RESUMEN

STUDY OBJECTIVE: To evaluate whether laparoendoscopic single-site surgery (LESS) offers advantages over conventional laparoscopy (CL) in benign adnexal surgery. DESIGN: Randomized controlled study. SETTING: Gynecology-Obstetrics Unit of the University Hospital of the Conception in Marseille, France. PATIENTS: Patients older than 18 years requiring ovarian cystectomy or salpingo-oophorectomy by laparoscopy for symptomatic ovarian cysts requiring benign or prophylactic surgery. INTERVENTIONS: In the case of ovarian cysts, premenopausal patients typically undergo a unilateral cystectomy, whereas postmenopausal patients undergo a unilateral or bilateral salpingo-oophorectomy upon a patient's request. In cases requiring prophylactic surgery, a bilateral salpingo-oophorectomy was performed. All participants were randomly assigned to either the LESS or the CL group. MEASUREMENTS AND MAIN RESULTS: Patients in both groups reported similar levels of pain at 24 hours: Simple Numerical Scale was 1.3 (standard deviation, 1.5) in the LESS group vs 1.7 (standard deviation, 1.5) in the CL group (p = .12), and there were no significant differences in postoperative pain at 2 hours, 4 hours, 6 hours, and 7 days. Furthermore, there was no difference in analgesic consumption. Regarding intraoperative criteria, the only difference was the longer operating time in the LESS group than the CL group. We also found that patients' satisfaction with their scar at 1 month may be higher with LESS than with CL. CONCLUSION: There was no significant difference between the 2 techniques in postoperative pain, although the LESS technique necessitated a longer operative time than the CL technique, while providing better aesthetic result patients.

Asunto(s)

RESUMEN

The aim of this study was to analyze the use of the diagnostic B-scan ultrasound. Should it be made accessible to all surgical centers in Sub-Saharan Africa in order to (i) avoid unnecessary cataract surgery and (ii) evaluate extraocular pathology? This study was conducted in Kinshasa from 2006 to 2019. Three hundred and twenty-three patients were included and separated into two groups. Group 1 included 262 patients with dense cataract. Group 2 consisted of 61 patients with pathologies of the ocular adnexa, and all were examined with a B-scan ultrasound. In group 1, there were 437 systematically screened eyes. Three hundred and ninety-eight eyes (91.08%) showed no abnormalities, 13 (2.97%) retinal detachments were identified, and 15 (3.43%) demonstrated a detached posterior hyaloid membrane. In the second group, 61 patients were examined (group 2). In 20 of them, surgery was performed for biopsy, tumor excision, mucoceles drainage, and palliative treatment. The need for routine B-scan examinations in dense cataract patients seems to be limited and can most likely be replaced by a thorough application of locally available examination techniques. B-scan application is recommended to manage orbital patients in the most cost-effective way.

RESUMEN

Background and objectives: An expert's subjective assessment is still the most reliable evaluation of adnexal pathology, thus raising the need for methods less dependent on the examiner's experience. The aim of this study was to evaluate the performance of standardized methods when applied by examiners with different levels of experience and to suggest the most suitable method for less-experienced gynecologists. Materials and methods: This single-center retrospective study included 50 cases of histologically proven first-time benign or malignant adnexal pathology. Three examiners evaluated the same transvaginal ultrasound images: an expert (level III), a 4th year resident in gynecology (level I), and a final year medical student after basic training (labeled as level 0). The assessment methods included subjective evaluation, Simple Rules (SR) with and without algorithm, ADNEX and Gynecologic Imaging Reporting and Data System (GI-RADS) models. Sensitivity, specificity, accuracy, positive and negative predictive values with 95% confidence interval were calculated. Results: Out of 50 cases, 33 (66%) were benign and 17 (34%) were malignant adnexal masses. Using only SR, level III could classify 48 (96%), level I-41 (82%) and level 0-40 (80%) adnexal lesions. Using SR and algorithm, the performance improved the most for all levels and yielded sensitivity and specificity of 100% for level III, 100% and 97% for level I, 94.4% and 100% for level 0, respectively. Compared to subjective assessment, ADNEX lowered the accuracy of level III evaluation from 97.9% to 88% and GI-RADS had no impact. ADNEX and GI-RADS improved the sensitivity up to 100% for the less experienced; however, the specificity and accuracy were notably decreased. Conclusions: SR and SR+ algorithm have the most potential to improve not only sensitivity, but also specificity and accuracy, irrespective of the experience level. ADNEX and GI-RADS can yield sensitivity of 100%; however, the accuracy is decreased.

Asunto(s)

RESUMEN

BACKGROUND: Opportunistic bilateral salpingectomy (OBS), also called as prophylactic salpingectomy or risk-reducing salpingectomy is the concurrent removal of the fallopian tubes in premenopausal women. Though there are some studies comparing the intraoperative complications and effect of salpingectomy on ovarian reserve, limited data are available on long-term follow-up after OBS. PURPOSE OF THE STUDY: To evaluate the surgical outcome of routine bilateral salpingectomy during total laparoscopic hysterectomy (TLH) in terms of intraoperative and postoperative complications. We also evaluated the incidence and reoperation rate for adnexal pathology after TLH. METHODS: A retrospective study of 1470 patients undergoing total laparoscopic hysterectomy (TLH) with opportunistic bilateral salpingectomy (OBS) over 13 years was carried out at Paul's Hospital. RESULTS: The mean age of the subjects was 43.6 ± 4.2 years, mean body mass index was 27 ± 5.4 kg/m2, and median parity was 2 (range 0-7). 43% of women had at least one previous surgery. The most common indication for surgery was fibroid uterus (67%, n = 985). The total complication rate was 4.4% (n = 65). One specimen showed paratubal borderline serous malignancy. The follow-up period ranged from 6 months to 13 years during which 17 (1.1%) women had adnexal pathology, and eight women (1.1%) needed resurgery for it. No ovarian malignancies were reported on follow-up. CONCLUSIONS: OBS is a simple and short surgical step during TLH without increasing morbidity. OBS eliminates the risk of future diseases of tubal origin, and there might be a possible reduction in incidence and reoperation rate for future ovarian pathologies.

RESUMEN

BACKGROUND: Laparoscopic surgery has become the preferred surgical approach due to a reduction in postoperative pain, better recovery, shorter hospitalization, and improved esthetic outcomes. Laparoscopic surgery with single-port laparoscopy (SPL) is a laparoscopic surgery technique that is based on making a single parietal incision using a single trocar specifically designed to allow introduction of several instruments. The level of evidence regarding the advantages of SPL in terms of postoperative pain has remained low despite several randomized studies. Adult patients exhibiting a surgical indication for an a priori benign ovarian pathology or for prophylactic purposes that can be performed by laparoscopy will be randomized to receive conventional laparoscopy (CL) or SPL. The aim of our study is to evaluate whether SPL offers advantages over CL in benign adnexal surgery. METHODS: The patients will be evaluated preoperatively to confirm their eligibility. The perioperative data up to 24 h after the intervention, as well as the postoperative data at day 7 and at one month from the intervention will be collected. The primary outcome for the study will be the postoperative pain at 24 h ± 2 h after the intervention. The pain will be assessed by a numeric rating scale of 0-10. Other outcomes will also be assessed, such as pain at other times, the consumption of analgesics, the operative time, perioperative bleeding, the number of additional trocars in the two groups, the incidence of laparoconversion, the esthetic criteria of the scar at one month, the incidence of complications, and the quality of life at one month. DISCUSSION: If our hypothesis is confirmed, this study will provide evidence that the use of SPL can decrease postoperative pain in adnexal surgery. The standard surgical treatment of this condition would thus be modified. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02739724 . Registered on 12 April 2016.

Asunto(s)

RESUMEN

STUDY OBJECTIVE: To compare the rates of oophorectomy performed by pediatric surgeons for benign indications before and after the addition of a gynecologist to the surgical staff of a children's hospital. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: We used a retrospective chart review of patients ages 5-21 years who underwent surgical management by pediatric surgeons for benign adnexal indications at a tertiary care children's hospital. Patient characteristics and clinical outcomes were recorded. Rates of oophorectomy for patients managed before the addition of a gynecologist (1998-2004) were compared with those managed after a gynecologist joined the surgical staff (2005-2013). Logistic regression analysis was conducted to compare the likelihood of oophorectomy before and after the addition of a gynecologist to the surgical staff. RESULTS: One hundred sixty-five cases were included in the final analysis. Pediatric surgeons were 8 times more likely to perform an oophorectomy for benign indications before the addition of a gynecologist to the surgical staff (odds ratio, 8.3; 95% confidence interval, 3.76-18.16). Oophorectomy was performed in 45% (25/56) of cases from 1998 to 2004 compared with 11% (12/109) of cases from 2005 to 2013. Younger age (P = .009), ischemic-appearing adnexa (P < .0001), presence of torsion (P = .017), and mature teratoma (P = .041) were associated with higher likelihood of oophorectomy. CONCLUSION: There was a higher rate of ovarian preservation for benign indications performed by pediatric surgeons after the addition of a gynecologist to the surgical staff. Younger patients, those with a mature teratoma, and ovarian torsion continue to be at higher risk for oophorectomy.

Asunto(s)

RESUMEN

Paraovarian cysts are a rare pathology, constituting 10-20% of the adnexal masses. The origin can be represented by paramesonephric ducts (Hydatid cysts of Morgagni), vestiges of mesonephric ducts also represented by mesothelium, or neoplastic (cystadenomas or cystadenofibromas) that are mostly benign. Borderline or malignant paraovarian tumors are encountered less often. This article presents a case of paraovarian cyst in a 37-year-old patient, with a history of 2 pregnancies, completed by cesarean. The patient sought medical attention for an asymptomatic voluminous ovarian cyst, detected in a routine ultrasound scan. Laboratory tests and tumor markers were within normal limits. Transvaginal ultrasound and color Doppler revealed a cystic adnexal mass with 10 cm transonic, smooth, homogeneous content, avascular walls with no internal papillary projections, with a "hyperechoic line" sign of delimitation from the ovarian capsule, mostly visible when the adnexa was mobilized. The diagnostic and curative laparoscopic surgery was successful, followed by a quick recovery. The histopathological exam confirmed the benignity and the origin of the paraovarian cyst. The case was discussed in the context of the literature review concerning this pathology, drawing attention to the real possibility of differentiating ovarian from paraovarian cysts by ultrasound.

Asunto(s)

RESUMEN

BACKGROUND: A proportion of patients undergoing laparoscopic gynecological surgery experiences excessive post-operative pain, which results in high rescue analgesic treatment and prolonged hospitalization. The aim of our study was to evaluate the efficacy of intraoperative topical ropivacaine in the control of post-operative pain in the first 48 h after operative laparoscopy for benign adnexal or uterine pathologies . METHODS: We conducted a prospective, randomized, double-blind, placebo-controlled clinical trial. Patients received a standard dose of topical ropivacaine (injected at the three portal sites and atomized in the abdominal cavity) or placebo. The primary outcome was the evaluation of post-operative pain intensity 6 h after surgery. Secondary outcomes included the intensity of pain during the 48 h after surgery, shoulder tip pain and the request for rescue analgesics during the first 48 h after surgery, time to discharge from recovery room, time to mobilizing on the ward and time to return to daily activities. Patients were divided in two groups (Group_A: benign adnexal pathologies; Group_B: benign uterine diseases) and assigned to Subgroup_1 (receiving ropivacaine) and Subgroup_2 (receiving placebo). RESULTS: A total of 187 women were included: 93 in Group_A and 94 in Group_B. Forty-seven patients entered Subgroup_A1, 46 Subgroup_A2, 48 Subgroup_B1 and 46 Subgroup_B2. Subgroup_A1 experienced lower post-operative pain at 4 (p = 0.008) and 6 h (p = 0.001) as well as a faster return to daily activities (p = 0.01) in comparison with Subgroup_A2. Both Subgroup_A1 and Subgroup_B1 showed lower shoulder tip pain (respectively, p = 0.032 and p = 0.001) as well as shorter time to mobilizing on the ward after surgery (respectively, p = 0.001 and p = 0.01). The remaining variables analysis did not show significant results. CONCLUSIONS: Combined topical analgesia with ropivacaine could represent a new safe and effective tool in the control of post-operative pain in gynecological laparoscopic surgery. Given the greater benefits for adnexal surgery, this strategy may be more suitable for this class of patients.

Asunto(s)

RESUMEN

OBJECTIVES: To study feasibility of day care surgery for laparoscopy for adnexial pathology, infertility treatment or exploration and to research influencing factors. MATERIAL AND METHOD: Women who beneficiate of laparoscopy for adnexial pathology, infertility treatment or exploration and to research influencing factors were included between 1st January 2010 and 30th June 2012 in this monocentric retrospective study. RESULTS: Four hundred women were included. Day care surgery was possible in 63% of cases. A switch to conventional hospitalization was required for 17% of the women planned for day care surgery. The rate of a second hospitalization in the month following day care procedure was 1% with 0.4% of second surgery for complications. Influencing factors for day care surgery are age, surgeon and time of the surgery. The global satisfaction rate of women was 98%. CONCLUSION: Day care surgery is feasible for women who beneficiate of laparoscopy for adnexial pathology, infertility treatment or exploration. Second hospitalization or surgery for complications is very rare.

Asunto(s)

RESUMEN

INTRODUCTION: Paraovarian cysts are very uncommon in children OBJECTIVE: To present a case of giant paraovarian cyst case in a child and its management using a modified laparoscopic-assisted technique CASE REPORT: A 13-year-old patient with a 15 day-history of intermittent abdominal pain, located in the left hemiabdomen and associated with progressive increase in abdominal volume. Diagnostic imaging was inconclusive, describing a giant cystic formation that filled up the abdomen, but without specifying its origin. Laboratory tests and tumor markers were within normal range. Video-assisted transumbilical cystectomy, a modified laparoscopic procedure with diagnostic and therapeutic intent, was performed with a successful outcome. The histological study reported giant paraovarian cyst. Cytology results were negative for tumor cells. The patient remained asymptomatic during the postoperative follow-up. CONCLUSIONS: The video-assisted transumbilical cystectomy is a safe procedure and an excellent diagnostic and therapeutic alternative for the treatment of giant paraovarian cysts.

Asunto(s)

RESUMEN

Introducción: Los quistes paraováricos son de diagnóstico infrecuente en la edad pediátrica. Objetivos: Dar a conocer un caso clínico de quiste paraovárico gigante en la infancia y su manejo a través de una técnica laparoscópica modificada. Caso Clínico: Paciente de 13 años con cuadro de dolor abdominal intermitente de 15 días de evolución, localizado en el hemiabdomen izquierdo, asociado a aumento de volumen abdominal progresivo. Las imágenes diagnósticas no fueron concluyentes, describiendo una formación quística gigante que ocupaba todo el abdomen, sin precisar su origen. Exámenes de laboratorio y marcadores tumorales dentro de los parámetros normales. Se realizó quistectomía transumbilical videoasistida, un procedimiento laparoscópico modificado, con intención diagnóstica y terapéutica con resultado exitoso. Estudio histológico compatible con quiste paraovárico gigante. El examen citológico resultó negativo para células tumorales. La paciente permaneció asintomática durante el seguimiento postoperatorio. Conclusiones: La quistectomía transumbilical videoasistida es una técnica segura y constituye una excelente alternativa diagnóstica y terapéutica para el tratamiento de quistes paraováricos gigantes.

Introduction: Paraovarian cysts are very uncommon in children. Objective: To present a case of giant paraovarian cyst case in a child and its management using a modified laparoscopic-assisted technique. Case report: A 13-year-old patient with a 15 day-history of intermittent abdominal pain, located in the left hemiabdomen and associated with progressive increase in abdominal volume. Diagnostic imaging was inconclusive, describing a giant cystic formation that filled up the abdomen, but without specifying its origin. Laboratory tests and tumor markers were within normal range. Video-assisted transumbilical cystectomy, a modified laparoscopic procedure with diagnostic and therapeutic intent, was performed with a successful outcome. The histological study reported giant paraovarian cyst. Cytology results were negative for tumor cells. The patient remained asymptomatic during the postoperative follow-up. Conclusions: The video-assisted transumbilical cystectomy is a safe procedure and an excellent diagnostic and therapeutic alternative for the treatment of giant paraovarian cysts.

Asunto(s)