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  1. Article ; Online: Deep infiltrating endometriosis: Laparoscopic nerve-sparing surgery and use of neutral argon plasma.

    Buttignol, Megane / Faller, Emilie / Lecointre, Lise / Boisrame, Thomas / Akladios, Cherif

    Journal of gynecology obstetrics and human reproduction

    2023  Volume 52, Issue 5, Page(s) 102573

    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, ... ...

    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.
    MeSH term(s) Female ; Humans ; Adult ; Endometriosis/complications ; Plasma Gases ; Laparoscopy/methods ; Uterus/pathology ; Pelvic Pain/etiology ; Pelvic Pain/surgery
    Chemical Substances Plasma Gases
    Language English
    Publishing date 2023-03-11
    Publishing country France
    Document type Case Reports
    ISSN 2468-7847
    ISSN (online) 2468-7847
    DOI 10.1016/j.jogoh.2023.102573
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Urological procedures performed by gynecologists: Activity profile in a gynecological surgery department, 10-year observation cohort.

    Lecointre, Lise / Buttignol, Megane / Faller, Emilie / Boisrame, Thomas / Martel, Camille / Host, Aline / Gabriele, Victor / Akladios, Chérif

    European journal of obstetrics, gynecology, and reproductive biology

    2023  Volume 288, Page(s) 204–210

    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 ... ...

    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.
    MeSH term(s) Humans ; Female ; Endometriosis/surgery ; Endometriosis/etiology ; Gynecologists ; Gynecologic Surgical Procedures/methods ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Postoperative Complications/surgery ; Ureter ; Pelvic Neoplasms ; Retrospective Studies ; Genital Neoplasms, Female/surgery ; Treatment Outcome ; Laparoscopy/methods
    Language English
    Publishing date 2023-07-29
    Publishing country Ireland
    Document type Observational Study ; Journal Article
    ZDB-ID 190605-7
    ISSN 1872-7654 ; 0301-2115 ; 0028-2243
    ISSN (online) 1872-7654
    ISSN 0301-2115 ; 0028-2243
    DOI 10.1016/j.ejogrb.2023.07.015
    Database MEDical Literature Analysis and Retrieval System OnLINE

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