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Osada M, Faller E, Lecointre L, Boisrame T, Martel C, Gabriele V, Akladios C, Host A. [Interest of multidisciplinary consultation meetings dedicated to endometriosis: From a series of 682 patients]. Gynecol Obstet Fertil Senol 2024; 52:336-342. [PMID: 38237734 DOI: 10.1016/j.gofs.2024.01.005] [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: 03/06/2023] [Revised: 12/20/2023] [Accepted: 01/05/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVE We decided to conduct a study based on these multidisciplinary team (MDT) in order to investigate their impact at the University Hospitals of Strasbourg and look for ways to improve this MDT. METHODS This is a retrospective study of the 682 patients presented to endometriosis MDT from its inception in March 2017 to December 2020. RESULTS The MDT decision was different from that initially proposed by the patient's referent for 406 patients (60%). Surgery was chosen for 417 patients (61%) and assisted reproduction for 261 patients (38%). A review of the MRI by a referring radiologist was carried out for 348 cases (51%), with a modification of the results for 255 patients (73%). Initial underestimation of lesions was noted in 198 cases. CONCLUSION Our study has shown the importance of MDT in endometriosis since the therapeutic proposal was modified in 60% of cases. In addition, we supported the importance of radiologists specializing in this field since they made a modification in two-thirds of the MRIs reread. These results show the importance of collegial discussions, which can modify the decisions of medical teams. This underlines the importance of setting up endometriosis networks.
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Affiliation(s)
- Marine Osada
- Hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France; Centre médico-chirurgical obstétrique, hôpitaux universitaires de Strasbourg, 19, rue Louis-Pasteur, 67300 Schiltigheim, France.
| | - Emilie Faller
- Hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France; Centre médico-chirurgical obstétrique, hôpitaux universitaires de Strasbourg, 19, rue Louis-Pasteur, 67300 Schiltigheim, France
| | - Lise Lecointre
- Hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France; Centre médico-chirurgical obstétrique, hôpitaux universitaires de Strasbourg, 19, rue Louis-Pasteur, 67300 Schiltigheim, France
| | - Thomas Boisrame
- Hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France; Centre médico-chirurgical obstétrique, hôpitaux universitaires de Strasbourg, 19, rue Louis-Pasteur, 67300 Schiltigheim, France
| | - Camille Martel
- Hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France; Centre médico-chirurgical obstétrique, hôpitaux universitaires de Strasbourg, 19, rue Louis-Pasteur, 67300 Schiltigheim, France
| | - Victor Gabriele
- Hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France; Centre médico-chirurgical obstétrique, hôpitaux universitaires de Strasbourg, 19, rue Louis-Pasteur, 67300 Schiltigheim, France
| | - Cherif Akladios
- Hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France; Centre médico-chirurgical obstétrique, hôpitaux universitaires de Strasbourg, 19, rue Louis-Pasteur, 67300 Schiltigheim, France
| | - Aline Host
- Hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France; Centre médico-chirurgical obstétrique, hôpitaux universitaires de Strasbourg, 19, rue Louis-Pasteur, 67300 Schiltigheim, France
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Collin-Bund V, Viviani V, Meyer N, Goetsch T, Boisramé T, Faller E, Lecointre L, Gabriele V, Akladios C, Garbin O, Host A. Study of the feasibility of outpatient sacrocolpopexy by laparoscopy. J Gynecol Obstet Hum Reprod 2024; 53:102792. [PMID: 38663686 DOI: 10.1016/j.jogoh.2024.102792] [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: 01/01/2024] [Revised: 03/18/2024] [Accepted: 04/22/2024] [Indexed: 05/05/2024]
Abstract
INTRODUCTION Laparoscopic sacrocolpopexy (LSCP) is currently the gold standard surgical technique for treating pelvic prolapse. This study aimed to evaluate the feasibility of laparoscopic sacrocolpopexy in ambulatory care. PATIENTS AND METHODS This prospective study was conducted to evaluate the feasibility of LSCP in women who visited the outpatient department of obstetrics and gynecology at the University Hospital of Strasbourg between July 2018 and December 2021. All women with indications for laparoscopic sacrocolpopexy for prolapse treatment who were willing to be treated as outpatients were included. The main criterion of the study was to evaluate the rate of re-hospitalization between discharge from the outpatient department after LSCP and postoperative follow-up consultations. RESULTS Among the whole population (57/200, 28.5 %) included, 4 (7 %) were hospitalized. The quality of life was not altered with a preserved EuroQol (EQ-5D) quality of life score with a mean score of 73±18.4 standard deviation (SD) 95 % confidence interval (CI) (67.9; 78.1) on postoperative day 3 (D3) and 91.2 ± 16.3 SD 95 % CI (86.2-96) on D30. On D1, D2, D3, and D7, the anxiety rate evaluated by State-Trait Anxiety Inventory score (STAI Y-A) remained low, with mean scores of 24.8 ± 9.6 SD 95 % [23.4-26.5] on D30. All patients were satisfied or very satisfied with the procedure and outpatient management, with an average score of 9.6/10 (range: 8-10). CONCLUSION This prospective, monocentric study evaluating the feasibility of outpatient LSCP reported demonstrated low rates of complications and re-hospitalization after outpatient management. Furthermore, the patients' quality of life was not altered, and they patients were satisfied with this type of management.
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Affiliation(s)
- V Collin-Bund
- Department of Gynecologic Surgery, Strasbourg University Hospital, Strasbourg, France; Laboratoire d'ImmunoRhumatologie Moléculaire, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR_S 1109, Institut thématique interdisciplinaire (ITI) de Médecine de Précision de Strasbourg, Transplantex NG, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.
| | - V Viviani
- Department of Gynecologic Surgery, Strasbourg University Hospital, Strasbourg, France
| | - N Meyer
- Department of Public Health, Biostatistic laboratory, Université de Strasbourg, 67081 Strasbourg, France
| | - T Goetsch
- Department of Public Health, Biostatistic laboratory, Université de Strasbourg, 67081 Strasbourg, France
| | - T Boisramé
- Department of Gynecologic Surgery, Strasbourg University Hospital, Strasbourg, France
| | - E Faller
- Department of Gynecologic Surgery, Strasbourg University Hospital, Strasbourg, France
| | - L Lecointre
- Department of Gynecologic Surgery, Strasbourg University Hospital, Strasbourg, France; I-Cube UMR 7357-Laboratoire des Sciences de L'ingénieur, de L'informatique et de L'imagerie, Université de Strasbourg, 67081 Strasbourg, France; Institut Hospitalo-Universitaire (IHU), Institute for Minimally Invasive Hybrid Image-Guided Surgery, Université de Strasbourg, 67081 Strasbourg, France
| | - V Gabriele
- Department of Gynecologic Surgery, Strasbourg University Hospital, Strasbourg, France
| | - C Akladios
- Department of Gynecologic Surgery, Strasbourg University Hospital, Strasbourg, France
| | - O Garbin
- Department of Gynecologic Surgery, Strasbourg University Hospital, Strasbourg, France
| | - A Host
- Department of Gynecologic Surgery, Strasbourg University Hospital, Strasbourg, France
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Marchandot B, Faller E, Akladios C, Matsushita K, Bäck M, Jesel L, Schini-Kerth V, Morel O. Fostering Cardio-Endometriosis: A Call to Action for a Comprehensive Understanding of Cardiovascular Disease in Endometriosis. Eur J Prev Cardiol 2024:zwae087. [PMID: 38421615 DOI: 10.1093/eurjpc/zwae087] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/06/2024] [Accepted: 02/27/2024] [Indexed: 03/02/2024]
Abstract
Recently, a growing body of evidence has highlighted a concerning link between endometriosis and cardiovascular disease. Endometriosis, a chronic, inflammatory hormone-dependent condition affecting 5 to 10% of reproductive-aged women worldwide, has long been associated with reproductive and gynecological consequences. However, emerging research has suggested that it may also contribute to adverse cardiovascular outcomes. This paper aims to shed light on the importance of recognizing cardio-endometriosis as a new and developing sphere of research in the field of cardiology, thereby urging the medical community to address this pressing issue.
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Affiliation(s)
- Benjamin Marchandot
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Strasbourg, France
- UR 3074 Médecine Cardiovasculaire Translationnelle, Strasbourg, France, CRBS, 67000 Strasbourg, France
| | - Emilie Faller
- Department of Obstetrics and Gynecology, Hautepierre Hospital, Strasbourg, University Hospital, 1 place de l'Hôpital, 67000 Strasbourg, France
- ENDOALSACE, Strasbourg Expert Center for Endometriosis, Hautepierre Hospital, Strasbourg, University Hospital, 1 place de l'Hôpital, 67000 Strasbourg, France
| | - Cherif Akladios
- Department of Obstetrics and Gynecology, Hautepierre Hospital, Strasbourg, University Hospital, 1 place de l'Hôpital, 67000 Strasbourg, France
- ENDOALSACE, Strasbourg Expert Center for Endometriosis, Hautepierre Hospital, Strasbourg, University Hospital, 1 place de l'Hôpital, 67000 Strasbourg, France
| | - Kensuke Matsushita
- UR 3074 Médecine Cardiovasculaire Translationnelle, Strasbourg, France, CRBS, 67000 Strasbourg, France
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Magnus Bäck
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Section of Translational Cardiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Université de Lorraine, Institut National de la Sante et de la Recherche Medicale U1116, Nancy, France
| | - Laurence Jesel
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Strasbourg, France
- UR 3074 Médecine Cardiovasculaire Translationnelle, Strasbourg, France, CRBS, 67000 Strasbourg, France
| | - Valérie Schini-Kerth
- UR 3074 Médecine Cardiovasculaire Translationnelle, Strasbourg, France, CRBS, 67000 Strasbourg, France
| | - Olivier Morel
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Strasbourg, France
- UR 3074 Médecine Cardiovasculaire Translationnelle, Strasbourg, France, CRBS, 67000 Strasbourg, France
- Hanoï Medical University, Vietnam
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Escriva-Boulley G, Philip CA, Warembourg S, Lenotre L, Flore P, Faure P, Michy T, Letouzey V, Arnold C, Piluso C, Chalmel L, Kacem R, Blum GF, Detayrac R, Trocmé C, Brigaud I, Herbach U, Branche P, Faller E, Chalabaev A. Effects of a physical activity and endometriosis-based education program delivered by videoconference on endometriosis symptoms: the CRESCENDO program (inCRease physical Exercise and Sport to Combat ENDOmetriosis) protocol study. Trials 2023; 24:759. [PMID: 38012776 PMCID: PMC10680283 DOI: 10.1186/s13063-023-07792-1] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/09/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Endometriosis is a chronic disease characterized by growth of endometrial tissue outside the uterine cavity which could affect 200 million women (The term "woman" is used for convenience. Individuals gendered as man or as nonbinary can also suffer from this disease) worldwide. One of the most common symptoms of endometriosis is pelvic chronic pain associated with fatigue. This pain can cause psychological distress and interpersonal difficulties. As for several chronic diseases, adapted physical activity could help to manage the physical and psychological symptoms. The present study will investigate the effects of a videoconference-based adapted physical activity combined with endometriosis-based education program on quality of life, pain, fatigue, and other psychological symptoms and on physical activity. METHODS This multicentric randomized-controlled trial will propose to 200 patients with endometriosis to be part of a trial which includes a 6-month program with 45 min to more than 120 min a week of adapted physical activity and/or 12 sessions of endometriosis-based education program. Effects of the program will be compared to a control group in which patients will be placed on a waiting list. All participants will be followed up 3 and 6 months after the intervention. None of the participants will be blind to the allocated trial arm. The primary outcome measure will be quality of life. Secondary outcomes will include endometriosis-related perceived pain, fatigue, physical activity, and also self-image, stereotypes, motivational variables, perceived support, kinesiophobia, basic psychological need related to physical activity, and physical activity barriers. General linear models and multilevel models will be performed. Predictor, moderator, and mediator variables will be investigated. DISCUSSION This study is one of the first trials to test the effects of a combined adapted physical activity and education program for improving endometriosis symptoms and physical activity. The results will help to improve care for patients with endometriosis. TRIAL REGISTRATION ClinicalTrials.gov, NCT05831735 . Date of registration: April 25, 2023.
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Affiliation(s)
- Géraldine Escriva-Boulley
- Université de Haute-Alsace, Université de Strasbourg, Université de Lorraine, LISEC UR 2310, F-68100, Mulhouse, France.
| | - Charles-André Philip
- 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
| | - Sophie Warembourg
- 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
| | - Lionel Lenotre
- Faculté des Sciences et Techniques, Université de Haute-Alsace, 18 Rue des Frères Lumière, 68200, Mulhouse, France
- PASTA - Processus aléatoires spatio-temporels et leurs applications, Inria Nancy - Grand Est, Villers-lès-, Nancy, France
| | - Patrice Flore
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, 38000, Grenoble, France
| | - Patrice Faure
- Grenoble University Hospital, Avenue Maquis du Grésivaudan, 38700, La Tronche, France
| | - Thierry Michy
- Department of Gynecology, Grenoble University Hospital, Avenue Maquis du Grésivaudan, 38700, La Tronche, France
| | | | - Carole Arnold
- Université de Lorraine, Inserm, UMRS 1256, NGERE - Nutrition, Genetics, and Environmental Risk Exposure, F-54000, Nancy, France
| | - Claire Piluso
- Université de Haute-Alsace, Université de Strasbourg, SAGE, F-68100, Mulhouse, France
| | - Loic Chalmel
- Université de Haute-Alsace, Université de Strasbourg, Université de Lorraine, LISEC UR 2310, F-68100, Mulhouse, France
| | - Ramzi Kacem
- Service gynécologie GHRMSA, Hôpital Emile Muller, Mulhouse, France
| | - Georges Fabrice Blum
- Cabinet Médical, Clinique du Diaconat-Fonderie et Université de Haute-Alsace, Mulhouse, France
| | | | - Candice Trocmé
- Grenoble University Hospital, Avenue Maquis du Grésivaudan, 38700, La Tronche, France
| | - Isabelle Brigaud
- Université de Haute-Alsace, CNRS, IS2M UMR 7361, Mulhouse, France
| | - Ulysse Herbach
- Université de Lorraine, CNRS, Inria, IECL, F-54000, Nancy, France
| | - Patricia Branche
- Service d'Anesthésie Réanimation Chirurgicale, Hospices Civils de Lyon, Groupement Hospitalier Nord Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix-Rousse, F-69317, Lyon, France
| | - Emilie Faller
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67200, Strasbourg, France
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Jouffrieau C, Cazzato RL, Gabriele V, Faller E, Weiss J, Host A, Garnon J, Garbin O, Gangi A. Percutaneous Imaging-guided Cryoablation of Endometriosis Scars of the Anterior Abdominal Wall. J Minim Invasive Gynecol 2023; 30:890-896. [PMID: 37422051 DOI: 10.1016/j.jmig.2023.06.018] [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: 05/16/2023] [Revised: 06/27/2023] [Accepted: 06/27/2023] [Indexed: 07/10/2023]
Abstract
STUDY OBJECTIVE To evaluate the safety and clinical efficacy of percutaneous imaging-guided cryoablation for the management of anterior abdominal wall endometriosis. DESIGN Patients with abdominal wall endometriosis underwent percutaneous imaging-guided cryoablation and had a 6-month follow-up. SETTING Data dealing with patients' and anterior abdominal wall endometriosis (AAWE) characteristics, cryoablation, and clinical and radiologic outcomes were retrospectively collected and analyzed. PATIENTS Twenty-nine consecutive patients underwent cryoablation from June 2020 to September 2022. INTERVENTIONS Interventions were performed under US/computed tomography (CT) guidance or magnetic resonance imaging (MRI) guidance. Cryoprobes were directly inserted into the AAWE, and cryoablation was performed with a single 5 to 10 minute freezing cycle, which was stopped when the iceball expanded 3 to 5 mm beyond AAWE borders as assessed on intra-procedural cross-sectional imaging. MEASUREMENTS AND MAIN RESULTS Fifteen patients (15/29; 51.7%) had prior endometriosis, 28 (28/29; 95.5%) had previous cesarian section, and 22 (22/29; 75.9%) referred association between symptoms and menses. Cryoablation was performed under local (16/29; 55.2%) or general anesthesia (13/29; 44.8%) and mainly in an out-patient basis (18/20; 62%). There was only one (1/29; 3.5%) minor procedure-related complication. Complete symptom relief was recorded in 62.1% (18/29) and 72.4% (21/29) patients at 1 and 6 months, respectively. In the whole population, pain significantly dropped at 6 months compared to the baseline (1.1 ± 2.3; range 0-8 vs 7.1 ± 1.9; range 3-10; p <.05). Eight (8/29; 27.6%) patients presented residual symptoms at 6 months, and 4 (4/29; 13.8%) had an MRI-confirmed residual/recurring disease. Contrast-enhanced MRI obtained for the first 14 (14/29; 48.3%) patients of the series, all without signs of residual/recurring disease, demonstrated a significantly smaller ablation area compared to the baseline volume of the AAWE (1.0 cm3 ± 1.4; range 0-4.7; vs 11.1 ± 9.9 cm3; range 0.6-36.4; p <.05). CONCLUSION Percutaneous imaging-guided cryoablation of AAWE is safe and clinically effective in achieving pain relief.
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Affiliation(s)
| | - Roberto Luigi Cazzato
- Department of Interventional Radiology (Drs. Cazzato, Weiss, Garnon, and Gangi), University Hospital of Strasbourg, Strasbourg, France
| | - Victor Gabriele
- Gynecology Unit, CMCO (Drs. Jouffrieau, Gabriele, Faller, Host, and Garbin)
| | - Emilie Faller
- Gynecology Unit, CMCO (Drs. Jouffrieau, Gabriele, Faller, Host, and Garbin)
| | - Julia Weiss
- Department of Interventional Radiology (Drs. Cazzato, Weiss, Garnon, and Gangi), University Hospital of Strasbourg, Strasbourg, France
| | - Aline Host
- Gynecology Unit, CMCO (Drs. Jouffrieau, Gabriele, Faller, Host, and Garbin)
| | - Julien Garnon
- Department of Interventional Radiology (Drs. Cazzato, Weiss, Garnon, and Gangi), University Hospital of Strasbourg, Strasbourg, France
| | - Olivier Garbin
- Gynecology Unit, CMCO (Drs. Jouffrieau, Gabriele, Faller, Host, and Garbin)
| | - Afshin Gangi
- Department of Interventional Radiology (Drs. Cazzato, Weiss, Garnon, and Gangi), University Hospital of Strasbourg, Strasbourg, France
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Faller E, Jackson A. A cost minimisation analysis comparing oral linezolid and intravenous daptomycin administered via an outpatient parenteral antibiotic therapy programme in patients requiring prolonged antibiotic courses. J Chemother 2023; 35:411-424. [PMID: 36398996 DOI: 10.1080/1120009x.2022.2145452] [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: 10/01/2022] [Revised: 10/28/2022] [Accepted: 11/03/2022] [Indexed: 11/20/2022]
Abstract
This study is an economic analysis seeking to examine cost savings that may be accrued from usage of oral linezolid in place of OPAT IV daptomycin in patients requiring prolonged courses of IV or highly bioavailable oral antibiotic therapy. In order to do so we conducted a literature review to establish the scenarios in which the agents could be considered equivalent. We then, using a decision-tree model, conducted a cost analysis to establish differences in cost between the approaches. Under the model base-case, the total cost of treatment with OPAT daptomycin was €3,496.84 and the total cost of treatment with oral linezolid was €772.01. Therefore the oral linezolid strategy would be projected to save the Irish health service €2,724.83 per patient. These results were robust to one-way deterministic sensitivity analyses and probabilistic sensitivity analysis. Our study suggests that significant savings could be safely accrued in the management of these patients.
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Affiliation(s)
- E Faller
- Infectious Disease Department, Cork University Hospital (CUH), Cork, Ireland
- London School of Economics and Political Science, London, UK
| | - A Jackson
- Infectious Disease Department, Cork University Hospital (CUH), Cork, Ireland
- School of Medicine, UCC, College Road, Cork, Ireland
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Lecointre L, Buttignol M, Faller E, Boisrame T, Martel C, Host A, Gabriele V, Akladios C. Urological procedures performed by gynecologists: Activity profile in a gynecological surgery department, 10-year observation cohort. Eur J Obstet Gynecol Reprod Biol 2023; 288:204-210. [PMID: 37572449 DOI: 10.1016/j.ejogrb.2023.07.015] [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: 04/16/2023] [Revised: 07/02/2023] [Accepted: 07/24/2023] [Indexed: 08/14/2023]
Abstract
INTRODUCTION The proximity of the urinary tract to the female genital tract explains its possible involvement in pelvic gynaecological cancer or deep endometriosis. Surgical treatment is aimed at improving overall survival and recurrence-free survival of patients, as well as restoring normal anatomy and functional integrity depending on the pathology. These operations are accompanied by significant post-operative complications. Thus, the urological procedures performed must be rigorously justified, and the different resection and reconstruction techniques adapted to the pathology and the level of infiltration. OBJECTIVE To describe the activity profile, over the last ten years, of a gynaecological surgery department in terms of urological procedures in the management of patients with deep endometriosis and pelvic carcinology. STUDY DESIGN This is a monocentric retrospective observational study, including all patients who underwent a urological procedure by a gynaecological surgeon only, as part of the management of pelvic gynaecological cancers or deep endometriosis, at the University Hospital Centre (CHU) of Strasbourg, between January 1st 2010 and April 31st 2021. The variables studied were early postoperative complications, the rate of surgical reintervention, operating time, length of hospital stay, the need for peri-operative drainage or transfusion, and post-operative functional disorders. RESULTS A total of 86 patients were included, 27 in the pelvic gynaecological cancer group and 59 in the deep endometriosis group. 61.6% of patients received uretero-vesical catheterization, 60.5% partial cystectomy, 10.5% psoic bladder ureteral reimplantation, and 3.5% trans-ileal Bricker skin ureterostomy. The mean operating time was 316 min in the pelvic gynaecological cancer group and 198.9 min in the deep endometriosis group. The average hospital stay was 11.5 days, 22.3 days for patients treated for pelvic cancer and 6.3 days for those treated for endometriosis. The rate of minor post-operative complications was 8.2% of cases, and major post-operative complications 17.4% of cases, the majority of which were in the gynecological cancer group. There were no cases of intra- or early post-operative death. Early postoperative urinary complications affected 14.0% of the total patients, mostly in the gynaecological cancer group with 33.3% of patients, but only 5.1% of patients in the deep endometriosis group. The total reoperation rate within 60 days postoperatively was 15.1%, 40.7% for patients treated for gynaecological cancer and 3.4% for those treated for deep pelvic endometriosis. The rate of reoperations for urinary complications was 11.6% of total patients, or 76.9% of total reoperations. 15 patients received labile blood products intra- or postoperatively, 11 in the pelvic gynaecological cancer group and 4 in the endometriosis group. CONCLUSION Our overall results appear comparable to those reported in the literature and are particularly satisfactory in terms of post-operative complications after partial cystectomy in the management of deep endometriosis compared to other gynaecological departments. This work encourages us to continue and improve the training of gynaecological surgeons in terms of multidisciplinary surgical procedures, including urological ones, to obtain a global vision of the pathology and to allow an optimal quality of care for the patients.
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Affiliation(s)
- Lise Lecointre
- Gynecologic Surgery, Hôpitaux universitaires de Strasbourg, 1 avenue de Molière, 67200 Strasbourg, Alsace, France; Insitute of Image-Guided Surgery, IHU-Strasbourg (Institut Hospitalo-Universitaire), 1 place de l'Hôpital, 67000 Strasbourg, France; ICube UMR 7357 - Laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie, CNRS, Université de Strasbourg, Strasbourg, France.
| | - Megane Buttignol
- Gynecologic Surgery, Hôpitaux universitaires de Strasbourg, 1 avenue de Molière, 67200 Strasbourg, Alsace, France.
| | - Emilie Faller
- Gynecologic Surgery, Hôpitaux universitaires de Strasbourg, 1 avenue de Molière, 67200 Strasbourg, Alsace, France.
| | - Thomas Boisrame
- Gynecologic Surgery, Hôpitaux universitaires de Strasbourg, 1 avenue de Molière, 67200 Strasbourg, Alsace, France.
| | - Camille Martel
- Gynecologic Surgery, Hôpitaux universitaires de Strasbourg, 1 avenue de Molière, 67200 Strasbourg, Alsace, France.
| | - Aline Host
- Gynecologic Surgery, Hôpitaux universitaires de Strasbourg, 1 avenue de Molière, 67200 Strasbourg, Alsace, France
| | - Victor Gabriele
- Gynecologic Surgery, Hôpitaux universitaires de Strasbourg, 1 avenue de Molière, 67200 Strasbourg, Alsace, France.
| | - Chérif Akladios
- Gynecologic Surgery, Hôpitaux universitaires de Strasbourg, 1 avenue de Molière, 67200 Strasbourg, Alsace, France.
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Mounien D, Martel C, Faller E. [Laparoscopic ultrasound-guided radiofrequency ablation of uterine fibroids]. Gynecol Obstet Fertil Senol 2023; 51:384-386. [PMID: 37276921 DOI: 10.1016/j.gofs.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/18/2023] [Accepted: 04/21/2023] [Indexed: 06/07/2023]
Affiliation(s)
- Djanagane Mounien
- Service de chirurgie gynécologique, hôpital de Haute-Pierre, CHRU de Strasbourg, Strasbourg, France.
| | - Camille Martel
- Service de chirurgie gynécologique, hôpital de Haute-Pierre, CHRU de Strasbourg, Strasbourg, France
| | - Emilie Faller
- Service de chirurgie gynécologique, hôpital de Haute-Pierre, CHRU de Strasbourg, Strasbourg, France
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Collin-Bund V, Gabriele V, Minella C, Lecointre L, Boisramé T, Faller E, Host A, Akladios C, Saussine C, Garbin O. Vaginal and laparoscopic sub-urethral sling explantation. Int Urogynecol J 2023:10.1007/s00192-023-05495-4. [PMID: 36905410 DOI: 10.1007/s00192-023-05495-4] [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: 09/08/2022] [Accepted: 10/18/2022] [Indexed: 03/12/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to describe the different laparoscopic and vaginal steps of sub-urethral infected mesh explantation as well as an unexpected and unusual complication: a sub-mucosal calcification on the sub-urethral segment of the sling that was not infiltrating the urethra. METHODS This was carried out at our University Teaching Hospital of Strasbourg. RESULTS We show the complete removal of an infected retropubic sling in a patient who had already undergone three previous surgeries without resolution of symptoms. This is a difficult case requiring a laparoscopic approach of the space of Retzius, which has been less familiar to surgeons since the advent of the midurethral sling. We show how to approach this space in an inflammatory environment by specifying its anatomical limits. Moreover, a great deal can be learned from the occurrence of an infectious complication after the surgery and the presence of a large calcification on the prosthesis. In this context, we advise a systematic antibiotic treatment to avoid this kind of complication. CONCLUSIONS Knowing the guidelines and the different surgical steps will help urogynecological surgeons to perform similar procedures in patients requiring removal of retropubic slings for complications such as infection and pain, where conservative management has not been successful. These cases must be discussed in a multidisciplinary meeting, as recommended by the French National Authority for Health, and managed in an expert establishment.
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Affiliation(s)
- Virginie Collin-Bund
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091, Strasbourg, France. .,Laboratoire d'ImmunoRhumatologie Moléculaire, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR_S 1109, Institut thématique interdisciplinaire (ITI) de Médecine de Précision de Strasbourg, Transplantex NG, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.
| | - Victor Gabriele
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091, Strasbourg, France
| | - Chris Minella
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091, Strasbourg, France
| | - Lise Lecointre
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091, Strasbourg, France
| | - Thomas Boisramé
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091, Strasbourg, France
| | - Emilie Faller
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091, Strasbourg, France
| | - Aline Host
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091, Strasbourg, France
| | - Chérif Akladios
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091, Strasbourg, France
| | - Christian Saussine
- Department of Urology Surgery, Hôpitaux Universitaires de Strasbourg, 67091, Strasbourg, France
| | - Olivier Garbin
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091, Strasbourg, France
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Buttignol M, Faller E, Lecointre L, Boisrame T, Akladios C. Deep infiltrating endometriosis: Laparoscopic nerve-sparing surgery and use of neutral argon plasma. J Gynecol Obstet Hum Reprod 2023; 52:102573. [PMID: 36914114 DOI: 10.1016/j.jogoh.2023.102573] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 02/06/2023] [Accepted: 03/08/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVE To present a minimally approach to the management of deep pelvic endometriosis by nerve-sparing surgery and use of neutral argon plasma for extensive endometriotic lesions. DESIGN This is a clinical case video of a 29 years-old patient, affected by deep pelvic endometriosis with primary dysmenorrhea, deep dyspareunia, chronic pelvic pain and dyschezia. Pelvic MRI shows a right ovarian endometrioma measuring 5 cm, a thickening of the right uterosacral ligament and a uterine torus nodule. SETTING Laparoscopy video. INTERVENTION This laparoscopic surgery begins by an adhesiolysis of the sigmoid and a blue tube test to check the correct permeability of the tubes. A bilateral ureterolysis is performed before the excision of a torus lesion and adhesiolysis of the rectovaginal septum. A fine dissection of the uterosacral ligament by nerve-sparing surgery is realized to respect the hypogastric nerve in the Okabayashi space. Endometriosis nodules of the lumbo-ovarian ligaments and multiples endometriosis peritoneal implants, inaccessible to a complete excision, are destroyed by argon plasma vaporization. A cystectomy of the right endometrioma and an appendectomy are performed at the end. CONCLUSION The surgical management of deep infiltrating endometriosis is complex, with the recent contribution of new technical procedures such as nerve-sparing surgery to reduce postoperative urinary complications, or argon plasma for ablation of extended peritoneal implants or endometrioma to preserve ovarian function.
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Affiliation(s)
- Megane Buttignol
- Gynecology Department, Strasbourg University Hospital, Strasbourg France.
| | - Emilie Faller
- Gynecology Department, Strasbourg University Hospital, Strasbourg France
| | - Lise Lecointre
- Gynecology Department, Strasbourg University Hospital, Strasbourg France
| | - Thomas Boisrame
- Gynecology Department, Strasbourg University Hospital, Strasbourg France
| | - Cherif Akladios
- Gynecology Department, Strasbourg University Hospital, Strasbourg France
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Gaultier V, Martel C, Boisramé T, Faller E, Lecointre L, Akladios C. Bilateral posterior Richter sacrospinous fixation with native tissue: anatomical and functional results and quality of life assessment over 10 years. J Gynecol Obstet Hum Reprod 2023; 52:102575. [PMID: 36972736 DOI: 10.1016/j.jogoh.2023.102575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 03/09/2023] [Indexed: 03/28/2023]
Abstract
INTRODUCTION Pelvic organ prolapse (POP) is a common condition that affects 50% of women who have given birth in their lifetime. With stop of vaginal mesh sale in 2019, the sacrospinous fixation technique according to Richter with native tissue has seen its incidence tripled in 15 years. Classically, sacrospinous fixation according to Richter is performed unilaterally, however its unilateral or bilateral character is controversial. Objective of this work is to evaluate the efficacy and safety of bilateral sacrospinous fixation according to Richter by the posterior approach with native tissue (SSB). METHODS We performed a retrospective single-center study. From March 12, 2010 to March 23, 2020, all first-time operated patients who underwent SSB in CHU Strasbourg gynecological surgery unit for symptomatic POP management were included. The main endpoint of our work is the anatomical and functional success rate at 12 and 24 months. The secondary judgment criteria of our work were based on the postoperative evaluation of patient's quality of life according to the PFDI-20 score as well as the rate of postoperative complications. RESULTS 77 patients were included in our work. The anatomical success rate at 12 months is 94% and 81% at 24 months regardless of the compartment affected. The functional success rate is 94% at 12 months and 82% at 24 months. Quality of life evaluation through the PFDI-20 scale revealed a clear improvement in the symptomatology related to POP: 127/300 +/- 27.3. preoperatively and 59.8 ± 14.7 postoperatively. CONCLUSION Bilateral sacrospinous fixation according to Richter by posterior approach with native tissue is a safe and effective surgical technique allowing a clear improvement in patients quality of life.
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Martel C, Arnalsteen C, Lecointre L, Lapointe M, Roy C, Faller E, Boisramé T, Soler L, Akladios C. Feasibility and clinical value of virtual reality for deep infiltrating pelvic endometriosis: A case report. J Gynecol Obstet Hum Reprod 2023; 52:102500. [PMID: 36351538 DOI: 10.1016/j.jogoh.2022.102500] [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: 05/06/2022] [Revised: 09/19/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022]
Abstract
Deep infiltrating pelvic endometriosis and its surgical management is associated with a risk of major postoperative complications. Magnetic Resonance Imaging (MRI) is recommended preoperatively in order to obtain the most precise mapping of the extent of endometriotic lesions. The aim of this work was to assess the feasibility and clinical interest of 3D modeling by surface rendering as a preoperative planning tool in a patient with deep infiltrating pelvic endometriosis. We report on a 42 years old patient with history of endometriosis and persistent pain underwent pre operative imaging with MRI that was consistent with deep infiltrating endometriosis. A 3D model of the deep infiltrating endometriosis was generated from the MRI and retrospectively compared to the intra-operative findings. The nodule's location and relationship to the uterus and the rectum was clearly defined by the 3D model and correlated with surgical findings. Virtual reality based on 3D models could be an interesting tool to assist in the preoperative planning of complex surgeries.
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Affiliation(s)
- Camille Martel
- University Hospitals of Strasbourg, Department of Gynecologic Surgery, Strasbourg, France.
| | - Charlotte Arnalsteen
- University Hospitals of Strasbourg, Department of Gynecologic Surgery, Strasbourg, France
| | - Lise Lecointre
- University Hospitals of Strasbourg, Department of Gynecologic Surgery, Strasbourg, France; IHU-Strasbourg (Institut Hospitalo-Universitaire), Insitute of Image-Guided Surgery, Strasbourg, France; ICube UMR 7357 - Laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie, CNRS, niversité de Strasbourg, Strasbourg, France
| | - Mathilde Lapointe
- University Hospitals of Strasbourg, Department of Gynecologic Surgery, Strasbourg, France
| | - Catherine Roy
- IHU-Strasbourg (Institut Hospitalo-Universitaire), Insitute of Image-Guided Surgery, Strasbourg, France
| | - Emilie Faller
- University Hospitals of Strasbourg, Department of Gynecologic Surgery, Strasbourg, France
| | - Thomas Boisramé
- University Hospitals of Strasbourg, Department of Gynecologic Surgery, Strasbourg, France
| | - Luc Soler
- Visible Patient S.A.S, 8 rue Gustave Adolphe Hirn 67000 Strasbourg, France
| | - Cherif Akladios
- University Hospitals of Strasbourg, Department of Gynecologic Surgery, Strasbourg, France
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13
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Collin-Bund V, Lecointre L, Ross C, Faller E, Boisramé T, Minella C, Baldauf JJ, Akladios C. Preliminary observational study of the implementation of hyperthermic intraperitoneal chemotherapy in ovarian cancer in the gynecological surgery department at the University Hospital of Strasbourg. J Gynecol Obstet Hum Reprod 2023; 52:102501. [PMID: 36356941 DOI: 10.1016/j.jogoh.2022.102501] [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: 09/06/2022] [Revised: 11/01/2022] [Accepted: 11/06/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE According to French guidelines, hyperthermic intraperitoneal chemotherapy (HIPEC) can be performed for Federation of Gynecology and Obstetrics stage III primary epithelial ovarian, tubal, and peritoneal cancers that are initially unresectable after 3 or 4 cycles of intravenous chemotherapy. The main objective of this preliminary study was to analyze the components necessary for the establishment of HIPEC in an expert gynecological oncological surgery center. The secondary objective was to compare HIPEC using conventional laparotomy and laparoscopic approaches. METHODS We conducted a single-center retrospective study of patients who received HIPEC. All patients who met the criteria of the French HIPEC guidelines were included from 2019 to 2021. RESULTS Prior to HIPEC, there were a mean of 3.7 courses of neoadjuvant chemotherapy with carboplatin and paclitaxel. Of the 16 patients who received HIPEC, 9 (56.2%) underwent HIPEC laparoscopically, while 7 (43.8%) underwent laparotomy. There were no differences between the rates of intra- and postoperative complications between the two groups. (p > 0.05). The duration of hospitalization was significantly shorter in patients who were operated laparoscopically than in those treated using laparotomy (55.6% <10 days vs. 0 by laparotomy, p = 0.01). There was also a tendency, although not significant, for a more rapid resumption of adjuvant chemotherapy in the laparoscopy group, with 57.1% resuming chemotherapy in <6 weeks compared to 42.9% in the laparotomy group (p = 0.52). CONCLUSIONS This study demonstrates the feasibility of HIPEC in a center with expertise in gynecological surgery when there is a suitable technical platform and close collaboration between the different teams involved. We also showed the first cases of HIPEC using laparoscopy, which seems to be a promising approach.
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Affiliation(s)
- Virginie Collin-Bund
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France; Laboratoire d'ImmunoRhumatologie Moléculaire, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR_S 1109, Institut thématique interdisciplinaire (ITI) de Médecine de Précision de Strasbourg, Transplantex NG, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.
| | - Lise Lecointre
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France; I-Cube UMR 7357-Laboratoire des Sciences de L'ingénieur, de L'informatique et de L'imagerie, Université de Strasbourg, 67081 Strasbourg, France; Institut Hospitalo-Universitaire (IHU), Institute for Minimally Invasive Hybrid Image-Guided Surgery, Université de Strasbourg, 67081 Strasbourg, France
| | - Célia Ross
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France
| | - Emilie Faller
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France
| | - Thomas Boisramé
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France
| | - Chris Minella
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France
| | - Jean-Jacques Baldauf
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France
| | - Chérif Akladios
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France
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14
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Gaultier V, Mounien D, Faller E, Boisramé T, Gabriele V, Lecointre L, Martel C, Akladios C. [How i do… laparotomy omentosplenectomy during complete cytoreductive surgery?]. Gynecol Obstet Fertil Senol 2022; 50:689-692. [PMID: 36028185 DOI: 10.1016/j.gofs.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 06/13/2022] [Accepted: 07/07/2022] [Indexed: 06/15/2023]
Affiliation(s)
- V Gaultier
- Service de chirurgie gynécologique, CHRU de Strasbourg, hôpital de Hautepierre, Strasbourg, France.
| | - D Mounien
- Service de chirurgie gynécologique, CHRU de Strasbourg, hôpital de Hautepierre, Strasbourg, France
| | - E Faller
- Service de chirurgie gynécologique, CHRU de Strasbourg, hôpital de Hautepierre, Strasbourg, France
| | - T Boisramé
- Service de chirurgie gynécologique, CHRU de Strasbourg, hôpital de Hautepierre, Strasbourg, France
| | - V Gabriele
- Service de chirurgie gynécologique, CHRU de Strasbourg, hôpital de Hautepierre, Strasbourg, France
| | - L Lecointre
- IHU-Strasbourg (institut hospitalo-universitaire), institut de chirurgie guidée par image, Strasbourg, France; ICube UMR 7357 - laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie, CNRS, université de Strasbourg, Strasbourg, France
| | - C Martel
- Service de chirurgie gynécologique, CHRU de Strasbourg, hôpital de Hautepierre, Strasbourg, France
| | - C Akladios
- Service de chirurgie gynécologique, CHRU de Strasbourg, hôpital de Hautepierre, Strasbourg, France
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15
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Osada M, Lecointre L, Lodi M, Faller E, Boisrame T, Host A, Gabriele V, Garbin O, Akladios C. Nerve anatomy around lumbo-aortic lymphadenectomy by retroperitoneal approach. J Minim Invasive Gynecol 2022; 29:588. [DOI: 10.1016/j.jmig.2022.02.002] [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] [Received: 10/14/2021] [Revised: 01/25/2022] [Accepted: 02/02/2022] [Indexed: 11/28/2022]
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Marchandot B, Curtiaud A, Matsushita K, Trimaille A, Host A, Faller E, Garbin O, Akladios C, Jesel L, Morel O. Endometriosis and cardiovascular disease. Eur Heart J Open 2022; 2:oeac001. [PMID: 35919664 PMCID: PMC9242051 DOI: 10.1093/ehjopen/oeac001] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/13/2021] [Indexed: 11/21/2022]
Abstract
Endometriosis is a chronic gynaecological disease affecting 1 in 10 reproductive-age women. It is defined as the presence of endometrium-like tissue outside the uterus. Beyond this placid anatomical definition, endometriosis is a complex, hormonal, inflammatory, and systemic condition that poses significant familial, psychological, and economic burden. The interaction between the cardiovascular system and endometriosis has become a field of interest as the underlying mutual mechanisms become better understood. On the basis of accumulating fundamental and clinical evidence, it is likely that there exists a close relationship between endometriosis and the cardiovascular system. Therefore, investigating the endometriosis-cardiovascular interaction is highly clinically significant. In this review, we highlight our current understanding of the pathophysiology of endometriosis with systemic hormonal, pro-inflammatory, pro-angiogenic, immunologic, and genetic processes beyond the peritoneal microenvironment. Additionally, we provide current clinical evidence about how endometriosis interacts with cardiovascular risk factors and cardiovascular disease (CVD). To date, only small associations between endometriosis and CVD have been reported in observational studies, inherently limited by the potential influence of unmeasured confounding. Cardiovascular disease in women with endometriosis remains understudied, under-recognized, and underdiagnosed. More detailed study of the cardiovascular-endometriosis interaction is needed to fully understand its clinical relevance, underlying pathophysiology, possible means of early diagnosis and prevention.
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Affiliation(s)
- Benjamin Marchandot
- Division of Cardiovascular Medicine, Nouvel Hopital Civil, Strasbourg University Hospital, 1 place de l’Hôpital, 67000 Strasbourg, France
| | - Anais Curtiaud
- Division of Cardiovascular Medicine, Nouvel Hopital Civil, Strasbourg University Hospital, 1 place de l’Hôpital, 67000 Strasbourg, France
| | - Kensuke Matsushita
- Division of Cardiovascular Medicine, Nouvel Hopital Civil, Strasbourg University Hospital, 1 place de l’Hôpital, 67000 Strasbourg, France
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS, Strasbourg, France
| | - Antonin Trimaille
- Division of Cardiovascular Medicine, Nouvel Hopital Civil, Strasbourg University Hospital, 1 place de l’Hôpital, 67000 Strasbourg, France
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS, Strasbourg, France
| | - Aline Host
- Department of Obstetrics and Gynecology, Hautepierre Hospital, Strasbourg University Hospital, 1 place de l’Hôpital, 67000 Strasbourg, France
- ENDOALSACE, Strasbourg Expert Center for Endometriosis, Hautepierre Hospital, Strasbourg University Hospital, 1 place de l’Hôpital, 67000 Strasbourg, France
| | - Emilie Faller
- Department of Obstetrics and Gynecology, Hautepierre Hospital, Strasbourg University Hospital, 1 place de l’Hôpital, 67000 Strasbourg, France
- ENDOALSACE, Strasbourg Expert Center for Endometriosis, Hautepierre Hospital, Strasbourg University Hospital, 1 place de l’Hôpital, 67000 Strasbourg, France
| | - Olivier Garbin
- Department of Obstetrics and Gynecology, Hautepierre Hospital, Strasbourg University Hospital, 1 place de l’Hôpital, 67000 Strasbourg, France
- ENDOALSACE, Strasbourg Expert Center for Endometriosis, Hautepierre Hospital, Strasbourg University Hospital, 1 place de l’Hôpital, 67000 Strasbourg, France
| | - Chérif Akladios
- Department of Obstetrics and Gynecology, Hautepierre Hospital, Strasbourg University Hospital, 1 place de l’Hôpital, 67000 Strasbourg, France
- ENDOALSACE, Strasbourg Expert Center for Endometriosis, Hautepierre Hospital, Strasbourg University Hospital, 1 place de l’Hôpital, 67000 Strasbourg, France
| | - Laurence Jesel
- Division of Cardiovascular Medicine, Nouvel Hopital Civil, Strasbourg University Hospital, 1 place de l’Hôpital, 67000 Strasbourg, France
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS, Strasbourg, France
| | - Olivier Morel
- Division of Cardiovascular Medicine, Nouvel Hopital Civil, Strasbourg University Hospital, 1 place de l’Hôpital, 67000 Strasbourg, France
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS, Strasbourg, France
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Bund V, Azaïs H, Bibi-Triki S, Lecointre L, Betrian SB, Angeles MA, Eberst L, Faller E, Boisramé T, Bendifallah S, Akladios C, Deluche É. Basics of immunotherapy for epithelial ovarian cancer. J Gynecol Obstet Hum Reprod 2021; 51:102283. [PMID: 34875397 DOI: 10.1016/j.jogoh.2021.102283] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/01/2021] [Accepted: 12/02/2021] [Indexed: 10/19/2022]
Abstract
Epithelial ovarian cancer (EOC) is the most lethal of all gynecological cancers. Despite excellent responses to standard treatment in approximately 70% of patients, most of them will relapse within 5 years of initial treatment and many of them will develop chemotherapy-resistant disease. It is then important to find other means of treatment for these patients such as immunotherapy or targeted therapy. To understand immunotherapy, it is important to explain the dynamic interplay between cancer and the immune system. Compared to traditional tumor therapies, immunotherapy acts primarily on the immune system or the tumor microenvironment but not directly on the tumor cells, and it may also promote synergistic anti-tumor actions as part of a combined treatment. The aim of this narrative review is to provide a basic understanding of immunotherapy the interest of this treatment in EOC, and to present the main ongoing studies that could change patient management in the future.
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Affiliation(s)
- Virginie Bund
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France; Laboratoire d'ImmunoRhumatologie Moléculaire, Institut national de la santé et de la recherche médicale (INSERM) UMR_S 1109, Institut thématique interdisciplinaire (ITI) de Médecine de Précision de Strasbourg, Transplantex NG, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.
| | - Henri Azaïs
- Department of Gynecologic and Breast Oncological Surgery, Georges-Pompidou European Hospital, APHP. Centre, France.
| | - Sabrina Bibi-Triki
- Laboratoire d'ImmunoRhumatologie Moléculaire, Institut national de la santé et de la recherche médicale (INSERM) UMR_S 1109, Institut thématique interdisciplinaire (ITI) de Médecine de Précision de Strasbourg, Transplantex NG, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.
| | - Lise Lecointre
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France; IHU-Strasbourg (Institut Hospitalo-Universitaire), Strasbourg, France.
| | - Sarah Bétrian Betrian
- Medical oncology Department, Institut Claudius Regaud, Institut Universitaire du Cancer, Toulouse, France.
| | - Martina Aida Angeles
- Department of Gynecologic and Breast Oncological Surgery, European Georges-Pompidou Hospital, APHP. Centre, France.
| | - Lauriane Eberst
- Department of Oncology, Institut de Cancérologie de Strasbourg (ICANS), Strasbourg, France.
| | - Emilie Faller
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - Thomas Boisramé
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | | | - Chérif Akladios
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France; I.R.C.A.D - Institut de Recherche contre les Cancers de l'Appareil Digestif. 67000 Strasbourg, France.
| | - Élise Deluche
- Medical oncology Department, Limoges University Hospital, France.
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Jochum F, De Rozario T, Lecointre L, Faller E, Boisrame T, Dabi Y, Lavoué V, Coutant C, Touboul C, Bolze PA, Bricou A, Canlorbe G, Collinet P, Huchon C, Bendifallah S, Ouldamer L, Mezzadri M, Querleu D, Akladios C. Adherence to European ovarian cancer guidelines and impact on survival: a French multicenter study (FRANCOGYN). Int J Gynecol Cancer 2021; 31:1443-1452. [PMID: 34607855 DOI: 10.1136/ijgc-2021-002934] [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: 07/09/2021] [Accepted: 09/14/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The primary objective of the study was to validate the European Society for Medical Oncology (ESMO)-European Society of Gynecologic Oncology (ESGO) ovarian cancer guideline as a method of assessing quality of care, and to identify patient characteristics predictive of non-adherence to European guideline care. The secondary objectives were to analyze the evolution of practices over the years and to evaluate heterogeneity between centers. METHODS This retrospective multicenter cohort study of invasive epithelial ovarian cancer reported to the FRANCOGYN database included data from 12 French centers between January 2000 and February 2017. The main outcome was adherence to ESMO-ESGO guidelines, defined by recommended surgical procedures according to the International Federation of Gynecology and Obstetrics (FIGO) stage and appropriate chemotherapy. Mixed multivariable logistic regression analysis with a random center effect was performed to estimate the probability of adherence to the guidelines. Survival analysis was carried out using the Kaplan-Meier method and a mixed Cox proportional hazards model. RESULTS 1463 patients were included in the study. Overall, 317 (30%) patients received complete guideline adherent care. Patients received appropriate surgical treatment in 69% of cases, while adequate chemotherapy was administered to 44% of patients. Both patient demographics and disease characteristics were significantly associated with the likelihood of receiving guideline adherent care, such as age, performance status, FIGO stage, and initial burden of disease. In univariate and multivariate survival analysis, adherence to the guidelines was a statistically significant and independent predictor of decreased overall survival. Patients receiving suboptimal care experienced an increased risk of death of more than 100% compared with those treated according to the guidelines (hazard ratio 2.14, 95% confidence interval 1.32 to 3.47, p<0.01). In both models, a significant random center effect was observed, confirming the heterogeneity between centers (p<0.001). CONCLUSIONS Adherence to ESMO-ESGO guidelines in ovarian cancer was associated with a higher overall survival and may be a useful method of assessing quality of care.
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Affiliation(s)
- Floriane Jochum
- Department of Gynecology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Tamara De Rozario
- Department of Gynecology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Lise Lecointre
- I-Cube UMR 7357-Laboratoire des Sciences de l'ingénieur, de l'informatique et de l'imagerie, Université de Strasbourg, Strasbourg, France.,Institut Hospitalo-Universitaire (IHU), Institute for Minimally Invasive Hybrid Image-Guided Surgery, Université de Strasbourg, Strasbourg, France
| | - Emilie Faller
- Department of Gynecology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Thomas Boisrame
- Department of Gynecology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Yohann Dabi
- Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal de Creteil, Creteil, France
| | - Vincent Lavoué
- Department of Gynecologic Surgery, Hôpital Universitaire de Rennes, Université de Rennes 1 Faculté de Médecine, Rennes, France
| | - Charles Coutant
- Department of Surgical Oncology, Georges-Francois Leclerc Centre, Dijon, France
| | - Cyril Touboul
- Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal de Creteil, Creteil, France
| | | | - Alexandre Bricou
- Department of Obstetrics and Gynecology, Hôpital Jean Verdier, Bondy, France
| | - Geoffroy Canlorbe
- Department of Gynecologic and Breast Surgery and Oncology, Hopital Universitaire Pitie Salpetriere Bibliotheque de La Pitie, Paris, France
| | - Pierre Collinet
- Department of Gynecological Surgery, Hopital Jeanne de Flandre, Lille, France
| | - Cyrille Huchon
- Department of Gynecology, Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye Site Hospitalier de Poissy, Poissy, France
| | | | - Lobna Ouldamer
- Department of Gynecology, Hôpital Universitaire de Tours, Tours, France
| | | | - Denis Querleu
- Department of Gynecology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Chérif Akladios
- Department of Gynecology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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19
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Mollion M, Host A, Faller E, Garbin O, Ionescu R, Roy C. Report of two cases of Accessory Cavitated Uterine Mass (ACUM): Diagnostic challenge for MRI. Radiol Case Rep 2021; 16:3465-3469. [PMID: 34527125 PMCID: PMC8430264 DOI: 10.1016/j.radcr.2021.07.071] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/19/2021] [Accepted: 07/24/2021] [Indexed: 11/18/2022] Open
Abstract
Cystic adenomyosis is an unusual form of adenomyosis, characterized by a well-circumscribed cavitated endometrial gland and stroma, ≥ 1 cm in diameter, located within the myometrium. Few cases have been reported in the gynecological literature, with confusing naming such as: juvenile cystic adenomyosis, cystic myometrial lesions, cystic adenomyoma or juvenile adenomyotic cysts. The current preferred terminology is accessory cavitated uterine mass /or malformation (ACUM). We report here the cases of two 17 and 18 -year-old nulliparous women, who complained of severe dysmenorrhea early after the onset of menarche, with none or partial efficiency of medical treatment. MRI findings, with a follow-up in one case and surgical treatment in both cases, are described with an emphasis on physiopathology. The typical MR appearance is a large well-circumscribed round mass within the external myometrium, composed by an inner cystic hemorrhagic layer surrounded by a thick fibrous crown. The first-line treatment is laparoscopic surgery with mass resection. This typical MRI pattern must be a part of the knowledge of the radiologists.
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Affiliation(s)
- Mélanie Mollion
- Department of Radiology B, Strasbourg University Hospital - New Civil Hospital, Strasbourg, 67091 Cedex, France
| | - Aline Host
- Department of Gynecology, Strasbourg University Hospital - Hautepierre Hospital, Strasbourg, 67200 Cedex, France
| | - Emilie Faller
- Department of Gynecology, Strasbourg University Hospital - Hautepierre Hospital, Strasbourg, 67200 Cedex, France
| | - Olivier Garbin
- Department of Gynecology, Strasbourg University Hospital - Hautepierre Hospital, Strasbourg, 67200 Cedex, France
| | - Raluca Ionescu
- Department of Radiology B, Strasbourg University Hospital - New Civil Hospital, Strasbourg, 67091 Cedex, France
| | - Catherine Roy
- Department of Radiology B, Strasbourg University Hospital - New Civil Hospital, Strasbourg, 67091 Cedex, France
- Department of Gynecology, Strasbourg University Hospital - Obstetric Medico-Surgical Center (CMCO), 67303 Schiltigheim Cedex, France
- Corresponding author.
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20
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Wehr M, Lecointre L, Schneider H, Schwartz L, Faller E, Boisramé T, Baldauf JJ, Akladios C. [Outpatient laparoscopic hysterectomy in France: A monocentric randomized trial]. ACTA ACUST UNITED AC 2021; 50:33-39. [PMID: 34509670 DOI: 10.1016/j.gofs.2021.09.003] [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: 05/24/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To demonstrate the feasibility of outpatient laparoscopic hysterectomy using the assessment of post-operative quality of life. METHODS A prospective randomized single-center trial was performed in France between 2013 and 2016. A total of 42 patients needed laparoscopic hysterectomy was included. Postoperative quality of life was assessed using the standardized Euroquol questionnaire. Patients filled the score before the operation and then on the 3rd and 30th postoperative day. Secondary outcomes were assessment of postoperative pain, overall quality of life, analgesic use, and anxiety. The patients were randomized into two groups, group A with a conventional hospital stay of 2 to 3 days and group B with a short stay and a discharge the day after the intervention. RESULTS Twenty-one patients were randomized to group A as well as group B. We did not find any significant differences between the two groups in our study either on our primary outcome or in the seconds ones. On day 3, the average of Euroquol score was 0.68 for group A against 0.50 for group B (P=0.05). Likewise, the scores for postoperative pain were similar with 70.6 in group A and 61.8 in group B (P=0.21). The trend was the same for quality of life score or anxiety. CONCLUSION Our study shows the possibility and the safety of outpatient laparoscopic hysterectomy.
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Affiliation(s)
- M Wehr
- Department of gynecologic surgery, hôpitaux universitaires de Strasbourg, 67091 Strasbourg, France.
| | - L Lecointre
- Department of gynecologic surgery, hôpitaux universitaires de Strasbourg, 67091 Strasbourg, France; I-Cube UMR 7357 laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie, université de Strasbourg, 67081 Strasbourg, France; Institut hospitalo-universitaire (IHU) Institute for Minimally Invasive Hybrid Image-Guided Surgery, université de Strasbourg, 67081 Strasbourg, France.
| | - H Schneider
- Centre hospitalier de Saverne, Saverne et Haguenau, France.
| | - L Schwartz
- Centre hospitalier de Haguenau, Saverne et Haguenau, France.
| | - E Faller
- Department of gynecologic surgery, hôpitaux universitaires de Strasbourg, 67091 Strasbourg, France.
| | - T Boisramé
- Department of gynecologic surgery, hôpitaux universitaires de Strasbourg, 67091 Strasbourg, France.
| | - J-J Baldauf
- Department of gynecologic surgery, hôpitaux universitaires de Strasbourg, 67091 Strasbourg, France.
| | - C Akladios
- Department of gynecologic surgery, hôpitaux universitaires de Strasbourg, 67091 Strasbourg, France.
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21
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Pellerin M, Faller E, Minella C, Garbin O, Host A, Lecointre L, Akladios C. Surgical management of deep pelvic endometriosis in France: Do we need to be a pelvic surgeon to deal with DPE? J Gynecol Obstet Hum Reprod 2021; 50:102158. [PMID: 33945889 DOI: 10.1016/j.jogoh.2021.102158] [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: 07/02/2020] [Revised: 02/11/2021] [Accepted: 04/27/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Endometriosis is a common disease in women, which requires a medical and surgical approach. Surgical societies recommend a multidisciplinary management in tertiary referral centers. The objective of our study is to assess the surgical management of endometriosis in France by studying the surgeons' attitude for bowel and urinary endometriosis. METHODS We sent a survey to french endometriosis surgeons. We did a descriptive analysis and a comparative analysis between surgeons who believe endometriosis surgeons should be considered as "pelvic surgeons", able to treat bowel and urinary involvement. RESULTS We included 90 answers, from gynaecologic surgeons from all over France. Gynaecologic surgeons perform minor bowel and urinary tract surgery, and more complex procedures are performed with digestive or urological surgeon (bowel resection 85% of cases, ureteric resection-anastomosis 84% of cases, ureteric reimplantation 91% of cases). Surgeons considering that gynaecologists should be able to deal with urinary and bowel endometriosis carry out more bowel and urinary procedures. They have an additional training in surgery and perform more endometriosis surgery every year. However, bowel and urinary endometriosis management by gynaecologic surgeons is contested amongst gynaecologists. CONCLUSION To this day, there is no dedicated training in France to coach gynaecologist to perform such procedures. Multidisciplinary approach is essential for quality care, in expert centers. The basic education of gynaecologic surgeons does not allow them to perform complex pelvic surgeries, but qualifications can be gained for these interventions with a special training, and perform a greater number of surgeries.
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Affiliation(s)
- Madeleine Pellerin
- Gynaecology Unit, Hautepierre Hospital, University Hospitals of Strasbourg, 1 avenue Molière, 67000 Strasbourg France
| | - Emilie Faller
- Gynaecology Unit, Hautepierre Hospital, University Hospitals of Strasbourg, 1 avenue Molière, 67000 Strasbourg France.
| | - Chris Minella
- Gynaecology Unit, Hautepierre Hospital, University Hospitals of Strasbourg, 1 avenue Molière, 67000 Strasbourg France
| | - Olivier Garbin
- Gynaecology Unit, Centre medico chirurgical et obstetrical (CMCO), University Hospitals of Strasbourg, 19 rue Louis Pasteur, 67300 Schiltigheim France
| | - Aline Host
- Gynaecology Unit, Centre medico chirurgical et obstetrical (CMCO), University Hospitals of Strasbourg, 19 rue Louis Pasteur, 67300 Schiltigheim France
| | - Lise Lecointre
- Gynaecology Unit, Hautepierre Hospital, University Hospitals of Strasbourg, 1 avenue Molière, 67000 Strasbourg France
| | - Chérif Akladios
- Gynaecology Unit, Hautepierre Hospital, University Hospitals of Strasbourg, 1 avenue Molière, 67000 Strasbourg France
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22
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Lecointre L, Bund V, Sangnier E, Ouldamer L, Bendifallah S, Koskas M, Bolze PA, Collinet P, Canlorbe G, Touboul C, Huchon C, Coutant C, Faller E, Boisramé T, Gantzer J, Demarchi M, Lavoué V, Akladios C. Status of Surgical Management of Borderline Ovarian Tumors in France: are Recommendations Being Followed? Multicentric French Study by the FRANCOGYN Group. Ann Surg Oncol 2021; 28:7616-7623. [PMID: 33904003 PMCID: PMC8521578 DOI: 10.1245/s10434-021-09852-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/23/2021] [Indexed: 11/22/2022]
Abstract
Background Borderline ovarian tumors (BOTs) are tumors with a favorable prognosis but whose management by consensus is essential to limit the risk of invasive recurrence. This study aimed to conduct an inventory of surgical practices for BOT in France and to evaluate the conformity of the treatment according to the current French guidelines. Methods This retrospective, multicenter cohort study included nine referral centers of France between January 2001 and December 2018. It analyzed all patients with serous and mucinous BOT who had undergone surgery. A peritoneal staging in accordance with the recommendations was defined by performance of a peritoneal cytology, an omentectomy, and at least one peritoneal biopsy. Results The study included 332 patients. A laparoscopy was performed in 79.5% of the cases. Treatment was conservative in 31.9% of the cases. The recurrence rate was significantly increased after conservative treatment (17.3% vs 3.1%; p < 0.001). Peritoneal cytology was performed for 95.5%, omentectomy for 83.1%, and at least one biopsy for 82.2% of the patients. The overall recurrence rate was 7.8%, and the recurrence was invasive in 1.2% of the cases. No link was found between the recurrence rate and the conformity of peritoneal staging. The overall rate of staging noncompliance was 22.9%. Conclusion The current standards for BOT management seem to be well applied.
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Affiliation(s)
- Lise Lecointre
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,I-Cube UMR 7357-Laboratoire des Sciences de L'ingénieur, de L'informatique et de L'imagerie, Université de Strasbourg, Strasbourg, France.,Institut Hospitalo-Universitaire (IHU), Institute for Minimally Invasive Hybrid Image-Guided Surgery, Université de Strasbourg, Strasbourg, France
| | - Virginie Bund
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France. .,Laboratoire d'ImmunoRhumatologie Moléculaire, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR_S 1109, Institut thématique interdisciplinaire (ITI) de Médecine de Précision de Strasbourg, Transplantex NG, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.
| | - Eva Sangnier
- Department of Gynecology, Hôpitaux Universitaires de Reims, Reims, France
| | - Lobna Ouldamer
- Department of Gynecology, Hôpital Universitaire de Tours, Tours, France
| | - Sofiane Bendifallah
- Department of Gynaecology and Obstetrics, Hôpital Tenon, AP-HP, Paris, France
| | - Martin Koskas
- Department of Gynecology, Hôpital Bichat, AP-HP, Paris, France
| | | | - Pierre Collinet
- Department of Gynecological Surgery, Hôpital Jeanne De Flandre, CHRU, Lille, France
| | - Geoffroy Canlorbe
- Department of Gynecologic and Breast Surgery and Oncology, Hôpital la Pitié Salpétrière, AP-HP, Paris, France
| | - Cyril Touboul
- Department of Obstetrics and Gynaecology, Centre Hospitalier Intercommunal, Créteil, France
| | - Cyrille Huchon
- Department of Gynecology, Centre Hospitalier de Poissy, Poissy, France
| | - Charles Coutant
- Department of Surgical Oncology, Georges-Francois Leclerc Cancer Center, Dijon, France
| | - Emilie Faller
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Thomas Boisramé
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Justine Gantzer
- Department of Medical Oncology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Martin Demarchi
- Medical Oncology Department, Centre Paul Strauss, Strasbourg, France
| | - Vincent Lavoué
- Department of Gynecologic Surgery, Hôpital Universitaire de Rennes, Rennes, France
| | - Chérif Akladios
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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23
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Jochum F, Aubry G, Pellerin M, Billard C, Faller E, Boisrame T, Lecointre L, Akladios C. Relevance of Laparoscopic Surgery for Ovarian Cancer in Well-selected Patients: A Propensity-matched Comparison With Laparotomy. Anticancer Res 2021; 41:955-965. [PMID: 33517302 DOI: 10.21873/anticanres.14849] [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: 01/04/2021] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM This study aimed to evaluate the relevance of laparoscopy in comparison with laparotomy in the management of ovarian cancer in well-selected patients. PATIENTS AND METHODS Data of consecutive ovarian cancer patients treated by laparoscopy were matched 1:1 to a cohort of patients operated by laparotomy using a propensity score matching. The inclusion criteria included patients who underwent a complete staging procedure in the early stages and optimal upfront or interval debulking surgery for advanced ovarian cancer. RESULTS In total, 153 patients were included. Propensity score matching led to the analysis of 41 well-balanced pairs of patients. For a median follow-up of 34.0 [19.0-64.0] months and 38.0 [24.5-75.0] months, respectively, no difference was found between the two groups in regards to overall survival (p=0.28) and disease-free survival (p=0.89). CONCLUSION In well-selected patients, laparoscopic surgery may be a safe and effective alternative to laparotomy.
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Affiliation(s)
- Floriane Jochum
- Department of Gynecology, Strasbourg University Hospital, Strasbourg, France;
| | - Gabrielle Aubry
- Assistance Publique des Hôpitaux de Paris (AP-HP), Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière University Hospital, Paris, France
| | - Madeleine Pellerin
- Department of Gynecology, Strasbourg University Hospital, Strasbourg, France
| | - Camille Billard
- Department of Gynecology, Strasbourg University Hospital, Strasbourg, France
| | - Emilie Faller
- Department of Gynecology, Strasbourg University Hospital, Strasbourg, France
| | - Thomas Boisrame
- Department of Gynecology, Strasbourg University Hospital, Strasbourg, France
| | - Lise Lecointre
- Department of Gynecology, Strasbourg University Hospital, Strasbourg, France.,I-Cube UMR 7357 - Laboratoire des Sciences de L'ingénieur, de L'informatique et de L'imagerie. Université de Strasbourg, Strasbourg, France.,Institut Hospitalo-Universitaire (IHU), Institute for Minimally Invasive Hybrid Image-Guided Surgery, Université de Strasbourg, Strasbourg, France
| | - Cherif Akladios
- Department of Gynecology, Strasbourg University Hospital, Strasbourg, France
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24
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Pélissié M, Fischbach E, Lecointre L, Faller E, Akladios C. Pudendal Neurolysis by Laparoscopy. J Minim Invasive Gynecol 2020; 28:938. [PMID: 33217560 DOI: 10.1016/j.jmig.2020.11.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 10/28/2020] [Accepted: 11/09/2020] [Indexed: 11/18/2022]
Abstract
STUDY OBJECTIVE To show how pudendal neurolysis can be managed safely with a laparoscopic approach. DESIGN Stepwise demonstration of the technique with narrated video footage. SETTING The pudendal nerve is formed from spinal roots at levels S2, S3, and S4. It passes through the pelvis parallel to the pudendal vein and artery. This nerve exits the pelvis between the sacrospinous and sacrotuberous ligaments then passes through Alcock's canal. It can be compressed and responsible for pain in the gluteal and perineal regions. After confirmation of the diagnosis by positive analgesic block with computed tomography infiltration of the pudendal nerve, surgical decompression may be considered. The usual access procedures are the transglutal and transischiorectal ways. INTERVENTIONS This video shows a total laparoscopic approach for a right pudendal neurolysis. It is a step-by-step didactic video. This technique of decompression of the right pudendal nerve by laparoscopy by means of dissection of the ischiorectal fossa along the right internal obturator muscle, after visualization of the obturator vessels and identification of the pudendal nerve, allowed the section of the right sacrospinous ligament and complete removal with repositioning of the nerve in its path. The nerve was followed until it passed freely through Alcock's canal. The procedure went well and without complications, with clinical improvement on waking up. CONCLUSION Pudendal nerve neurolysis by laparoscopic technique is a reproducible and safe method for treating pudendal neuralgia, allowing good visualization and dissection of the entire pelvis toward the ischiorectal fossa.
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Affiliation(s)
- Mathilde Pélissié
- Department of Gynecological Surgery, The University Hospitals of Strasbourg, Hospital of Hautepierre, Strasbourg, France (all authors).
| | - Elodie Fischbach
- Department of Gynecological Surgery, The University Hospitals of Strasbourg, Hospital of Hautepierre, Strasbourg, France (all authors)
| | - Lise Lecointre
- Department of Gynecological Surgery, The University Hospitals of Strasbourg, Hospital of Hautepierre, Strasbourg, France (all authors)
| | - Emilie Faller
- Department of Gynecological Surgery, The University Hospitals of Strasbourg, Hospital of Hautepierre, Strasbourg, France (all authors)
| | - Chérif Akladios
- Department of Gynecological Surgery, The University Hospitals of Strasbourg, Hospital of Hautepierre, Strasbourg, France (all authors)
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25
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Jochum F, Vermel M, Faller E, Boisrame T, Lecointre L, Akladios C. Three and Five-Year Mortality in Ovarian Cancer after Minimally Invasive Compared to Open Surgery: A Systematic Review and Meta-Analysis. J Clin Med 2020; 9:E2507. [PMID: 32759715 PMCID: PMC7463583 DOI: 10.3390/jcm9082507] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/27/2020] [Accepted: 07/30/2020] [Indexed: 12/24/2022] Open
Abstract
As regards ovarian cancer, the use of minimally invasive surgery has steadily increased over the years. Reluctance persists, however, about its oncological outcomes. The main objective of this meta-analysis was to compare the three and five-year mortality of patients operated by minimally invasive surgery (MIS) for ovarian cancer to those operated by conventional open surgery (OPS), as well as their respective perioperative outcomes. PubMed, Cochrane library and CinicalTrials.gov were systematically searched, using the terms laparoscopy, laparoscopic or minimally invasive in combination with ovarian cancer or ovarian carcinoma. We finally included 19 observational studies with a total of 7213 patients. We found no statistically significant difference for five-year (relative risk (RR) = 0.89, 95% CI 0.53-1.49, p = 0.62)) and three-year mortality (RR = 0.95, 95% CI 0.80-1.12, p = 0.52) between the patients undergoing MIS and those operated by OPS. When five and three-year recurrences were analyzed, no statistically significant differences were also observed. Analysis in early and advanced stages subgroups showed no significant difference for survival outcomes, suggesting oncological safety of MIS in all stages. Whether the surgery was primary or interval debulking surgery in advanced ovarian cancer, did not influence the comparative results on mortality or recurrence. Although the available studies are retrospective, and mostly carry a high risk for bias and confounding, an overwhelming consistency of the evidence suggests the likely effectiveness of MIS in selected cases of ovarian cancer, even in advanced stages. To validate the use of MIS, the development of future randomized interventional studies should be a priority.
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Affiliation(s)
| | | | | | | | | | - Cherif Akladios
- Department of Gynecology, Strasbourg University Hospital, 67000 Strasbourg, France; (F.J.); (M.V.); (E.F.); (T.B.); (L.L.)
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26
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Bund V, Lecointre L, Velten M, Ouldamer L, Bendifallah S, Koskas M, Bolze PA, Collinet P, Canlorbe G, Touboul C, Huchon C, Coutant C, Faller E, Boisramé T, Gantzer J, Demarchi M, Baldauf JJ, Ballester M, Lavoué V, Akladios C. Impact of Lymphadenectomy on Survival of Patients with Serous Advanced Ovarian Cancer After Neoadjuvant Chemotherapy: A French National Multicenter Study (FRANCOGYN). J Clin Med 2020; 9:jcm9082427. [PMID: 32751303 PMCID: PMC7464978 DOI: 10.3390/jcm9082427] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/15/2020] [Accepted: 07/23/2020] [Indexed: 11/24/2022] Open
Abstract
Background: The population of interest to this study comprised individuals with advanced-stage ovarian carcinoma who were exposed to neoadjuvant chemotherapy (NAC) followed by interval debulking surgery (IDS). Those who had not received systematic lymphadenectomy (SL; Group 1) were compared to those who had received SL (Group 2). Outcome measures included progression-free survival (PFS), overall survival (OS), and surgical complications. Methods: This was a retrospective, multicenter cohort study in nine referral centers of France between January 2000 and June 2017. OS analysis using the multivariate Cox regression model was performed. PFS and surgery-related morbidity were analyzed. Results: Of the 255 patients included, 100 were in Group 1 and 155 in Group 2. Patient majority was, on average, younger and less comorbid, with predominant R0 surgery in Group 2. Dindo–Clavien score was similar between the two groups (p = 0.15). Median OS was 26.8 months in Group 2 and 27.6 months in Group 1. SL was not statistically significant on OS (p = 0.7). Median PFS was 18.3 months in Group 2 and 16.6 months in Group 1. SL had positive impact on PFS (p = 0.005). Conclusions: patients who had received SL (Group 2) had significantly higher PFS regardless of node-positivity status when compared to those who had not received SL (Group 1).
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Affiliation(s)
- Virginie Bund
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France; (L.L.); (E.F.); (T.B.); (J.-J.B.); (C.A.)
- Department of Public Health, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France;
- Correspondence: ; Tel.: +33-(0)7-8170-2239
| | - Lise Lecointre
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France; (L.L.); (E.F.); (T.B.); (J.-J.B.); (C.A.)
- I-Cube UMR 7357—Laboratoire des Sciences de L’ingénieur, de L’informatique et de L’imagerie, Université de Strasbourg, 67081 Strasbourg, France
- Institut Hospitalo-Universitaire (IHU), Institute for Minimally Invasive Hybrid Image-Guided Surgery, Université de Strasbourg, 67081 Strasbourg, France
| | - Michel Velten
- Department of Public Health, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France;
| | - Lobna Ouldamer
- Department of Gynecology, Hôpital Universitaire de Tours, 37000 Tours, France;
| | - Sofiane Bendifallah
- Department of Gynaecology and Obstetrics, Hôpital Tenon, AP-HP, 75020 Paris, France;
| | - Martin Koskas
- Department of Gynecology, Hôpital Bichat, AP-HP, 75018 Paris, France;
| | - Pierre-Adrien Bolze
- Gynecological Surgery Service, CHU Lyon-Sud, Pierre-Bénite, 69000 Lyon, France;
| | - Pierre Collinet
- Department of Gynecological Surgery, Hôpital Jeanne De Flandre, CHRU, 59000 Lille, France;
| | - Geoffroy Canlorbe
- Department of Gynecologic and Breast Surgery and Oncology, Hôpital la Pitié Salpétrière, AP-HP, 75013 Paris, France;
| | - Cyril Touboul
- Department of Obstetrics and Gynaecology, Centre Hospitalier Intercommunal, 94000 Créteil, France;
| | - Cyrille Huchon
- Department of Gynecology, Centre Hospitalier de Poissy, 78100 Poissy, France;
| | - Charles Coutant
- Department of Surgical Oncology, Georges-Francois Leclerc Cancer Center, 21000 Dijon, France;
| | - Emilie Faller
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France; (L.L.); (E.F.); (T.B.); (J.-J.B.); (C.A.)
| | - Thomas Boisramé
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France; (L.L.); (E.F.); (T.B.); (J.-J.B.); (C.A.)
| | - Justine Gantzer
- Department of Medical Oncology, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France;
| | - Martin Demarchi
- Medical Oncology Department, Centre Paul Strauss, 67000 Strasbourg, France;
| | - Jean-Jacques Baldauf
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France; (L.L.); (E.F.); (T.B.); (J.-J.B.); (C.A.)
| | - Marcos Ballester
- Department of Gynecologic and Breast Surgery, Groupe Hospitalier Diaconesses Croix, Saint-Simon, 75020 Paris, France;
| | - Vincent Lavoué
- Department of Gynecologic Surgery, Hôpital Universitaire de Rennes, 35000 Rennes, France;
| | - Chérif Akladios
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France; (L.L.); (E.F.); (T.B.); (J.-J.B.); (C.A.)
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Stoll F, Lecointre L, Meyer N, Faller E, Host A, Hummel M, Boisrame T, Akladios C, Garbin O. Randomized Study Comparing a Reusable Morcellator with a Resectoscope in the Hysteroscopic Treatment of Uterine Polyps: The RESMO Study. J Minim Invasive Gynecol 2020; 28:801-810. [PMID: 32681995 DOI: 10.1016/j.jmig.2020.07.007] [Citation(s) in RCA: 3] [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: 03/19/2020] [Revised: 07/09/2020] [Accepted: 07/11/2020] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE To compare a reusable hysteroscopic morcellator and standard resectoscopes in the hysteroscopic management of uterine polyps. DESIGN Single-center randomized prospective single-blind trial (resectoscope-morcellator study). SETTING Centre Médico-chirurgical Obstétrique teaching hospital, Strasbourg University Hospitals, France. PATIENTS All patients presenting with a single endometrial polyp of size 1 cm or larger. INTERVENTIONS After consent, the patients were randomized into 2 groups: hysteroscopic morcellation (HM) group or standard resection (SR) group. Office-based review hysteroscopy was performed 6 weeks to 8 weeks after surgery. Primary end point: time of morcellation or resection. SECONDARY OUTCOMES total operating time (minutes), volume of fluid used (mL), fluid deficit (mL), number of morcellator or resectoscope insertions, operator comfort (visual analog scale: 0 to 10) and quality of vision (0 to 5), perioperative complications, completeness of resection, need to convert to another technique, pain assessment (visual analog scale), and length of hospitalization. At review hysteroscopy, we noted whether the resection or morcellation had been effective and if synechiae were present or absent. Statistical analyses followed Bayesian methods. MEASUREMENTS AND MAIN RESULTS Ninety patients were randomized: 45 in the HM group and 45 in the SR group. The average size of polyps at hysteroscopy was 13.3 mm. Morcellation time was lower than resection time (6.1 minutes vs 9 minutes; p [HM < SR] = .996). This also applied to total operating time (12.7 minutes vs 15.6 minutes; p [HM < SR] = .985), number of device insertions (1.50 vs 6; p [HM < SR] > .999), volume of fluid used (766.9 mL vs 1118.9 mL; p [HM < SR] = .994), and fluid deficit (60.2 mL vs 169.8 mL; p [HM < SR] = .989). Operator comfort was better in the HM group (8.4 vs 7.4; p [HM > SR] = .999) as was visualization (4 vs 3.7; p [HM > SR] = .911, highly probable). Operative complications were higher in the SR group (5 vs 0; p [HM < SR] = .989]. One patient in the SR group died after surgery owing to an anesthetic complication (anaphylactic shock complicated by pulmonary embolism). No differences were noted between the groups for pain assessment, length of hospitalization, and outcome on review hysteroscopy. CONCLUSION The reusable morcellator is quicker, uses less fluid with less deficit and fewer introductory maneuvers, and offers better comfort and visualization than the resectoscope while being as effective for the hysteroscopic treatment of uterine polyps.
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Affiliation(s)
- François Stoll
- Department of Obstetrics and Gynecology (Drs. Stoll, Lecointre, Faller, Host, Hummel, Boisrame, Akladios, and Garbin); Medical Information Department (Dr. Meyer), Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
| | - Lise Lecointre
- Department of Obstetrics and Gynecology (Drs. Stoll, Lecointre, Faller, Host, Hummel, Boisrame, Akladios, and Garbin); Medical Information Department (Dr. Meyer), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Nicolas Meyer
- Department of Obstetrics and Gynecology (Drs. Stoll, Lecointre, Faller, Host, Hummel, Boisrame, Akladios, and Garbin); Medical Information Department (Dr. Meyer), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Emilie Faller
- Department of Obstetrics and Gynecology (Drs. Stoll, Lecointre, Faller, Host, Hummel, Boisrame, Akladios, and Garbin); Medical Information Department (Dr. Meyer), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Aline Host
- Department of Obstetrics and Gynecology (Drs. Stoll, Lecointre, Faller, Host, Hummel, Boisrame, Akladios, and Garbin); Medical Information Department (Dr. Meyer), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Michel Hummel
- Department of Obstetrics and Gynecology (Drs. Stoll, Lecointre, Faller, Host, Hummel, Boisrame, Akladios, and Garbin); Medical Information Department (Dr. Meyer), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Thomas Boisrame
- Department of Obstetrics and Gynecology (Drs. Stoll, Lecointre, Faller, Host, Hummel, Boisrame, Akladios, and Garbin); Medical Information Department (Dr. Meyer), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Cherif Akladios
- Department of Obstetrics and Gynecology (Drs. Stoll, Lecointre, Faller, Host, Hummel, Boisrame, Akladios, and Garbin); Medical Information Department (Dr. Meyer), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Olivier Garbin
- Department of Obstetrics and Gynecology (Drs. Stoll, Lecointre, Faller, Host, Hummel, Boisrame, Akladios, and Garbin); Medical Information Department (Dr. Meyer), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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Blanc F, Lefeuvre C, Floquet A, Chaltiel D, Ray-Coquard IL, Meriaux E, Berton D, Bello D, Guillemet C, Dupre PF, Faller E, Alexandre J, Hardy-Bessard AC, Collard O, Fabbro M, Provansal M, Kalbacher E, Genestie C, Pautier P. Effect of high-dose chemotherapy with autologous stem cell rescue (HDC-aSCR) on outcome in ovarian small-cell carcinoma, hypercalcemic type (SCCOHT): Prospective series from the French Rare Gynecologic Malignant Tumors Network (TMRG). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.6023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6023 Background: Small cell carcinoma of the ovary, hypercalcemic type (SCCOHT), is a rare and rapidly lethal disease affecting young women with over half dying within 2 years of diagnosis. We previously reported improved outcomes with cytoreductive surgery followed by HDC-aSCR in a prospective study, but these encouraging results needed to be confirmed in an independent and larger cohort. Methods: Between 2008 and 2019, out of 44 patients (pts) diagnosed with centrally confirmed SCCOHT in 16 referent centers of the TMRG network, 38 were treated prospectively according to the French recommendations of the network with complete surgery (primary or after neoadjuvant chemotherapy), 4 to 6 cycles of PAVEP chemotherapy (cisplatin, doxorubicin, vepeside, and cyclophosphamide), and for pts with complete response (CR), HDC-aSCR, followed by pelvic radiotherapy. The 6 patients who could not receive PAVEP (unfit or diagnostic delay) relapsed and died rapidly. The primary endpoint was the event-free survival (EFS) in the intention-to-treat cohort. Results: Median age at diagnosis was 33 years (14-76). 13 pts presented with FIGO stage I, 17 stage III and 6 stage IV, 2 unknown. Median follow-up was 55.5 months. 34 patients achieved CR with CT + surgery and 30 received HDC-aSCR (40%, 47% and 10% with stages I, III and IV diseases respectively) and 21 received also pelvic radiotherapy. Median overall and event-free survival was 36.4 and 15.9 months respectively, and 2-years event-free survival rate was 40% (CI95% 25-56). Median OS was respectively not reached, 18 and 9.6 months for FIGO I, III and IV patients. Among the pts (N = 14) who did not receive HDC-aSCR (rapid progression during or after PAVEP), the 2-yr EFS was 0% compared to 50.5% for the 30 patients receiving HDC. In multivariate analysis, HDC was significantly correlated with better outcomes (p < 0.001). For the 21 patients receiving also pelvic radiotherapy, 57% (12/21) are free of recurrence at 4 years. Grades 3/4 adverse events were frequent (78%) but, in most cases, manageable, although one toxic death (3%) occurred during HDC (fungal septic shock). Conclusions: Treatment of SCCOHT, with intensive multimodal therapy, is associated with a 40% 2-yr event-free survival. However, this protocol is associated with significant toxicity and should be restricted to good performance status patient and expert centers.
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Affiliation(s)
| | | | - Anne Floquet
- Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, and Groupe d’Investigateurs Nationaux pour l’Etude des Cancers Ovariens, Bordeaux, France
| | | | | | | | - Dominique Berton
- Groupe d'Investigateurs Nationaux pour l'Étude des Cancers Ovariens (GINECO), Institut de Cancérologie de l'Ouest (ICO) Centre René Gauducheau, Saint Herblain, France
| | | | | | | | | | - Jérôme Alexandre
- Department of Oncology, Paris Descartes University, Cochin-Port-Royal Hospital, AP-HP, Paris, France
| | - Anne-Claire Hardy-Bessard
- GINECO-Centre Armoricain de Radiothérapie d'Imagerie Médicale et d'Oncologie-Hôpital Privé des Côtes d'Armor, Plérin, France
| | - Olivier Collard
- Institut de Cancérologie de la Loire, St. Priest En Jarez, France
| | | | | | | | | | - Patricia Pautier
- GINECO, French Sarcoma Group and Gustave Roussy Cancer Center, Villejuif, France
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Faller E, Lapthorne S, Barry R, Shamile F, Salleh F, Doyle D, O'Halloran D, Prentice M, Sadlier C. The Presentation and Diagnosis of the First Known Community-Transmitted Case of SARS-CoV-2 in the Republic of Ireland. Ir Med J 2020; 113:78. [PMID: 32603572] [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: 06/11/2023]
Abstract
Introduction This case series describes the diagnosis of the first case of community transmission of SARS-CoV-2 in the Republic of Ireland. Cases Case 1: A 25 year old male presented with dyspnoea, cough and high fevers for 4 days. He was commenced on broad-spectrum antimicrobials and oxygen therapy. His respiratory function deteriorated in spite of these measures and he required mechanical ventilation. CT showed left upper lobe consolidation as well as multifocal ground-glass opacification. Case 2: A 43 year-old male presented with headache and was found incidentally to have pneumonia. He was recently diagnosed with pituitary apoplexy secondary to an adenoma with resultant pituitary insufficiency but MRI brain was stable. His respiratory function deteriorated in spite of antibiotics and he required mechanical ventilation. CT showed likely atypical infection with resultant ARDS. Outcome Both underwent nasopharyngeal RT-PCR testing for SARS-CoV-2. Patient 2 was positive. Patient 1 was extubated and made a good recovery. Patient 2 was transferred to another centre for ECMO therapy. He died 27 days after transfer. Conclusion Given the atypical presentations in generally otherwise young and healthy individuals, the decision was made outside of national guidance to perform testing for SARS-CoV-2. This diagnosis had far-reaching implications for the SARS-CoV-2 pandemic within Ireland.
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Affiliation(s)
- E Faller
- Cork University Hospital, Wilton, Cork, Ireland
| | - S Lapthorne
- Cork University Hospital, Wilton, Cork, Ireland
| | - R Barry
- Cork University Hospital, Wilton, Cork, Ireland
| | - F Shamile
- Cork University Hospital, Wilton, Cork, Ireland
| | - F Salleh
- Cork University Hospital, Wilton, Cork, Ireland
| | - D Doyle
- Cork University Hospital, Wilton, Cork, Ireland
| | | | - M Prentice
- Cork University Hospital, Wilton, Cork, Ireland
| | - C Sadlier
- Cork University Hospital, Wilton, Cork, Ireland
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Tissot M, Petry S, Lecointre L, Faller E, Baldauf JJ, Akladios C, Boisrame T. Two Surgical Techniques for Essure Device Ablation: The Hysteroscopic Way and the Laparoscopic Way by Salpingectomy with Tubal Interstitial Resection. J Minim Invasive Gynecol 2019; 26:603. [DOI: 10.1016/j.jmig.2018.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 07/19/2018] [Accepted: 07/20/2018] [Indexed: 11/26/2022]
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Collin V, Schaub M, Faller E, Burel C, Temporal G, Roy C, Exacoustos C, Akladios C, Wattiez A. Preserving Fertility by Treating the 3 Compartments: Laparoscopic Approach to Deep Infiltrating Endometriosis. J Minim Invasive Gynecol 2018; 26:804. [PMID: 30195079 DOI: 10.1016/j.jmig.2018.08.026] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 08/06/2018] [Accepted: 08/25/2018] [Indexed: 10/28/2022]
Abstract
STUDY OBJECTIVE To describe a laparoscopic technique for the resection of deep endometriosis, treating the 3 compartments. DESIGN Educational video. SETTING Tertiary referral center in Strasbourg, France PATIENT: A 37-year-old primiparous woman. INTERVENTION Adenomyomectomy, partial cystectomy, and bowel resection. Fertility preservation was mandatory because of the patient's desire for future pregnancy. MEASUREMENTS AND MAIN RESULTS A 37-year-old primiparous woman presented with main symptoms of dysmenorrhea and dyspareunia associated with pollakiuria and macroscopic menstrual hematuria (with emission of endometriotic tissue on analysis). She also complained of dyschezia. Magnetic resonance imaging revealed an endometriotic nodule in the vesicouterine space with an involvement of the anterior wall of the uterus and a suspicion of bladder adenomyosis. There were lateral spicules attracting the ovaries toward the midline and an infiltration of the round ligaments and nodules related to the rectovaginal space's endometriosis. A possible invasion was noted underneath the rectal mucosa. The patient expressed her desire preserve fertility. The local institutional review board has approved the video. Initially, an ultrasonography was performed showing the adenomyoma invading the bladder. The second step was a cystoscopic evaluation by means of a double J probe and a bladder catheter. After surgery the bladder catheter was left in place for 15 days and the double J stents for 6 weeks. The first step was the dissection of the vesicouterine space to dissect the anterior adenomyoma from the bladder. A partial cystectomy was then performed to remove the bladder nodule. The adenomyoma was resected at its uterine portion and the uterus sutured. Surgery was then performed in the posterior compartment. Ureterolysis was performed bilaterally, and the pararectal fossas were then opened. The rectovaginal space was dissected. A rectosigmoid resection was mandatory to remove the bowel nodule. Patient follow-up included regular consultations and a hysterosonography at 6 weeks after surgery. Hysterosonography demonstrated an adequate patency. No adhesions to the uterus were found. We recommended to wait for 6 months to allow pregnancy according to the department's protocols. A clinical improvement was observed. Today, at 8 months she has not attempted pregnancy. CONCLUSIONS A complete surgery is feasible for severe and deep endometriosis with a multicompartmental disease, using a laparoscopic approach aiming to preserve fertility.
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Affiliation(s)
- Virginie Collin
- Service de Chirurgie Gynécologique, (Drs. Collin, Schaub, Faller, Akladios, and Wattiez).
| | - Marie Schaub
- Service de Chirurgie Gynécologique, (Drs. Collin, Schaub, Faller, Akladios, and Wattiez)
| | - Emilie Faller
- Service de Chirurgie Gynécologique, (Drs. Collin, Schaub, Faller, Akladios, and Wattiez)
| | - Christopher Burel
- Département WebSurg (Mr. Burel and Temporal), Université virtuelle de l'IRCAD, Strasbourg, France
| | - Guy Temporal
- Département WebSurg (Mr. Burel and Temporal), Université virtuelle de l'IRCAD, Strasbourg, France
| | - Catherine Roy
- Service de Radiologie, (Dr. Roy), Hôpitaux Universitaires, Strasbourg, France
| | - Caterina Exacoustos
- Département de Biomédecine et Prévention (Dr. Exacoustos), Clinique de Gynécologie et Obstétrique, Université de Rome "Tor Vergata", Rome, Italy
| | - Cherif Akladios
- Service de Chirurgie Gynécologique, (Drs. Collin, Schaub, Faller, Akladios, and Wattiez)
| | - Arnaud Wattiez
- Service de Chirurgie Gynécologique, (Drs. Collin, Schaub, Faller, Akladios, and Wattiez)
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Schaub M, Lecointre L, Faller E, Boisramé T, Baldauf JJ, Akladios CY. Transvaginal Resection of an Infected Sacrocolpopexy Mesh by Single-Port Trocar. J Minim Invasive Gynecol 2018; 25:391-392. [DOI: 10.1016/j.jmig.2017.09.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 09/13/2017] [Accepted: 09/23/2017] [Indexed: 11/16/2022]
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Mahgoub S, Gabriele V, Faller E, Langer B, Wattiez A, Lecointre L, Akladios C. Cesarean Scar Ectopic Pregnancy: Laparoscopic Resection and Total Scar Dehiscence Repair. J Minim Invasive Gynecol 2018; 25:297-298. [DOI: 10.1016/j.jmig.2017.01.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 01/17/2017] [Accepted: 01/29/2017] [Indexed: 10/20/2022]
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Faller E, Baldauf JJ, Becmeur F, Lehn A, Akladios CY, Lecointre L. Laparoscopic Management of a Rudimentary Uterine Horn. J Minim Invasive Gynecol 2017; 25:769-770. [PMID: 29133151 DOI: 10.1016/j.jmig.2017.10.027] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 10/19/2017] [Accepted: 10/24/2017] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE To demonstrate a technique of laparoscopic management of a rudimentary horn in a 12-year-old girl. DESIGN A step-by-step explanation of the surgery using a video (instructive video) approved by the local institutional review board. SETTING A university hospital (University Hospital of Strasbourg, Strasbourg, France). PATIENT A 12-year-old girl with a uterine rudimentary horn. INTERVENTION We describe a case of a 12-year-old girl who had no medical history. She had her first menstruation at 11 years old with major left pelvic pain occurring each month. Ultrasonography showed a duplication of the uterus with a liquid collection on the left side; this type of malformation is called an accessory and cavitated uterine mass. Medical treatment was initiated with progestin. Magnetic resonance imaging showed a left noncommunicating rudimentary horn with a unicornuate uterus. No other malformation was present, particularly in the kidneys. A primary vaginal endoscopy was performed showing a single cervix without vaginal malformation. It was decided to perform a laparoscopic excision of the left rudimentary horn. We placed a 10-mm optical port into the umbilicus and 3 accessory 5-mm trocars. Evaluation of the abdominal cavity showed 2 normal adnexas with normal ovaries. We decided to start with a left salpingectomy using the Ligasure device (Medtronic, Minneapolis, MN), staying close to the tube to preserve ovarian vascularization. The remnant fimbria must be removed to avoid cancerization. Then, the vesicouterine septum was divided until we reached the cervix to dissect the bladder from the rudimentary horn. The broad ligament was fenestrated in order to push the left ureter laterally .The utero-ovarian pedicle was transected with the Ligasure device; the left ovary was preserved and vascularized by the left infundibulopelvic ligament. We then dissected the left uterine artery. The posterior peritoneum was opened. The resection of the rudimentary horn was performed by means of a monopolar hook. The dissection was performed slowly with selective coagulation until we reached the cavity of the horn, with old blood flowing out. The entire cavity was removed, and we confirmed the absence of communication with the other part of the uterus. Uterine reconstruction was performed with inverted separated stiches of a 2-0 braided suture, and, finally, an antiadhesion barrier was placed. CONCLUSIONS Laparoscopic management of a uterine rudimentary horn is feasible with satisfactory uterine reconstruction. This is not the first case of this surgery performed by laparoscopy. A similar case has been published in 2015 [1], and recently another video [2] has been published describing 2 other cases.
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Affiliation(s)
- Emilie Faller
- Gynecologic Surgery Unit and Pediatric Surgery Unit, Hautepierre Universitary Hospital, Strasbourg, France.
| | - Jean Jacques Baldauf
- Gynecologic Surgery Unit and Pediatric Surgery Unit, Hautepierre Universitary Hospital, Strasbourg, France
| | - François Becmeur
- Gynecologic Surgery Unit and Pediatric Surgery Unit, Hautepierre Universitary Hospital, Strasbourg, France
| | - Anne Lehn
- Gynecologic Surgery Unit and Pediatric Surgery Unit, Hautepierre Universitary Hospital, Strasbourg, France
| | - Cherif Youssef Akladios
- Gynecologic Surgery Unit and Pediatric Surgery Unit, Hautepierre Universitary Hospital, Strasbourg, France
| | - Lise Lecointre
- Gynecologic Surgery Unit and Pediatric Surgery Unit, Hautepierre Universitary Hospital, Strasbourg, France
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Schaub M, Lecointre L, Faller E, Boisramé T, Wattiez A, Baldauf JJ, Akladios C. Retroperitoneal Lumboaortic Lymphadenectomy Using a Vessel-Sealing Device in 10 Steps. J Minim Invasive Gynecol 2017; 25:765-766. [PMID: 29079464 DOI: 10.1016/j.jmig.2017.10.019] [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: 09/02/2017] [Revised: 10/10/2017] [Accepted: 10/17/2017] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE Lumboaortic lymphadenectomy is frequently performed in the surgical management of different gynecologic pelvic malignancies: cervical endometrial and ovarian cancer. The retroperitoneal access presents a real advantage, allowing direct access to vascular axes, thus avoiding bowel segments. The use of a vessel-sealing device could facilitate the technique by providing an ergonomic alternative to conventional tools such as a bipolar grasper and scissors. Here the surgical technique of laparoscopic retroperitoneal lumboaortic lymphadenectomy using a vessel-sealing device in 10 steps is described. DESIGN Educative video (Canadian Task Force classification III). SETTING Tertiary referral center in Strasbourg, France. PATIENTS Women undergoing lumboaortic lymphadenectomy. INTERVENTION Laparoscopic retroperitoneal lumboaortic lymphadenectomy using a vessel-sealing device. The local institutional review board approved the video. MEASUREMENTS AND MAIN RESULTS The surgeon and assistant are positioned on the left of the patient and the column is placed in front. After peritoneal exploration 3 trocars are introduced in the left flank according to a very precise arrangement. We use a camera scope with a zero-degree view angle. After development of the extraperitoneal space and identification of the vascular landmarks, lymphadenectomy using a vessel-sealing device involves several steps in an anticlockwise direction starting from the left common iliac group. We first start with the lateroaortic group of lymph nodes. We then continue with the preaortic, interaorticocaval, and precaval supramesenteric group. After that, we perform the inframesenteric dissection of lymph nodes, the bifurcation of the aorta, and finally the right common iliac group. At the end of the procedure, in the absence of signs of metastatic lymph nodes, we open the peritoneum. CONCLUSION Retroperitoneal lumboaortic lymphadenectomy using a vessel-sealing device is useful because of better ergonomics of the multitasking instrument, avoiding alternating between scissors and bipolar forceps. The surgeon will be able to use both hands for exposure and for surgery. The presence of a metastatic ganglion is an important and decisive factor in the choice of adjuvant or neoadjuvant management of cancers, especially for cervical cancer.
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Affiliation(s)
- Marie Schaub
- Service de Chirurgie Gynécologique, Hôpitaux Universitaires, Strasbourg, France.
| | - Lise Lecointre
- Service de Chirurgie Gynécologique, Hôpitaux Universitaires, Strasbourg, France
| | - Emilie Faller
- Service de Chirurgie Gynécologique, Hôpitaux Universitaires, Strasbourg, France
| | - Thomas Boisramé
- Service de Chirurgie Gynécologique, Hôpitaux Universitaires, Strasbourg, France
| | - Arnaud Wattiez
- Service de Chirurgie Gynécologique, Hôpitaux Universitaires, Strasbourg, France
| | | | - Cherif Akladios
- Service de Chirurgie Gynécologique, Hôpitaux Universitaires, Strasbourg, France
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Martel-Billard C, Goillot V, Jacquin A, Lecointre L, Faller E, Boisramé T, Baldauf JJ, Akladios CY, Wattiez A. Laparoscopic Transperitoneal Para-Aortic Lymphadenectomy in 10 Steps. J Minim Invasive Gynecol 2017; 25:386-387. [PMID: 28965981 DOI: 10.1016/j.jmig.2017.09.017] [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: 08/24/2017] [Revised: 09/18/2017] [Accepted: 09/23/2017] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVE Laparoscopic transperitoneal lymphadenectomy has a few advantages. First, it is a minimally invasive approach, and the transperitoneal approach is also the best option when intra-abdominal surgery is indicated. Although the procedure was described more than 2 decades ago, there is a lack of diffusion of the technique. The main objective of this video is standardization and a simple description of the technique. We described this procedure in 10 logical steps, which should help to understand and perform this procedure. METHODS This video presents a systematic approach to transperitoneal lumboaortic lymphadenectomy, which is clearly divided in 10 steps ordered in a counterclockwise direction. RESULTS The 10 steps are as follows: step 1, retroperitoneal access; step 2, creating a space for subsequent lymphadenectomy and identification of anatomic landmarks; step 3, left common iliac lymph node dissection; step 4, right common iliac lymph node dissection; step 5, presacral lymph node dissection; step 6, lateroaortal lymph node dissection; step 7, laterocaval lymph node dissection; step 8, aortocaval lymph node dissection; step 9, vaginal extraction of bags with specimens; and step 10, vaginal suture. CONCLUSIONS Laparoscopic transperitoneal access to lumboaortic lymph nodes is an effective method of lymphadenectomy, which may bring benefits to a patient and physician. The presented 10 steps help to perform each part of surgery in a logical sequence, making the procedure ergonomic and easier to adopt and learn. Standardization of laparoscopic techniques could help to reduce the learning curve.
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Affiliation(s)
| | - Vinciane Goillot
- Gynecology Unit, Hautepierre Universitary Hospital, Strasbourg, France
| | - Alice Jacquin
- Gynecology Unit, Hautepierre Universitary Hospital, Strasbourg, France
| | - Lise Lecointre
- Gynecology Unit, Hautepierre Universitary Hospital, Strasbourg, France
| | - Emilie Faller
- Gynecology Unit, Hautepierre Universitary Hospital, Strasbourg, France
| | - Thomas Boisramé
- Gynecology Unit, Hautepierre Universitary Hospital, Strasbourg, France
| | | | | | - Arnaud Wattiez
- Gynecology Unit, Hautepierre Universitary Hospital, Strasbourg, France
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Tissot M, Lecointre L, Faller E, Afors K, Akladios C, Audebert A. Clinical presentation of endometriosis identified at interval laparoscopic tubal sterilization: Prospective series of 465 cases. J Gynecol Obstet Hum Reprod 2017; 46:647-650. [DOI: 10.1016/j.jogoh.2017.05.003] [Citation(s) in RCA: 11] [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: 02/19/2017] [Revised: 05/01/2017] [Accepted: 05/09/2017] [Indexed: 10/19/2022]
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Bel S, Billard C, Godet J, Viviani V, Akladios C, Host A, Faller E, Boisrame T, Hummel M, Baldauf JJ, Lecointre L, Garbin O. Risk of malignancy on suspicion of polyps in menopausal women. Eur J Obstet Gynecol Reprod Biol 2017; 216:138-142. [DOI: 10.1016/j.ejogrb.2017.07.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 06/27/2017] [Accepted: 07/08/2017] [Indexed: 12/13/2022]
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Schaub M, Lecointre L, Faller E, Boisramé T, Baldauf JJ, Wattiez A, Akladios CY. Laparoscopic Sacral Colpopexy: The "6-Points" Technique. J Minim Invasive Gynecol 2017; 24:1081-1082. [PMID: 28435129 DOI: 10.1016/j.jmig.2017.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 03/22/2017] [Revised: 04/01/2017] [Accepted: 04/08/2017] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE To illustrate laparoscopic sacral colpopexy for pelvic organ prolapse, a new method using a simplified mesh fixation technique, with only 6 fixing points. DESIGN Step-by-step explanation of the surgery using video (educative video). The video was approved by the local institutional review board. SETTING University Hospital of Strasbourg, France (Canadian Task Force Classification III). PATIENTS Women with multicompartment prolapse. INTERVENTION We first dissected the promontorium and vertically incise the posterior parietal peritoneum on the right pelvic sidewall up the pouch of Douglas. We then dissect the rectovaginal septum up to the anal cap, laterally exposing the puborectalis muscle on each side. Middle rectal vessels can be coagulated and cut without increasing the risk of digestive disorders (especially constipation), but it is preferable to conserve them if the space is sufficient for suture. Then, we dissect the vesicovaginal space and realized the subtotal hysterectomy. Finally, we realized the fastening of the anterior and posterior meshes. The particularity is that we performed only 6 points for fixing the meshes: 1 on the puborectalis muscle on each side without tension (to reduce the risk of mesh contracture, dyspareunia, and chronic pelvic pain), 1 for the fixing of the anterior mesh on the anterior vaginal wall at the level of the bladder neck, and 1 on each side of the cervix for the reconstitution of the pericervical ring gathering together the anterior mesh, the pubocervical fascia, and the insertion of the uterosacral ligament at the level of the cervix and the posterior mesh. The sixth stitch fastened 1 of 2 meshes to the anterior paravertebral ligament at the level of the sacral promontory. We finished with the peritonization. MAIN RESULTS The duration of surgery lasts approximately 120 minutes in well-experienced hands. Based on our experience the 6-point technique was relatively simple (few laparoscopic stiches) with few operative difficulties and was also associated with a low rate of reintervention. CONCLUSION Surgical management of middle compartment prolapse could be performed quickly and efficiently under laparoscopy with the "6-points" technique.
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Affiliation(s)
- Marie Schaub
- Service de Chirurgie Gynécologique, Hôpitaux Universitaires, Strasbourg, France.
| | - Lise Lecointre
- Service de Chirurgie Gynécologique, Hôpitaux Universitaires, Strasbourg, France
| | - Emilie Faller
- Service de Chirurgie Gynécologique, Hôpitaux Universitaires, Strasbourg, France
| | - Thomas Boisramé
- Service de Chirurgie Gynécologique, Hôpitaux Universitaires, Strasbourg, France
| | | | - Arnaud Wattiez
- Service de Chirurgie Gynécologique, Hôpitaux Universitaires, Strasbourg, France
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Brossat H, Faller E, Marot-Richter A, Metten MA, Wattiez A, Langer B, Akladios C. The 6 points technique: the simple laparoscopic sacrocolpopexy in the Management of Multicompartement Pelvic Organ Prolapse. Eur J Obstet Gynecol Reprod Biol 2016. [DOI: 10.1016/j.ejogrb.2016.07.353] [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: 11/28/2022]
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Bautrant E, Quintas-Marquès L, Eggermont J, Faller E, Weber P, Poirson E, Boyer R, Carbone P. 18. Use of botulinum neurotoxin type A (Xeomin) injections to the perineal muscles in cases of perineal pain and dysfunction associated with pelvic floor muscle overcontraction and myalgia. Toxicon 2015. [DOI: 10.1016/j.toxicon.2014.11.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Akladios C, Messori P, Faller E, Puga M, Afors K, Leroy J, Wattiez A. Is ileostomy always necessary following rectal resection for deep infiltrating endometriosis? J Minim Invasive Gynecol 2014; 22:103-9. [PMID: 25109779 DOI: 10.1016/j.jmig.2014.08.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [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: 07/07/2014] [Revised: 07/31/2014] [Accepted: 08/01/2014] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To verify the hypothesis that in most patients bowel segmental resection to treat endometriosis can be safely performed without creation of a stoma and to discuss the limitations of this statement. DESIGN Retrospective study (Canadian Task Force classification III). SETTING Tertiary referral center. PATIENTS Forty-one women with sigmoid and rectal endometriotic lesions who underwent segmental resection. INTERVENTION Segmental resection procedures performed between 2004 and 2011. Patient demographic, operative, and postoperative data were compared. MEASUREMENTS AND MAIN RESULTS Sigmoid resection was performed in 6 patients (15%), and rectal anterior resection in 35 patients (high in 21 patients [51%], and low, i.e., <10 cm from the anal verge, in 14 [34%]). In 4 patients a temporary ileostomy was created. There was 1 anastomotic leak (2.4%), in a patient with an unprotected anastomosis, which was treated via laparoscopic surgery and creation of a temporary ileostomy. Other postoperative complications included hemoperitoneum, pelvic abscess, pelvic collection, and a ureteral vaginal fistula, in 1 patient each (all 2.4%). CONCLUSION A protective stoma may be averted in low anastomosis if it is >5 cm from the anal verge and there are no adverse intraoperative events.
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Affiliation(s)
- Cherif Akladios
- Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France; IRCAD, Strasbourg, France.
| | - Pietro Messori
- Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France; IRCAD, Strasbourg, France
| | - Emilie Faller
- Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France; IRCAD, Strasbourg, France
| | - Marco Puga
- Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France; IRCAD, Strasbourg, France
| | - Karolina Afors
- Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France; IRCAD, Strasbourg, France
| | - Joel Leroy
- Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France; IRCAD, Strasbourg, France
| | - Arnaud Wattiez
- Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France; IRCAD, Strasbourg, France
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Akladios C, Faller E, Afors K, Puga M, Albornoz J, Redondo C, Leroy J, Wattiez A. Totally laparoscopic intracorporeal anastomosis with natural orifice specimen extraction (NOSE) techniques, particularly suitable for bowel endometriosis. J Minim Invasive Gynecol 2014; 21:1095-102. [PMID: 24858985 DOI: 10.1016/j.jmig.2014.05.003] [Citation(s) in RCA: 5] [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: 01/08/2014] [Revised: 03/16/2014] [Accepted: 05/14/2014] [Indexed: 01/31/2023]
Abstract
The objective of this retrospective study was to evaluate the feasibility of natural orifice specimen extraction (NOSE) techniques in 41 patients undergoing bowel resection for treatment of deep infiltrating endometriosis. In all patients laparoscopic treatment of rectovaginal endometriosis with bowel resection had been performed. In 32 patients the classic approach was adopted (group 1), and in 9 a NOSE technique was performed (group 2). Demographic, operative, and postoperative data were compared. Statistical analyses were performed using SPSS software, version 16.0. When needed, qualitative variables were compared using the χ(2) test or the Fisher exact test. Quantitative variables using the t-test were used. The threshold of statistical significance was set at p = .05. No statistically significant difference was observed between the 2 groups. Eight complications (19.5%) were observed, 2 minor (4.8%) and 6 major (14.6%). Of major complications, 2 were observed in the NOSE group (n = 2; 22.2%). It was concluded that the NOSE technique is a feasible approach in patients undergoing bowel resection for treatment of deep infiltrating endometriosis.
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Affiliation(s)
- Cherif Akladios
- Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France.
| | - Emilie Faller
- Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France
| | - Karolina Afors
- Institut de Recherche Contre le Cancer de l'Appareil Digestif, Strasbourg, France
| | - Marco Puga
- Institut de Recherche Contre le Cancer de l'Appareil Digestif, Strasbourg, France
| | - Jaime Albornoz
- Institut de Recherche Contre le Cancer de l'Appareil Digestif, Strasbourg, France
| | - Christina Redondo
- Institut de Recherche Contre le Cancer de l'Appareil Digestif, Strasbourg, France
| | - Joel Leroy
- Institut de Recherche Contre le Cancer de l'Appareil Digestif, Strasbourg, France
| | - Arnaud Wattiez
- Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France
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Faller E, Albornoz J, Messori P, Leroy J, Wattiez A. A new technique of laparoscopic intracorporeal anastomosis for transrectal bowel resection with transvaginal specimen extraction. J Minim Invasive Gynecol 2013; 20:333. [PMID: 23659753 DOI: 10.1016/j.jmig.2013.02.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 02/12/2013] [Accepted: 02/13/2013] [Indexed: 02/08/2023]
Abstract
STUDY OBJECTIVE To show a new technique of laparoscopic intracorporeal anastomosis for transrectal bowel resection with transvaginal specimen extraction, a technique particularly suited for treatment of bowel endometriosis. DESIGN Step-by-step explanation of the technique using videos and pictures (educative video). SETTING Endometriosis may affect the bowel in 3% to 37% of all endometriosis cases. Bowel endometriosis affects young women, without any co-morbidities and in particular without any vascular disorders. In addition, affected patients often express a desire for childbearing. Radical excision is sometimes required because of the impossibility of conservative treatment such as shaving, mucosal skinning, or discoid resection. Bowel endometriosis should not be considered a cancer, and consequently maximal resection is not the objective. Rather, the goal would be to achieve functional benefit. As a result, resection must be as economic and cosmetic as possible. The laparoscopic approach has proved its superiority over the open technique, although mini-laparotomy is generally performed to prepare for the anastomosis. INTERVENTIONS Total laparoscopic approach in patients with partial bowel stenosis, using the vagina for specimen extraction. CONCLUSION This technique of intracorporeal anastomosis with transvaginal specimen extraction enables a smaller resection and avoidance of abdominal incision enlargement that may cause hernia, infection, or pain. When stenosis is partial, this technique seems particularly suited for treatment of bowel endometriosis requiring resection. If stenosis is complete, the anvil can be inserted above the lesion transvaginally.
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Affiliation(s)
- Emilie Faller
- Service de Chirurgie Gynecologique, Clinique Axium, Aix en Provence, France.
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Messori P, Faller E, Albornoz J, Leroy J, Wattiez A. Laparoscopic sigmoidectomy for endometriosis with transanal specimen extraction. J Minim Invasive Gynecol 2013; 20:412. [PMID: 23618589 DOI: 10.1016/j.jmig.2013.02.025] [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: 02/26/2013] [Accepted: 02/26/2013] [Indexed: 02/07/2023]
Abstract
STUDY OBJECTIVE To describe a more conservative and less invasive surgical approach to laparoscopic colorectal segmental resection for treatment of endometriosis. DESIGN Video of elective sigmoidectomy to treat colorectal endometriosis. SETTING Tertiary referral center for laparoscopic gynecologic surgery at the University Hospitals of Strasbourg, France. PATIENT A 29-year-old woman with dysmenorrhea, constipation, and cyclic diarrhea and two sigmoid endometriotic lesions evident at colonoscopy. INTERVENTION The conservative surgical strategy, possible in cases of benign lesions such as endometriosis, consists of dividing the mesentery close to the digestive tract to preserve the vascular-lymphatic vessels and the surrounding sympathetic and parasympathetic nerves. The less invasive approach consists of natural orifice specimen extraction via the transanal route. MEASUREMENTS AND MAIN RESULTS The postoperative course was favorable. The conservative technique enables preservation of the superior rectal vessels, which contribute to 80% of the vascularization of the rectum, to maintain the best vascularization, essential for intestinal anastomosis. Transanal specimen extraction maximizes the benefits of laparoscopy by sparing the abdominal wall from incision and its associated complications. CONCLUSION A conservative surgical approach should be used in segmental bowel resection for treatment of endometriosis. Moreover, the segmental bowel resection can be safely performed with transanal specimen extraction, with great advantages for the patient.
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Affiliation(s)
- Pietro Messori
- Department of Gynecologic Surgery, Strasbourg University Hospitals, IRCAD/EITS, Strasbourg, France.
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Wattiez A, Puga M, Albornoz J, Faller E. Surgical strategy in endometriosis. Best Pract Res Clin Obstet Gynaecol 2013; 27:381-92. [PMID: 23340291 DOI: 10.1016/j.bpobgyn.2012.12.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 12/02/2012] [Indexed: 01/17/2023]
Abstract
Endometriosis is a common disease affecting young women. Its clinical manifestations include pain and infertility, and it can dramatically affect quality of life. Treatments should be tailored to address the wishes of women according to the specific characteristics of the disease. Although many questions remain unanswered, strong evidence supports the use of laparoscopic surgery to improve pain and infertility. The systematisation of strategy is essential to make surgery more reproducible, safer and less time-consuming. Nevertheless, even in the most expert hands, complications may occur. Further investigations are needed to compare the different approaches. Outcomes must, however, include pain, fertility, organ dysfunction, and quality of life.
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Faller E, Garbin O, Hummel M, Nisand I. Retrograde Tubal Catheterization: About a Retrospective Study of 103 Cases. J Minim Invasive Gynecol 2012. [DOI: 10.1016/j.jmig.2012.08.153] [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]
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Albornoz J, Faller E, Messori P, Wattiez A. Left Ureterovaginal Fistula Repair after Partial Ureteral Resection and End-to-End Anastomosis for Deep Infiltrating Endometriosis (DIE). J Minim Invasive Gynecol 2012. [DOI: 10.1016/j.jmig.2012.08.646] [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: 11/27/2022]
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Albornoz J, Faller E, Messori P, Wattiez A. Fertility Outcome after Excision of Deep Infiltration Endometriosis with Segmental Bowel Resection and Primary Anastomosis. J Minim Invasive Gynecol 2012. [DOI: 10.1016/j.jmig.2012.08.156] [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: 10/27/2022]
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Messori P, Faller E, Albornoz J, Leroy J, Wattiez A. Laparoscopic Sigmoidectomy for Endometriosis with Transanal Specimen Extraction. J Minim Invasive Gynecol 2012. [DOI: 10.1016/j.jmig.2012.08.647] [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: 10/27/2022]
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