University, Faculty of Medicine, F-59000, Lille, France.
| | - Pierre Collinet
- Gynaecology Surgery Department, CHU Lille, F-59000, Lille, France; Lille University, Faculty of Medicine, F-59000, Lille, France.
| | - Chrystèle Rubod
- Gynaecology Surgery Department, CHU Lille, F-59000, Lille, France; Lille University, Faculty of Medicine, F-59000, Lille, France.
| |
Collapse
|
24
|
Renard N, Bartolo S, Giraudet G, Declas E, Rubod C, Cosson M. Feasibility of vaginal mesh for anterior vaginal wall prolapse in an ambulatory setting: A retrospective case series. J Gynecol Obstet Hum Reprod 2020; 49:101684. [PMID: 31926349 DOI: 10.1016/j.jogoh.2020.101684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 12/10/2019] [Accepted: 12/20/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Vaginal mesh has been proven to be an effective aid in the treatment of cystocele. Could an ambulatory approach be feasible for the Uphold Lite®-mesh? HYPOTHESIS We investigate the feasibility of an ambulatory approach of Uphold Lite® insertion in a well-selected population. Risk factors for a non-successful ambulatory approach are identified. METHODOLOGY We conducted a retrospective case series of 236 women who underwent Uphold Lite® vaginal mesh insertion for the treatment of pelvic organ prolapse at our center. Indications for surgery were symptomatic anterior and/or apical prolapse, stages POPQ≥2. We compared women having an ambulatory approach, to those having a one day hospitalization planned but needed to stay. Comparisons between percentages were calculated using the chi-square or Fisher's exact test, depending on the number of women in each group. The mean comparisons were performed using the Student t-test, and the median test comparisons by the Kruskal-Wallis test. A difference was considered significant if p<0.05. RESULTS The most common reason for staying (85.7% of all ambulatory failures) after Uphold® surgery is the presence of an elevated post void residual. This complication was more found in the following: surgery in the afternoon, use of high-dose morphinics in general anesthesia, and in women with a higher parity. CONCLUSIONS Our study shows that Uphold® surgery in a one-day setting is feasible and safe. Women desiring this approach should be counselled on the 42.6% risk of one-day failure though, mostly due to non-validation of a post void residual. General anesthesia with high-dose morphinics, a higher parity, and surgery in the afternoon are risk factors for failure of an ambulatory protocol.
Collapse
Affiliation(s)
- N Renard
- department of Obstetrics and Gynaecology, St Vincentius Hospital Antwerp, Belgium.
| | - S Bartolo
- department of Obstetrics and Gynaecology, Centre Hospitalier de Douai, France
| | - G Giraudet
- department of Gynaecological Surgery, Jeanne De Flandre Hospital, France
| | - E Declas
- department of Gynaecological Surgery, Jeanne De Flandre Hospital, France
| | - C Rubod
- department of Gynaecological Surgery, Jeanne De Flandre Hospital, France
| | - M Cosson
- department of Gynaecological Surgery, Jeanne De Flandre Hospital, France
| |
Collapse
|
25
|
Vanspranghels R, Abergel A, Robin G, Jean Dit Gautier-Gaudenzi E, Giraudet G, Rubod C. Fertiloscopy in women with unexplained infertility: Long-term cumulative pregnancy rate. J Gynecol Obstet Hum Reprod 2019; 49:101671. [PMID: 31811973 DOI: 10.1016/j.jogoh.2019.101671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 11/14/2019] [Accepted: 11/29/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Fertiloscopy is as safe as laparoscopy in literature, but we don't know its relevance in women with unexplained infertility (UI). Our objective was to assess the effects of fertiloscopy procedures on the outcomes of subsequent pregnancy occurrences in patients with UI. METHODS Retrospective, single-center study of all patients followed up after fertiloscopy procedures between 2002 and 2007. The occurrence and outcome of pregnancies were studied in the five years following the procedure. RESULTS 124 fertiloscopies were performed. Pelvic exploration was considered as sufficient in 83.8% of cases, of which no abnormalities were found in 78.2%. Laparoconversions occurred for 19 patients (16.5%). The pregnancy rate at five years was 76.9%. The mean delay for pregnancy occurrence was 10.7 months (±17). CONCLUSION The pregnancy rate in our study is similar to that after laparoscopy. Fertiloscopy, a less intrusive procedure, should be considered as a reliable option for the management of patients with UI.
Collapse
Affiliation(s)
- Roxane Vanspranghels
- Gynecological Department, Jeanne de Flandre Hospital, University Hospital, Lille Cedex, 59037, France
| | - Aurélie Abergel
- Gynecological Department, Jeanne de Flandre Hospital, University Hospital, Lille Cedex, 59037, France
| | - Geoffroy Robin
- CHU Lille, Department of Endocrine Gynecology and Reproductive Medicine, Hospital Jeanne de Flandre, 2, rue E. Avinée, F-59000 Lille, France
| | | | - Géraldine Giraudet
- Gynecological Department, Jeanne de Flandre Hospital, University Hospital, Lille Cedex, 59037, France
| | - Chrystèle Rubod
- Gynecological Department, Jeanne de Flandre Hospital, University Hospital, Lille Cedex, 59037, France.
| |
Collapse
|
26
|
G.Doucède, Morch A, Pouseele B, Lecomte-Grosbras P, Brieu M, Cosson M, Rubod C. Evolution of the mechanical properties of a medical device regarding implantation time. Eur J Obstet Gynecol Reprod Biol 2019; 242:139-143. [DOI: 10.1016/j.ejogrb.2019.08.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 08/12/2019] [Accepted: 08/27/2019] [Indexed: 11/27/2022]
|
27
|
Rubod C, Fouquet A, Bartolo S, Lepage J, Capelle A, Lefebvre C, Kamus E, Dewailly D, Collinet P. Factors associated with pregnancy after in vitro fertilization in infertile patients with posterior deep pelvic endometriosis: A retrospective study. J Gynecol Obstet Hum Reprod 2019; 48:235-239. [DOI: 10.1016/j.jogoh.2018.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 06/09/2018] [Accepted: 06/12/2018] [Indexed: 11/28/2022]
|
28
|
Pécout M, Cosson M, Collinet P, Rubod C, Giraudet G. Disappearance of a myoma after pregnancy in a 38 years old patient, treated by ulipristal acetate without success before getting pregnant. J Gynecol Obstet Hum Reprod 2019; 48:781-783. [PMID: 30898625 DOI: 10.1016/j.jogoh.2019.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 03/07/2019] [Accepted: 03/15/2019] [Indexed: 11/16/2022]
Abstract
Uterine fibroids are the most common form of benign gynaecological tumors in women of childbearing age Piecak et al. (2017) [1]. These uterine fibroids can be responsible for abnormal uterine bleeding, pelvic pain, pelvic pressure and infertility Pritts et al. (2009), Ali and Al-Hendy (2017) [2,3]. Their treatment can be carried out according to several methods: medical treatment, uterine artery embolization or surgery (myomectomy or hysterectomy). Although surgery is the main option, there are medical treatments to reduce their size and decrease and control their symptoms. Ulipristal acetate (UPA) has been the first selective progesterone-receptor modulator approved for the preoperative and long-term treatment for uterine fibroids Ferrero et al. (2018) [4]. Here we present the case of a 38-years-old patient whose large fibroma (initially treated with UPA) totally disappeared after pregnancy.
Collapse
Affiliation(s)
- M Pécout
- Gynaecological Surgery Department, Jeanne de Flandre Hospital, University Hospital of Lille, Avenue Eugène Avinée, 59007 Lille Cedex, France.
| | - M Cosson
- Gynaecological Surgery Department, Jeanne de Flandre Hospital, University Hospital of Lille, Avenue Eugène Avinée, 59007 Lille Cedex, France; Lille University, Faculty of Medicine, F-59000 Lille, France.
| | - P Collinet
- Gynaecological Surgery Department, Jeanne de Flandre Hospital, University Hospital of Lille, Avenue Eugène Avinée, 59007 Lille Cedex, France; Lille University, Faculty of Medicine, F-59000 Lille, France.
| | - C Rubod
- Gynaecological Surgery Department, Jeanne de Flandre Hospital, University Hospital of Lille, Avenue Eugène Avinée, 59007 Lille Cedex, France; Lille University, Faculty of Medicine, F-59000 Lille, France.
| | - G Giraudet
- Gynaecological Surgery Department, Jeanne de Flandre Hospital, University Hospital of Lille, Avenue Eugène Avinée, 59007 Lille Cedex, France; Lille University, Faculty of Medicine, F-59000 Lille, France.
| |
Collapse
|
29
|
Kerbage Y, Rubod C, Hubert T, Bassil A, Ghesquière L, Garabedian C. Comment je fais… un modèle d’hystéroscopie à moindre coût. ACTA ACUST UNITED AC 2018; 46:664-666. [DOI: 10.1016/j.gofs.2018.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Indexed: 11/25/2022]
|
30
|
Giraudet G, Patrouix L, Fontaine C, Demondion X, Cosson M, Rubod C. Three dimensional model of the female perineum and pelvic floor muscles. Eur J Obstet Gynecol Reprod Biol 2018; 226:1-6. [DOI: 10.1016/j.ejogrb.2018.05.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/01/2018] [Accepted: 05/10/2018] [Indexed: 11/26/2022]
|
31
|
Collinet P, Fritel X, Revel-Delhom C, Ballester M, Bolze PA, Borghese B, Bornsztein N, Boujenah J, Brillac T, Chabbert-Buffet N, Chauffour C, Clary N, Cohen J, Decanter C, Denouël A, Dubernard G, Fauconnier A, Fernandez H, Gauthier T, Golfier F, Huchon C, Legendre G, Loriau J, Mathieu-d'Argent E, Merlot B, Niro J, Panel P, Paparel P, Philip CA, Ploteau S, Poncelet C, Rabischong B, Roman H, Rubod C, Santulli P, Sauvan M, Thomassin-Naggara I, Torre A, Wattier JM, Yazbeck C, Bourdel N, Canis M. Management of endometriosis: CNGOF/HAS clinical practice guidelines - Short version. J Gynecol Obstet Hum Reprod 2018; 47:265-274. [PMID: 29920379 DOI: 10.1016/j.jogoh.2018.06.003] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 06/12/2018] [Indexed: 11/18/2022]
Abstract
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.
Collapse
Affiliation(s)
- P Collinet
- CHRU Lille, Clinique de gynécologie, Hôpital Jeanne de Flandre, 59000 Lille, France; Université Lille-Nord-de-France, 59000 Lille, France
| | - X Fritel
- Service de Gynécologie-Obstétrique et Médecine de la reproduction, Inserm CIC 1402, 2, rue de la Milétrie, 86000 Poitiers, France; Université de Poitiers, 86000 Poitiers, France; Inserm CIC 1402, 86000 Poitiers, France
| | - C Revel-Delhom
- Haute Autorité de Santé, 5 avenue du Stade de France, 93218 La Plaine St Denis Cedex, France
| | - M Ballester
- Service de Gynécologie-Obstétrique et Médecine de la reproduction, CHU Tenon, APHP, 4, rue de la Chine, 75020 Paris, France
| | - P A Bolze
- Service de Chirurgie Gynécologique Oncologique, Obstétrique, CHU Lyon Sud, 165, chemin du Grand Revoyet, 69495 Pierre Bénite, France; Université Claude Bernard Lyon 1, 69000 Lyon, France
| | - B Borghese
- Service de Chirurgie Gynécologie Obstétrique 2 et Médecine de la Reproduction, CHU Cochin, APHP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Equipe Génomique, Epigénétique et Physiopathologie de la Reproduction, Département Développement, Reproduction, Cancer, Inserm U1016, Université Paris Descartes, Sorbonne Paris Cité, 12, rue de l'École de Médecine, 75270 Paris cedex 06, France
| | | | - J Boujenah
- Service de Gynécologie-Obstétrique, CHU Bondy, avenue du 14 Juillet, 93140 Bondy, France; Centre médical du Château, 22, rue Louis-Besquel, 94300 Vincennes, France
| | - T Brillac
- 98 route de Blagnac, 31200 Toulouse, France
| | - N Chabbert-Buffet
- Service de Gynécologie-Obstétrique et Médecine de la reproduction, CHU Tenon, APHP, 4, rue de la Chine, 75020 Paris, France; GRC-6 Centre Expert en Endométriose (C3E), Sorbonne Université, 75005 Paris, France; UMR-S938 INSERM Sorbonne Université, 75005 Paris, France
| | - C Chauffour
- Service de Gynécologie-Obstétrique et Reproduction Humaine, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - N Clary
- 3 rue Pablo Picasso, 92160 Antony, France
| | - J Cohen
- Service de Gynécologie-Obstétrique et Médecine de la reproduction, CHU Tenon, APHP, 4, rue de la Chine, 75020 Paris, France
| | - C Decanter
- Service d'Assistance médicale à la procréation et de préservation de la fertilité, Hôpital Jeanne de Flandre, CHRU Lille, 1, rue Eugène-Avinée, 59037 Lille cedex, France; EA 4308 Gamétogenèse et qualité du gamète, CHRU Lille, 59037 Lille cedex, France
| | - A Denouël
- EndoFrance, BP 50053, 01124 Montluel cedex, France
| | - G Dubernard
- Clinique gynécologique et obstétricale, CHU de Lyon HCL - GH Nord-Hôpital de la Croix Rousse, CHU de Lyon - HCL, 103, Grande Rue de la Croix-Rousse, 69317 Lyon cedex, France
| | - A Fauconnier
- Service de Gynécologie-Obstétrique, CHI Poissy-St-Germain, 10, rue du ChampGaillard, 78303 Poissy, France; EA 7285 Risques cliniques et sécurité en santé des femmes, Université Versailles - Saint-Quentin-en-Yvelines, 78180 Saint-Quentin-en-Yvelines, France
| | - H Fernandez
- Service de Gynécologie-Obstétrique, CHU Bicêtre, APHP, 78, avenue du Général de Gaulle, 94275 Le Kremlin-Bicêtre, France; CESP-INSERM, U1018, Equipe Epidémiologie et évaluation des stratégies de prise en charge: VIH, reproduction, pédiatrie, Université Paris Sud, 94807 Villejuif, France
| | - T Gauthier
- Service de Gynécologie-Obstétrique, Hôpital Mère-Enfant, CHU Limoges, 8, avenue Dominique Larrey, 87042 Limoges, France; UMR-1248, Faculté de Médecine, 87042 Limoges, France
| | - F Golfier
- Service de Chirurgie Gynécologique et Oncologique - Obstétrique, CHU Lyon Sud, 69495 Pierre-Bénite cedex, France
| | - C Huchon
- Service de Gynécologie-Obstétrique, CHI Poissy-St-Germain, 10, rue du ChampGaillard, 78303 Poissy, France
| | - G Legendre
- Service de Gynécologie-Obstétrique, CHU Angers, 4, rue Larrey, 49033 Angers cedex 01, France; CESP-INSERM, U1018, Equipe 7, Genre, Santé Sexuelle et Reproductive, Université Paris Sud, 94276 Le Kremlin-Bicêtre cedex, France
| | - J Loriau
- Service de Chirurgie digestive, GH Paris Saint-Joseph, 185, rue Raymond-Losserand, 75001 Paris, France
| | - E Mathieu-d'Argent
- Service de Gynécologie-Obstétrique et Médecine de la reproduction, CHU Tenon, APHP, 4, rue de la Chine, 75020 Paris, France; Université Pierre-et-Marie-Curie Paris 6, 75005 Paris, France; GRC6-UPMC: centre expert en endométriose (C3E), hôpital Tenon, Paris, France
| | - B Merlot
- 10 Clinique Tivoli-Ducos, 33000 Bordeaux, France
| | - J Niro
- Service de Gynécologie-Obstétrique, Centre Hospitalier de Versailles, 177, route de Versailles, 78157 Le Chesnay cedex, France
| | - P Panel
- Service de Gynécologie-Obstétrique, Centre Hospitalier de Versailles, 177, route de Versailles, 78157 Le Chesnay cedex, France
| | - P Paparel
- Service d'Urologie, CHU Lyon Sud, 165, chemin du Grand Revoyet, 60495 Pierre Bénite, France
| | - C A Philip
- Clinique gynécologique et obstétricale, CHU de Lyon HCL - GH Nord-Hôpital de la Croix Rousse, CHU de Lyon - HCL, 103, Grande Rue de la Croix-Rousse, 69317 Lyon cedex, France
| | - S Ploteau
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital MèreEnfant, CHU Nantes, 8, boulevard Jean-Monnet, 44093 Nantes, France
| | - C Poncelet
- Service de Gynécologie-Obstétrique, CH Renée Dubos, 6, avenue de l'Ile-de-France, 95300 Pontoise, France; Université Paris 13, Sorbonne Paris Cité, UFR SMBH, 93022 Bobigny, France
| | - B Rabischong
- Service de Gynécologie-Obstétrique et Reproduction Humaine, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - H Roman
- Centre Expert de Diagnostic et Prise en Charge Multidisciplinaire de l'Endométriose, Clinique Gynécologique et Obstétricale, CHU Charles Nicolle, 1, rue de Germont, 76031 Rouen, France
| | - C Rubod
- CHRU Lille, Clinique de gynécologie, Hôpital Jeanne de Flandre, 59000 Lille, France; Université Lille-Nord-de-France, 59000 Lille, France
| | - P Santulli
- Service de Chirurgie Gynécologie Obstétrique 2 et Médecine de la Reproduction, CHU Cochin, APHP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Equipe Génomique, Epigénétique et Physiopathologie de la Reproduction, Département Développement, Reproduction, Cancer, Inserm U1016, Université Paris Descartes, Sorbonne Paris Cité, 12, rue de l'École de Médecine, 75270 Paris cedex 06, France
| | - M Sauvan
- Service de Gynécologie-Obstétrique, CHU Bicêtre, APHP, 78, avenue du Général de Gaulle, 94275 Le Kremlin-Bicêtre, France
| | - I Thomassin-Naggara
- Service d'Imagerie, Hôpital Tenon, APHP, 4, rue de la Chine, 75020 Paris, France; Sorbonne Universités, UPMC Univ Paris 06, Institut Universitaire de Cancérologie, Assistance Publique, 75006 Paris, France
| | - A Torre
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Arnaud de Villeneuve, CHU Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier, France
| | - J M Wattier
- Centre d'étude et traitement de la douleur, Hôpital Claude Huriez, CHRU Lille, rue Michel-Polonowski, 59000 Lille, France
| | - C Yazbeck
- Service de Gynécologie-Obstétrique, Hôpital Foch, APHP, 40, rue Worth, 92151 Suresnes, France; Centre d'Assistance Médicale à la Procréation, Clinique Pierre Cherest, 5, rue Pierre-Cherest, 92200 Neuilly-Sur-Seine, France
| | - N Bourdel
- Service de Gynécologie-Obstétrique et Reproduction Humaine, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - M Canis
- Service de Gynécologie-Obstétrique et Reproduction Humaine, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| |
Collapse
|
32
|
Vignolle J, Lefebvre C, Lucot JP, Rubod C. About a case of traumatic separation of the cervix from the uterine corpus, diagnosed in a context of infertility. J Gynecol Obstet Hum Reprod 2018; 47:257-260. [PMID: 29574053 DOI: 10.1016/j.jogoh.2018.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 03/09/2018] [Accepted: 03/20/2018] [Indexed: 10/17/2022]
Abstract
This article reports a case of cervico-isthmic disjunction unnoticed during childhood, diagnosed in a context of primary infertility and endometriosis, and surgically treated. It is an uncommon condition. The diagnosis is most often made as part of an assessment of primary amenorrhea in a young woman with a history of severe pelvic trauma. It is suspected after imaging assessment and confirmed intraoperatively. The treatment consists in an anastomosis between the cervix and the uterine body, after individualizing these two structures, around a drain guiding healing. After this surgery, multiple pregnancies have been successfully carried out.
Collapse
Affiliation(s)
- J Vignolle
- Service de gynécologie chirurgicale, pôle Femme-Mère-Nouveau-né, hôpital Jeanne-de-Flandre, CHRU Lille, avenue Eugène-Avinée, 59037 Lille cedex, France.
| | - C Lefebvre
- Service de procréation médicalement assistée, pôle Femme-Mère-Nouveau-né, hôpital Jeanne-de-Flandre, CHRU Lille, avenue Eugène-Avinée, 59037 Lille cedex, France
| | - J P Lucot
- Service de gynécologie chirurgicale, pôle Femme-Mère-Nouveau-né, hôpital Jeanne-de-Flandre, CHRU Lille, avenue Eugène-Avinée, 59037 Lille cedex, France
| | - C Rubod
- Service de gynécologie chirurgicale, pôle Femme-Mère-Nouveau-né, hôpital Jeanne-de-Flandre, CHRU Lille, avenue Eugène-Avinée, 59037 Lille cedex, France; Faculté de médecine Henri Warembourg. Université de Lille, France
| |
Collapse
|
33
|
Collinet P, Fritel X, Revel-Delhom C, Ballester M, Bolze PA, Borghese B, Bornsztein N, Boujenah J, Bourdel N, Brillac T, Chabbert-Buffet N, Chauffour C, Clary N, Cohen J, Decanter C, Denouël A, Dubernard G, Fauconnier A, Fernandez H, Gauthier T, Golfier F, Huchon C, Legendre G, Loriau J, Mathieu-d'Argent E, Merlot B, Niro J, Panel P, Paparel P, Philip CA, Ploteau S, Poncelet C, Rabischong B, Roman H, Rubod C, Santulli P, Sauvan M, Thomassin-Naggara I, Torre A, Wattier JM, Yazbeck C, Canis M. [Management of endometriosis: CNGOF-HAS practice guidelines (short version)]. ACTA ACUST UNITED AC 2018; 46:144-155. [PMID: 29550339 DOI: 10.1016/j.gofs.2018.02.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Indexed: 10/17/2022]
Abstract
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.
Collapse
Affiliation(s)
- P Collinet
- Clinique de gynécologie, hôpital Jeanne-de-Flandre, CHRU de Lille, 59000 Lille, France; Université Lille-Nord-de-France, 59000 Lille, France.
| | - X Fritel
- Service de gynécologie-obstétrique et médecine de la reproduction, Inserm CIC 1402, 2, rue de la Milétrie, 86000 Poitiers, France; Université de Poitiers, 86000 Poitiers, France; Inserm CIC 1402, 86000 Poitiers, France
| | - C Revel-Delhom
- Haute Autorité de santé, 5, avenue du Stade-de-France, 93218 La Plaine-Saint-Denis cedex, France
| | - M Ballester
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - P A Bolze
- Service de chirurgie gynécologique oncologique, obstétrique, CHU Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; Université Claude-Bernard-Lyon 1, 69000 Lyon, France
| | - B Borghese
- Service de chirurgie gynécologie-obstétrique 2 et médecine de la reproduction, CHU Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Équipe génomique, épigénétique et physiopathologie de la reproduction, département développement, reproduction, cancer, Inserm U1016, université Paris Descartes, Sorbonne Paris Cité, 12, rue de l'École-de-Médecine, 75270 Paris cedex 06, France
| | | | - J Boujenah
- Service de gynécologie-obstétrique, CHU Bondy, avenue du 14-Juillet, 93140 Bondy, France; Centre médical du Château, 22, rue Louis-Besquel, 94300 Vincennes, France
| | - N Bourdel
- Service de gynécologie-obstétrique et reproduction humaine, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France; Faculté de médecine, Encov-ISIT, UMR6284 CNRS, université d'Auvergne, 28, place Henri-Dunant, 63000 Clermont-Ferrand, France
| | - T Brillac
- 98, route de Blagnac, 31200 Toulouse, France
| | - N Chabbert-Buffet
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; GRC-6 centre expert en endométriose (C3E), Sorbonne université, Paris, France; UMR-S938 Inserm Sorbonne université, Paris, France
| | - C Chauffour
- Service de gynécologie-obstétrique et reproduction humaine, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - N Clary
- 3, rue Pablo-Picasso, 92160 Antony, France
| | - J Cohen
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - C Decanter
- Service d'assistance médicale à la procréation et de préservation de la fertilité, hôpital Jeanne-de-Flandre, CHRU de Lille, 1, rue Eugène-Avinée, 59037 Lille cedex, France; EA 4308 gamétogenèse et qualité du gamète, CHRU de Lille, 59037 Lille cedex, France
| | - A Denouël
- EndoFrance, BP 50053, 01124 Montluel cedex, France
| | - G Dubernard
- Université Claude-Bernard-Lyon 1, 69000 Lyon, France; Clinique gynécologique et obstétricale, hôpital de la Croix-Rousse, groupe hospitalier Nord, CHU de Lyon-HCL, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex, France
| | - A Fauconnier
- Service de gynécologie-obstétrique, CHI Poissy-St-Germain, 10, rue du Champ-Gaillard, 78303 Poissy, France; EA 7285 risques cliniques et sécurité en santé des femmes, université Versailles-Saint-Quentin-en-Yvelines, Saint-Quentin-en-Yvelines, France
| | - H Fernandez
- Service de gynécologie-obstétrique, CHU Bicêtre, AP-HP, 78, avenue du Général-de-Gaulle, 94275 Le Kremlin-Bicêtre, France; CESP-INSERM, U1018, équipe épidémiologie et évaluation des stratégies de prise en charge, VIH, reproduction, pédiatrie, université Paris-Sud, Paris, France
| | - T Gauthier
- Service de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Limoges, 8, avenue Dominique-Larrey, 87042 Limoges, France; UMR-1248, faculté de médecine, 87042 Limoges, France
| | - F Golfier
- Service de chirurgie gynécologique oncologique, obstétrique, CHU Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - C Huchon
- Service de gynécologie-obstétrique, CHI Poissy-St-Germain, 10, rue du Champ-Gaillard, 78303 Poissy, France
| | - G Legendre
- Service de gynécologie-obstétrique, CHU d'Angers, 4, rue Larrey, 49033 Angers cedex 01, France; CESP-Inserm, U1018, équipe 7, genre, santé sexuelle et reproductive, université Paris-Sud, 94276 Le Kremlin-Bicêtre cedex, France
| | - J Loriau
- Service de chirurgie digestive, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75001 Paris, France
| | - E Mathieu-d'Argent
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Université Pierre-et-Marie-Curie Paris 6, Paris, France; GRC6-UPMC, centre expert en endométriose (C3E), hôpital Tenon, Paris, France
| | - B Merlot
- Service de chirurgie gynécologique, clinique Tivoli, 220, rue Mandron, 33000 Bordeaux, France
| | - J Niro
- Service de gynécologie-obstétrique, centre hospitalier de Versailles, 177, route de Versailles, 78157 Le Chesnay cedex, France
| | - P Panel
- Service de gynécologie-obstétrique, centre hospitalier de Versailles, 177, route de Versailles, 78157 Le Chesnay cedex, France
| | - P Paparel
- Service d'urologie, CHU Lyon-Sud, 165, chemin du Grand-Revoyet, 60495 Pierre-Bénite, France
| | - C A Philip
- Université Claude-Bernard-Lyon 1, 69000 Lyon, France; Clinique gynécologique et obstétricale, hôpital de la Croix-Rousse, groupe hospitalier Nord, CHU de Lyon-HCL, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex, France
| | - S Ploteau
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Mère-Enfant, CHU de Nantes, 8, boulevard Jean-Monnet, 44093 Nantes, France
| | - C Poncelet
- Service de gynécologie-obstétrique, centre hospitalier Renée-Dubos, 6, avenue de l'Île-de-France, 95300 Pontoise, France; Université Paris 13, Sorbonne Paris Cité, UFR SMBH, 93022 Bobigny, France
| | - B Rabischong
- Service de gynécologie-obstétrique et reproduction humaine, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - H Roman
- Centre expert de diagnostic et prise en charge multidisciplinaire de l'endométriose, clinique gynécologique et obstétricale, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen, France
| | - C Rubod
- Clinique de gynécologie, hôpital Jeanne-de-Flandre, CHRU de Lille, 59000 Lille, France; Université Lille-Nord-de-France, 59000 Lille, France
| | - P Santulli
- Service de chirurgie gynécologie-obstétrique 2 et médecine de la reproduction, CHU Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Équipe génomique, épigénétique et physiopathologie de la reproduction, département développement, reproduction, cancer, Inserm U1016, université Paris Descartes, Sorbonne Paris Cité, 12, rue de l'École-de-Médecine, 75270 Paris cedex 06, France
| | - M Sauvan
- Service de gynécologie-obstétrique, CHU Bicêtre, AP-HP, 78, avenue du Général-de-Gaulle, 94275 Le Kremlin-Bicêtre, France
| | - I Thomassin-Naggara
- Service d'imagerie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Sorbonne universités, UPMC université Paris 06, Paris, France; Institut universitaire de cancérologie, Assistance publique, Paris, France
| | - A Torre
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Arnaud-de-Villeneuve, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier, France
| | - J M Wattier
- Centre d'étude et traitement de la douleur, hôpital Claude-Huriez, CHRU de Lille, rue Michel-Polonowski, 59000 Lille, France
| | - C Yazbeck
- Service de gynécologie-obstétrique, hôpital Foch, AP-HP, 40, rue Worth, 92151 Suresnes, France; Centre d'assistance médicale à la procréation, clinique Pierre-Cherest, 5, rue Pierre-Cherest, 92200 Neuilly-Sur-Seine, France
| | - M Canis
- Service de gynécologie-obstétrique et reproduction humaine, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France; Faculté de médecine, Encov-ISIT, UMR6284 CNRS, université d'Auvergne, 28, place Henri-Dunant, 63000 Clermont-Ferrand, France
| |
Collapse
|
34
|
Roman H, Ballester M, Loriau J, Canis M, Bolze PA, Niro J, Ploteau S, Rubod C, Yazbeck C, Collinet P, Rabischong B, Merlot B, Fritel X. [Strategies and surgical management of endometriosis: CNGOF-HAS Endometriosis Guidelines]. ACTA ACUST UNITED AC 2018. [PMID: 29526793 DOI: 10.1016/j.gofs.2018.02.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
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.
Collapse
Affiliation(s)
- H Roman
- Centre expert de diagnostic et prise en charge multidisciplinaire de l'endométriose, clinique gynécologique et obstétricale, CHU Charles Nicolle, 1, rue de Germont, 76031 Rouen, France.
| | - M Ballester
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - J Loriau
- Service de chirurgie digestive, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond Losserand, 75001 Paris, France
| | - M Canis
- Service de gynécologie-obstétrique et reproduction humaine, CHU Estaing, 1, place Lucie Aubrac, 63003 Clermont-Ferrand, France; Faculté de médecine, Encov-ISIT, UMR6284 CNRS, université d'Auvergne, 28, place Henri Dunant, 63000 Clermont-Ferrand, France
| | - P A Bolze
- Service de chirurgie gynécologique oncologique, obstétrique, CHU Lyon Sud, 165, chemin du Grand Revoyet, 69495 Pierre Bénite, France; Université Claude Bernard Lyon 1, 69000 Lyon, France
| | - J Niro
- Service de chirurgie gynécologique, clinique Tivoli, 220, rue Mandron, 33000 Bordeaux, France
| | - S Ploteau
- Service de gynecologie-obstétrique et médecine de la reproduction, hôpital Mère-Enfant, CHU Nantes, 8, boulevard Jean-Monnet, 44093 Nantes, France
| | - C Rubod
- Clinique de gynécologie, hôpital Jeanne-de-Flandre, CHRU Lille, 59000 Lille, France; Université Lille-Nord-de-France, 59000 Lille, France
| | - C Yazbeck
- Service de gynécologie-obstétrique, hôpital Foch, AP-HP, 40, rue Worth, 92151 Suresnes, France; Centre d'assistance médicale à la procréation, clinique Pierre Cherest, 5, rue Pierre Cherest, 92200 Neuilly-Sur-Seine, France
| | - P Collinet
- Clinique de gynécologie, hôpital Jeanne-de-Flandre, CHRU Lille, 59000 Lille, France; Université Lille-Nord-de-France, 59000 Lille, France
| | - B Rabischong
- Service de gynécologie-obstétrique et reproduction humaine, CHU Estaing, 1, place Lucie Aubrac, 63003 Clermont-Ferrand, France; Faculté de médecine, Encov-ISIT, UMR6284 CNRS, université d'Auvergne, 28, place Henri Dunant, 63000 Clermont-Ferrand, France
| | - B Merlot
- Service de chirurgie gynécologique, clinique Tivoli, 220, rue Mandron, 33000 Bordeaux, France
| | - X Fritel
- Service de gynécologie-obstétrique et médecine de la reproduction, inserm CIC 1402, 2, rue de la Milétrie, 86000 Poitiers, France; Université de Poitiers, 86000 Poitiers, France; Inserm CIC 1402, 86000 Poitiers, France
| |
Collapse
|
35
|
Ghesquière L, Garabedian C, Boukerrou M, Dennis T, Garbin O, Hery R, Rubod C, Cosson M. Implementation of laparoscopy surgery training via simulation in a low-income country. J Gynecol Obstet Hum Reprod 2018; 47:187-190. [PMID: 29510268 DOI: 10.1016/j.jogoh.2018.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 02/23/2018] [Accepted: 03/02/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate laparoscopy training using pelvitrainers for gynaecological surgeons in a low-income country. METHODS The study was carried out in Madagascar from April 2016 to January 2017. The participants were gynaecological surgeons who had not previously performed laparoscopy. Each surgeon was timed to evaluate the execution times of four proposed exercises, based on the fundamentals of laparoscopic surgery (FLS) programme's skills manual, as follows: exercise 1, involving a simple object transfer; exercises 2 and 3, comprising complex object transfers; and exercise 4, a precision cutting exercise. The 8-month training and evaluation programme was divided into different stages, and the four following evaluations were compared: a pretest (T0), assessment at the end of the first training (T1) and auto-evaluation at 2 months (T2) and 8 months (T3). RESULTS Eight participants were included. The median time was significantly reduced (P<0.05) at each evaluation for exercises 1, 2 and 4 compared to the pretest. For exercise 3, there was no difference between T0 and T1 (P=0.07). After 8 months of training, all participants progressed in all exercises. CONCLUSION Our study showed that it is possible and beneficial to develop a programme for teaching laparoscopic surgery in low-income countries before providing the necessary equipment.
Collapse
Affiliation(s)
- L Ghesquière
- CHU Lille, Department of Gynaecology, 59000, Lille, France; University of Lille North of France, EA4489 - Perinatal Environment and Infant Growth, 59000 Lille, France.
| | - C Garabedian
- CHU Lille, Department of Gynaecology, 59000, Lille, France; University of Lille North of France, EA4489 - Perinatal Environment and Infant Growth, 59000 Lille, France
| | - M Boukerrou
- University Hospital of Reunion Island, Gynaecology and Obstetrics Unit, BP 350, 97448 Saint Pierre Cedex, Réunion, France; Perinatal Studies Center of the Indian Ocean, University Hospital of Reunion Island, BP 350, 97448 Saint Pierre Cedex, Réunion, France; Faculty of Medicine, University of Reunion, 97490 Saint Denis, Réunion, France
| | - T Dennis
- University Hospital of Reunion Island, Gynaecology and Obstetrics Unit, BP 350, 97448 Saint Pierre Cedex, Réunion, France
| | - O Garbin
- CHU Strasbourg, CMCO, Gynecology Unit, 67000 Strasbourg, France
| | - R Hery
- CHU Befelatanana, Maternity of Befelatanana, Antananarivo University, Madagascar
| | - C Rubod
- CHU Lille, Department of Gynaecology, 59000, Lille, France; University of Lille North of France, 59000 Lille, France
| | - M Cosson
- CHU Lille, Department of Gynaecology, 59000, Lille, France; University of Lille North of France, 59000 Lille, France
| |
Collapse
|
36
|
Ferrier C, Roman H, Alzahrani Y, d'Argent EM, Bendifallah S, Marty N, Perez M, Rubod C, Collinet P, Daraï E, Ballester M. Fertility outcomes in women experiencing severe complications after surgery for colorectal endometriosis. Hum Reprod 2018; 33:411-415. [DOI: 10.1093/humrep/dex375] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 12/10/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- C Ferrier
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, 75006 Paris, France
| | - H Roman
- Expert Center in the Diagnosis and Multidisciplinary Management of Endometriosis, Department of Gynecology and Obstetrics, Rouen University Hospital, 76031 Rouen, France
| | - Y Alzahrani
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, 75006 Paris, France
| | - E Mathieu d'Argent
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, 75006 Paris, France
| | - S Bendifallah
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, 75006 Paris, France
- Groupe de Recherche Clinique GRC6-UPMC, Centre Expert En Endométriose (C3E), University Pierre and Marie Curie, 75006 Paris, France
| | - N Marty
- Expert Center in the Diagnosis and Multidisciplinary Management of Endometriosis, Department of Gynecology and Obstetrics, Rouen University Hospital, 76031 Rouen, France
| | - M Perez
- Department of Gynaecology and Obstetrics, Jeanne de Flandre University Hospital, Université Lille Nord-de-France, CHRU de Lille, 59000 Lille, France
| | - C Rubod
- Department of Gynaecology and Obstetrics, Jeanne de Flandre University Hospital, Université Lille Nord-de-France, CHRU de Lille, 59000 Lille, France
| | - P Collinet
- Department of Gynaecology and Obstetrics, Jeanne de Flandre University Hospital, Université Lille Nord-de-France, CHRU de Lille, 59000 Lille, France
| | - E Daraï
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, 75006 Paris, France
- Groupe de Recherche Clinique GRC6-UPMC, Centre Expert En Endométriose (C3E), University Pierre and Marie Curie, 75006 Paris, France
- UMR_S938, Université Pierre et Marie Curie, 75006 Paris, France
| | - M Ballester
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, 75006 Paris, France
- Groupe de Recherche Clinique GRC6-UPMC, Centre Expert En Endométriose (C3E), University Pierre and Marie Curie, 75006 Paris, France
- UMR_S938, Université Pierre et Marie Curie, 75006 Paris, France
| |
Collapse
|
37
|
Mizrahi S, Cosson M, Rubod C, Giraudet G. Female pelvic anatomy: Are we there yet? Assessment of the knowledge of residents. J Gynecol Obstet Hum Reprod 2017; 46:675-680. [DOI: 10.1016/j.jogoh.2017.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 08/17/2017] [Accepted: 08/21/2017] [Indexed: 10/18/2022]
|
38
|
Ledu N, Rubod C, Piessen G, Roman H, Collinet P. Management of deep infiltrating endometriosis of the rectum: Is a systematic temporary stoma relevant? J Gynecol Obstet Hum Reprod 2017; 47:1-7. [PMID: 29097291 DOI: 10.1016/j.jogoh.2017.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 10/18/2017] [Accepted: 10/24/2017] [Indexed: 12/15/2022]
Abstract
STUDY OBJECTIVE To assess the value of performing a protective stoma in patients operated for rectal endometriosis. MATERIAL AND METHODS From June 2009 to December 2011, 47 patients were operated for rectal endometriosis by segmental or discoid resection in 4 different centers. Two groups were formed: one with protective stoma (group S), n=33 and one without protective stoma (group NS), n=14. Data were collected from the CIRENDO database. MEASUREMENTS AND MAIN RESULTS Postoperative complication rate of group NS was 57% against 48% in group S (P=0.75). There was an increasing trend of the rate of anastomotic leakage in group S as compared to group NS: 21% against 3% (P=0.073). All 3 patients of group NS with an anastomotic leakage were reoperated and the group S patient had medical treatment. In a center, digestive operative time was not necessarily performed in association with a gastrointestinal surgeon. All patients in group S had a restoration of continuity in about 3 months. Two of them had dilation of anastomotic stricture and 3 others showed a transient postoperative ileus during this recovery. Quality of life was assessed by the MOS SF-36 and significantly improved in both groups thanks to the intervention. CONCLUSION Temporary digestive stoma in patients operated for rectal endometriosis has to be considered because in our study, it seems reducing complications such as anastomotic leakage. This must be confirmed with studies with larger numbers.
Collapse
Affiliation(s)
- N Ledu
- Clinique de gynécologie, hôpital Jeanne-de-Flandre, université Lille-Nord-de-France, 1, rue Eugène-Avinée, 59037 Lille cedex, France.
| | - C Rubod
- Clinique de gynécologie, hôpital Jeanne-de-Flandre, université Lille-Nord-de-France, 1, rue Eugène-Avinée, 59037 Lille cedex, France
| | - G Piessen
- Service de chirurgie digestive et générale du Pr Mariette, hôpital Huriez, CHRU Lille, place de Verdun, 59037 Lille, France
| | - H Roman
- Clinique gynécologique et obstétricale, centre hospitalier universitaire Charles-Nicolle, 76031 Rouen, France
| | - P Collinet
- Clinique de gynécologie, hôpital Jeanne-de-Flandre, université Lille-Nord-de-France, 1, rue Eugène-Avinée, 59037 Lille cedex, France
| |
Collapse
|
39
|
Giraudet G, Lucot JP, Sanz F, Rubod C, Collinet P, Cosson M. Outpatient vaginal hysterectomy: Comparison of conventional suture ligature versus electrosurgical bipolar vessel sealing. J Gynecol Obstet Hum Reprod 2017; 46:399-404. [PMID: 28934083 DOI: 10.1016/j.jogoh.2017.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 03/17/2017] [Accepted: 03/23/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of our study was to evaluate the feasibility of vaginal hysterectomy in an ambulatory care system and the best way to perform it between conventional and bipolar vessel sealing system ligatures. PATIENTS AND METHODS This was a prospective study of 32 patients with vaginal hysterectomy at Lille University Hospital between December 2013 and May 2015. Two surgical techniques were compared: conventional suture ligature (CSL) and electrosurgical bipolar vessel sealing (BVS). Patients stayed in classical hospitalization but were managed how if they were in an ambulatory unit to evaluate their capacity to come back home the same evening of the surgery. The evaluation of same-day discharge was based on Post Anesthetic Discharge Scoring System (PADSS) score?9/10 and Visual Analogic Scale (VAS) score?4/10. Other data collected were: operative time, uterus weight, peroperative bleeding, PADSS score at the 8th postoperative hour, VAS score at the 4th, 6th, 8th, 12th and 24th postoperative hours, the presence of postoperative nausea/vomiting and rehospitalization. RESULTS In the BVS group, 93.8% of patients validated the combined score (PADSS+VAS) on the evening of the intervention against 50% of patients in the CSL group (P<0.05). Hundred percent of BVS group patients were discharged on the day after surgery against 87.5% in the CSL group. The VAS was significantly lower in the BVS group at the 8th (1.4), 12th (1.2) and 24th (1.3) postoperative hours. Operative time was significantly shorter in the BVS group. We found more events such as nausea/vomiting in the CSL group. CONCLUSION Vaginal hysterectomy is feasible in an ambulatory care system most of times. By reducing postoperative pain, electrosurgical bipolar vessel sealing would promote outpatient hospitalization.
Collapse
Affiliation(s)
- G Giraudet
- Department of Gynecological Surgery, Jeanne-de-Flandre Hospital, Regional University Hospital of Lille, avenue Eugène-Avinée, 59000 Lille, France.
| | - J P Lucot
- Department of Gynecological Surgery, Jeanne-de-Flandre Hospital, Regional University Hospital of Lille, avenue Eugène-Avinée, 59000 Lille, France; Department of Gynecology and Obstetrics, Hospital of Bethune, 27, rue Delbecque, 62131 Verquigneul, France
| | - F Sanz
- Department of Anesthesiology in Obstetrics, Gynecology and Reproductive Medicine, Jeanne-de-Flandre Hospital, avenue Eugène-Avinée, 59000 Lille, France; Department of anesthesia, groupement des hôpitaux de l'institut catholique de Lille, hôpital Saint-Philibert, rue du Grand-But, 59160 Lomme, France
| | - C Rubod
- Department of Gynecological Surgery, Jeanne-de-Flandre Hospital, Regional University Hospital of Lille, avenue Eugène-Avinée, 59000 Lille, France
| | - P Collinet
- Department of Gynecological Surgery, Jeanne-de-Flandre Hospital, Regional University Hospital of Lille, avenue Eugène-Avinée, 59000 Lille, France
| | - M Cosson
- Department of Gynecological Surgery, Jeanne-de-Flandre Hospital, Regional University Hospital of Lille, avenue Eugène-Avinée, 59000 Lille, France
| |
Collapse
|
40
|
Bassil A, Rubod C, Borghesi Y, Kerbage Y, Schreiber ES, Azaïs H, Garabedian C. Operative and diagnostic hysteroscopy: A novel learning model combining new animal models and virtual reality simulation. Eur J Obstet Gynecol Reprod Biol 2017; 211:42-47. [PMID: 28178577 DOI: 10.1016/j.ejogrb.2017.01.058] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 01/17/2017] [Accepted: 01/30/2017] [Indexed: 11/16/2022]
Abstract
CONTEXT Hysteroscopy is one of the most common gynaecological procedure. Training for diagnostic and operative hysteroscopy can be achieved through numerous previously described models like animal models or virtual reality simulation. We present our novel combined model associating virtual reality and bovine uteruses and bladders. STUDY DESIGN End year residents in obstetrics and gynaecology attended a full day workshop. The workshop was divided in theoretical courses from senior surgeons and hands-on training in operative hysteroscopy and virtual reality Essure® procedures using the EssureSim™ and Pelvicsim™ simulators with multiple scenarios. Theoretical and operative knowledge was evaluated before and after the workshop and General Points Averages (GPAs) were calculated and compared using a Student's T test. RESULTS GPAs were significantly higher after the workshop was completed. The biggest difference was observed in operative knowledge (0,28 GPA before workshop versus 0,55 after workshop, p<0,05). All of the 25 residents having completed the workshop applauded the realism an efficiency of this type of training. The force feedback allowed by the cattle uteruses gives the residents the possibility to manage thickness of resection as in real time surgery. Furthermore, the two-horned bovine uteruses allowed to reproduce septa resection in conditions close to human surgery CONCLUSION: Teaching operative and diagnostic hysteroscopy is essential. Managing this training through a full day workshop using a combined animal model and virtual reality simulation is an efficient model not described before.
Collapse
Affiliation(s)
- Alfred Bassil
- CHRU Lille, Department of Gynaecology and Obstetrics, F-59000 Lille, France.
| | - Chrystèle Rubod
- CHRU Lille, Department of Gynaecology and Obstetrics, F-59000 Lille, France; University of Lille North of France, F-59000 Lille, France
| | - Yves Borghesi
- CH Valenciennes, Department of Gynaecology and Obstetrics, F-59300 Lille, France
| | - Yohan Kerbage
- CHRU Lille, Department of Gynaecology and Obstetrics, F-59000 Lille, France
| | | | - Henri Azaïs
- CHRU Lille, Department of Gynaecology and Obstetrics, F-59000 Lille, France; University of Lille North of France, F-59000 Lille, France
| | - Charles Garabedian
- CHRU Lille, Department of Gynaecology and Obstetrics, F-59000 Lille, France; University of Lille North of France, F-59000 Lille, France
| |
Collapse
|
41
|
Jean Dit Gautier E, Bot-Robin V, Libessart A, Doucède G, Cosson M, Rubod C. Design of a Serious Game for Handling Obstetrical Emergencies. JMIR Serious Games 2016; 4:e21. [PMID: 28003175 PMCID: PMC5214697 DOI: 10.2196/games.5526] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 05/25/2016] [Accepted: 08/08/2016] [Indexed: 01/06/2023] Open
Abstract
Background The emergence of new technologies in the obstetrical field should lead to the development of learning applications, specifically for obstetrical emergencies. Many childbirth simulations have been recently developed. However, to date none of them have been integrated into a serious game. Objective Our objective was to design a new type of immersive serious game, using virtual glasses to facilitate the learning of pregnancy and childbirth pathologies. We have elaborated a new game engine, placing the student in some maternity emergency situations and delivery room simulations. Methods A gynecologist initially wrote a scenario based on a real clinical situation. He also designed, along with an educational engineer, a tree diagram, which served as a guide for dialogues and actions. A game engine, especially developed for this case, enabled us to connect actions to the graphic universe (fully 3D modeled and based on photographic references). We used the Oculus Rift in order to immerse the player in virtual reality. Each action in the game was linked to a certain number of score points, which could either be positive or negative. Results Different pathological pregnancy situations have been targeted and are as follows: care of spontaneous miscarriage, threat of preterm birth, forceps operative delivery for fetal abnormal heart rate, and reduction of a shoulder dystocia. The first phase immerses the learner into an action scene, as a doctor. The second phase ask the student to make a diagnosis. Once the diagnosis is made, different treatments are suggested. Conclusions Our serious game offers a new perspective for obstetrical emergency management trainings and provides students with active learning by immersing them into an environment, which recreates all or part of the real obstetrical world of emergency. It is consistent with the latest recommendations, which clarify the importance of simulation in teaching and in ongoing professional development.
Collapse
Affiliation(s)
- Estelle Jean Dit Gautier
- Department of Gynecology Surgery, Hopital Jeanne de Flandre, University of Lille, Lille cedex, France
| | | | | | - Guillaume Doucède
- Department of Gynecology Surgery, Hopital Jeanne de Flandre, University of Lille, Lille cedex, France
| | - Michel Cosson
- Department of Gynecology Surgery, Hopital Jeanne de Flandre, University of Lille, Lille cedex, France
| | - Chrystèle Rubod
- Department of Gynecology Surgery, Hopital Jeanne de Flandre, University of Lille, Lille cedex, France
| |
Collapse
|
42
|
Garabedian C, Rubod C, Faye N, Ledu NK, Merlot B, Collinet P. Improved surgical management through optimized imaging of pelvic endometriosis. Minerva Ginecol 2016; 68:713-721. [PMID: 25907975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Deep infiltrating endometriosis is a frequent benign pathology that is found in 10-15% of fertile women and in 20% of infertile women. It has an impact on fertility but also on everyday life. In case of failure of medical treatment, surgical treatment can be offered to the patient. To provide adequate treatment and give the clearest information to patients, it seems essential to achieve optimal preoperative imaging. The aim of this work was to define for each compartment the surgeon's expectations and the indications of iconographic work-ups before surgical management of pelvic endometriosis. We do not discuss technical examinations nor surgical indications and techniques.
Collapse
Affiliation(s)
- Charles Garabedian
- Department of Gynecologic Surgery, Jeanne de Flandre Hospital, Lille Regional Center University Hospital, Lille cedex, France -
| | | | | | | | | | | |
Collapse
|
43
|
Lamblin G, Mayeur O, Giraudet G, Jean Dit Gautier E, Chene G, Brieu M, Rubod C, Cosson M. Pathophysiological aspects of cystocele with a 3D finite elements model. Arch Gynecol Obstet 2016; 294:983-989. [PMID: 27402504 DOI: 10.1007/s00404-016-4150-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 07/06/2016] [Indexed: 01/01/2023]
Abstract
PURPOSES The objective of this study is to design a 3D biomechanical model of the female pelvic system to assess pelvic organ suspension theories and understand cystocele mechanisms. METHODS A finite elements (FE) model was constructed to calculate the impact of suspension structure geometry on cystocele. The sample was a geometric model of a control patient's pelvic organs. The method used geometric reconstruction, implemented by the biomechanical properties of each anatomic structure. Various geometric configurations were simulated on the FE method to analyse the role of each structure and compare the two main anatomic theories. RESULTS The main outcome measure was a 3D biomechanical model of the female pelvic system. The various configurations of bladder displacement simulated mechanisms underlying medial, lateral and apical cystocele. FE simulation revealed that pubocervical fascia is the most influential structure in the onset of median cystocele (essentially after 40 % impairment). Lateral cystocele showed a stronger influence of arcus tendineus fasciae pelvis (ATFP) on vaginal wall displacement under short ATFP lengthening. In apical cystocele, the uterosacral ligament showed greater influence than the cardinal ligament. Suspension system elongation increased displacement by 25 % in each type of cystocele. CONCLUSIONS A 3D digital model enabled simulations of anatomic structures underlying cystocele to better understand cystocele pathophysiology. The model could be used to predict cystocele surgery results and personalising technique by preoperative simulation.
Collapse
Affiliation(s)
- Géry Lamblin
- Department of Urogynecology, HFME, HCL, Femme Mère Enfant University Hospital, 59 Boulevard Pinel, Lyon-Bron, 69677, Bron, France.
- University of Claude Bernard Lyon 1, Villeurbanne, France.
- University of Medicine Henri Warembourg, Lille University, Villeneuve-d'Ascq, France.
| | - Olivier Mayeur
- FRE 3723-LML-Laboratoire de Mécanique de Lille, Univ. Lille, 59000, Lille, France
- Centrale Lille, Cité Scientifique CS 20048, 59000, Lille, France
| | - Géraldine Giraudet
- University of Medicine Henri Warembourg, Lille University, Villeneuve-d'Ascq, France
- Department of Urogynecology, Jeanne de Flandre Hospital, Lille, France
- Lille 2 University, Lille, France
| | - Estelle Jean Dit Gautier
- University of Medicine Henri Warembourg, Lille University, Villeneuve-d'Ascq, France
- Department of Urogynecology, Jeanne de Flandre Hospital, Lille, France
- Lille 2 University, Lille, France
| | - Gautier Chene
- Department of Urogynecology, HFME, HCL, Femme Mère Enfant University Hospital, 59 Boulevard Pinel, Lyon-Bron, 69677, Bron, France
- University of Claude Bernard Lyon 1, Villeurbanne, France
| | - Mathias Brieu
- FRE 3723-LML-Laboratoire de Mécanique de Lille, Univ. Lille, 59000, Lille, France
- Centrale Lille, Cité Scientifique CS 20048, 59000, Lille, France
| | - Chrystèle Rubod
- University of Medicine Henri Warembourg, Lille University, Villeneuve-d'Ascq, France
- FRE 3723-LML-Laboratoire de Mécanique de Lille, Univ. Lille, 59000, Lille, France
- Department of Urogynecology, Jeanne de Flandre Hospital, Lille, France
- Lille 2 University, Lille, France
| | - Michel Cosson
- University of Medicine Henri Warembourg, Lille University, Villeneuve-d'Ascq, France
- FRE 3723-LML-Laboratoire de Mécanique de Lille, Univ. Lille, 59000, Lille, France
- Department of Urogynecology, Jeanne de Flandre Hospital, Lille, France
- Lille 2 University, Lille, France
| |
Collapse
|
44
|
Leroy A, Azaïs H, Garabedian C, Bregegere S, Rubod C, Collier F. Psychologie et sexologie : une approche essentielle, du diagnostic à la prise en charge globale de l’endométriose. ACTA ACUST UNITED AC 2016; 44:363-7. [DOI: 10.1016/j.gyobfe.2016.03.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 03/29/2016] [Indexed: 12/24/2022]
|
45
|
Kerbage Y, Collinet P, Rubod C, Merlot B, Cosson M. [Litigation in gynecological surgery: A retrospective study in the French university hospital of Lille between 1997 and 2015]. ACTA ACUST UNITED AC 2016; 44:196-9. [PMID: 27053035 DOI: 10.1016/j.gyobfe.2016.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 01/28/2016] [Indexed: 10/22/2022]
Abstract
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.
Collapse
Affiliation(s)
- Y Kerbage
- Service de chirurgie gynécologique, hôpital Jeanne-de-Flandre, CHRU de Lille, rue Eugène-Avinée, 59000 Lille, France; Faculté de médecine, université de Lille, 59000 Lille, France.
| | - P Collinet
- Service de chirurgie gynécologique, hôpital Jeanne-de-Flandre, CHRU de Lille, rue Eugène-Avinée, 59000 Lille, France; Faculté de médecine, université de Lille, 59000 Lille, France
| | - C Rubod
- Service de chirurgie gynécologique, hôpital Jeanne-de-Flandre, CHRU de Lille, rue Eugène-Avinée, 59000 Lille, France; Faculté de médecine, université de Lille, 59000 Lille, France
| | - B Merlot
- Service de chirurgie gynécologique, hôpital Jeanne-de-Flandre, CHRU de Lille, rue Eugène-Avinée, 59000 Lille, France; Faculté de médecine, université de Lille, 59000 Lille, France
| | - M Cosson
- Service de chirurgie gynécologique, hôpital Jeanne-de-Flandre, CHRU de Lille, rue Eugène-Avinée, 59000 Lille, France; Faculté de médecine, université de Lille, 59000 Lille, France
| |
Collapse
|
46
|
Kerbage Y, Debarge V, Lucot JP, Clouqueur E, Rubod C. Simulation training to teach postpartum hemorrhage surgery to residents. Eur J Obstet Gynecol Reprod Biol 2016; 201:27-30. [PMID: 27042768 DOI: 10.1016/j.ejogrb.2016.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 03/07/2016] [Accepted: 03/09/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Description of the aims, the framework and the results of a postpartum hemorrhage surgery workshop for residents. STUDY DESIGN This article is the first publication to describe a simulation workshop for the surgical management of maternal hemorrhage. Training was divided into both theoretical and practical workshops. Four obstetrician-gynecologists supervised residents who performed all the surgical procedures on a cadaver. This training course included the oldest residents at the Faculty of Medicine of Lille and was evaluated by participants using pre-test and post-test questionnaires. Medical knowledge was also evaluated. RESULTS The pre-test questionnaire showed that medical knowledge for the treatment of postpartum hemorrhage was acceptable but that real practice was lacking. Eighty-six percent of the residents responded that they were not able deal with the situation correctly and most considered it stressful. The post-test questionnaire showed that training greatly improved the participants' theoretical knowledge and technical skills as well as significantly improving self-confidence. CONCLUSIONS Based on these positive results this workshop will be included in the resident training program and also be extended to professionals as a part of the continuing medical education program.
Collapse
Affiliation(s)
- Y Kerbage
- Université de Lille - Faculté de Médecine, F-59000 Lille, France; Service de gynécologie-obstétrique - CHU Lille, F-59000 Lille, France
| | - V Debarge
- Université de Lille - Faculté de Médecine, F-59000 Lille, France; Service de gynécologie-obstétrique - CHU Lille, F-59000 Lille, France
| | - J P Lucot
- Service de gynécologie-obstétrique - CHU Lille, F-59000 Lille, France
| | - E Clouqueur
- Service de gynécologie-obstétrique - CHU Lille, F-59000 Lille, France
| | - C Rubod
- Université de Lille - Faculté de Médecine, F-59000 Lille, France; Service de gynécologie-obstétrique - CHU Lille, F-59000 Lille, France.
| |
Collapse
|
47
|
le Carpentier M, Merlot B, Bot Robin V, Rubod C, Collinet P. [Partial cystectomy for bladder endometriosis: Robotic assisted laparoscopy versus standard laparoscopy]. ACTA ACUST UNITED AC 2016; 44:315-21. [PMID: 27032760 DOI: 10.1016/j.gyobfe.2016.02.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 02/03/2016] [Indexed: 11/29/2022]
Abstract
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.
Collapse
Affiliation(s)
- M le Carpentier
- Chirurgie gynécologique, clinique de gynécologie, hôpital Jeanne-de-Flandre, CHRU de Lille, 59037 Lille cedex, France.
| | - B Merlot
- Chirurgie gynécologique, clinique de gynécologie, hôpital Jeanne-de-Flandre, CHRU de Lille, 59037 Lille cedex, France
| | - V Bot Robin
- Chirurgie gynécologique, clinique de gynécologie, hôpital Jeanne-de-Flandre, CHRU de Lille, 59037 Lille cedex, France
| | - C Rubod
- Chirurgie gynécologique, clinique de gynécologie, hôpital Jeanne-de-Flandre, CHRU de Lille, 59037 Lille cedex, France
| | - P Collinet
- Chirurgie gynécologique, clinique de gynécologie, hôpital Jeanne-de-Flandre, CHRU de Lille, 59037 Lille cedex, France
| |
Collapse
|
48
|
Mesdag V, Bot-Robin V, Deruelle P, Rubod C. État des lieux de l’enseignement en gynécologie-obstétrique en France. ACTA ACUST UNITED AC 2016; 45:257-69. [DOI: 10.1016/j.jgyn.2015.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 01/27/2015] [Accepted: 02/11/2015] [Indexed: 11/27/2022]
|
49
|
Vermersch C, Dessein R, Lucot JP, Rubod C, Cosson M, Giraudet G. Évaluation de la faisabilité du traitement des abcès tubo-ovariens par ponction trans-vaginale écho-guidée. ACTA ACUST UNITED AC 2016; 45:243-8. [DOI: 10.1016/j.jgyn.2015.04.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 04/14/2015] [Accepted: 04/23/2015] [Indexed: 11/16/2022]
|
50
|
Leroy A, Garabedian C, Fourquet T, Azaïs H, Merlot B, Collinet P, Rubod C. [Pictures balance for optimal surgical management of pelvic endometriosis. Imaging and surgery of endometriosis]. ACTA ACUST UNITED AC 2016; 45:214-25. [PMID: 26874665 DOI: 10.1016/j.jgyn.2016.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 12/24/2015] [Accepted: 01/08/2016] [Indexed: 10/22/2022]
Abstract
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.
Collapse
Affiliation(s)
- A Leroy
- Service de chirurgie gynécologique, hôpital Jeanne-de-Flandre, centre hospitalier régional universitaire de Lille, avenue Eugène-Avinée, 59037 Lille, France.
| | - C Garabedian
- Service de chirurgie gynécologique, hôpital Jeanne-de-Flandre, centre hospitalier régional universitaire de Lille, avenue Eugène-Avinée, 59037 Lille, France; Faculté de médecine Henri-Warembourg, université Lille nord de France, avenue Eugène-Avinée, 59045 Lille, France.
| | - T Fourquet
- Centre d'imagerie de la femme, hôpital Jeanne-de-Flandre, centre hospitalier régional universitaire de Lille, 59037 Lille cedex, France
| | - H Azaïs
- Service de chirurgie gynécologique, hôpital Jeanne-de-Flandre, centre hospitalier régional universitaire de Lille, avenue Eugène-Avinée, 59037 Lille, France; Faculté de médecine Henri-Warembourg, université Lille nord de France, avenue Eugène-Avinée, 59045 Lille, France
| | - B Merlot
- Service de chirurgie gynécologique, hôpital Jeanne-de-Flandre, centre hospitalier régional universitaire de Lille, avenue Eugène-Avinée, 59037 Lille, France
| | - P Collinet
- Service de chirurgie gynécologique, hôpital Jeanne-de-Flandre, centre hospitalier régional universitaire de Lille, avenue Eugène-Avinée, 59037 Lille, France; Faculté de médecine Henri-Warembourg, université Lille nord de France, avenue Eugène-Avinée, 59045 Lille, France
| | - C Rubod
- Service de chirurgie gynécologique, hôpital Jeanne-de-Flandre, centre hospitalier régional universitaire de Lille, avenue Eugène-Avinée, 59037 Lille, France; Faculté de médecine Henri-Warembourg, université Lille nord de France, avenue Eugène-Avinée, 59045 Lille, France
| |
Collapse
|