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OBJECTIVE: To draw up recommendations on the use of prophylactic gynecologic procedures during surgery for other indications. DESIGN: A consensus panel of 19 experts was convened. A formal conflict of interest policy was established at the onset of the process and applied throughout. The entire study was performed independently without funding from pharmaceutical companies or medical device manufacturers. The panel applied the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system to evaluate the quality of evidence on which the recommendations were based. The authors were advised against making strong recommendations in the presence of low-quality evidence. Some recommendations were ungraded. METHODS: The panel studied 22 key questions on seven prophylactic procedures: 1) salpingectomy, 2) fimbriectomy, 3) salpingo-oophorectomy, 4) ablation of peritoneal endometriosis, 5) adhesiolysis, 6) endometrial excision or ablation, and 7) cervical ablation. RESULTS: The literature search and application of the GRADE system resulted in 34 recommendations. Six were supported by high-quality evidence (GRADE 1+/-) and 28 by low-quality evidence (GRADE 2+/-). Recommendations on two questions were left ungraded due to a lack of evidence in the literature. CONCLUSIONS: A high level of consensus was achieved among the experts regarding the use of prophylactic gynecologic procedures. The ensuing recommendations should result in improved current practice.

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In March 2019, Harter et al. published the results of the LION study (Lymphadenectomy in patients with advanced ovarian neoplasms) which raises the question of pelvic and para-aortic lymphadenectomy for patients with advanced-stage epithelial ovarian cancer (EOC). These results influenced the new French recommendations published in December 2018 by the French National Cancer Institute (INCa). Thus, it no longer seems consistent to perform a systematic lymphadenectomy for patients for whom there is no argument for nodal involvement, when a macroscopic complete peritoneal cytoreductive surgery has been performed. The question of preoperative lymph node assessment is therefore essential, whereas more than half of the patients in the LION study had metastatic lymph node involvement that was histologically proven. For the assessment of lymph node status by imaging, superior sensitivity for Positron Emission Tomography is demonstrated in comparison with CT-scan or Magnetic Resonance Imaging. Nevertheless, thoraco-abdomino-pelvic CT-scan with contrast injection remains the gold standard for this indication. In the absence of suspected involvement, supra-renal, mesenteric, coelio-hepatic, and cardio-phrenic lymphadenectomy are not recommended. Lymphadenectomies should always be performed in the other situations of EOC management apart from the rare case of stage 1 expansile subtype mucinous carcinoma. The aim of this review is to discuss lymphadenectomy indications for the surgical management of EOC by taking into account new data from the scientific literature.

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INTRODUCTION: The objective of this work is to report the first 6 months of a robotic program in a surgical gynecological team, trained in advanced laparoscopy, in terms of operating times, complication rate, analgesic consumption and average duration of hospitalization. METHODS: This is a prospective observational study, intended to treat. RESULTS: During the study period, 98 women underwent laparoscopic robot assisted surgery. The average BMI was 27.2kg/m2 (±7). Malignant diseases accounted for 41% of operative indications. Comparing the first 30 procedures to the last 30 procedures, there is a significant decrease in docking times: 14.7min (±7.0) vs 8.9min (±5.0), P=0.009. There is also a trend towards a decrease in operative times for hysterectomy: 151.9min (±56.2) vs 113min (±51.4), P=0.08. The rates of complications were not significantly different at the beginning and end of inclusion during the study (10.0% vs 16.7%). CONCLUSION: The implementation of a robotic surgery program in a gynecological surgery department does not lead to an increase in complications for the patients, including for the first procedures. The learning curve mainly allows a reduction in the robot's installation time.

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OBJECTIVES: To evaluate the feasibility of outpatient laparoscopy in gynaecology. MATERIALS AND METHODS: This prospective monocentric study included 50 patients. Postoperative pain was evaluated by the visual analogic scale (VAS). Reasons for hospital stay and emergency consultation rates in the first postoperative month were noted. Patient's satisfaction was recorded at the postoperative visit one month after the intervention. RESULTS: The following procedures were included in the study: cystectomy, oophorectomy±salpingectomy, explorative laparoscopy for chronic pelvic pain and tubal sterilization. Mean operative time never exceeded 90 minutes (mean 60±26.5min). A resident performed 70% of the procedures. No intraoperative complication was reported. Only one patient stayed hospitalised overnight. On the first and second postoperative days, the VAS was 4.89 (±2.25) and 4.14 (±2.20) respectively. Twenty-five patients (50%) were very satisfied of the medical care, 23 patients (46%) were satisfied and one patient (2%) was not much satisfied. CONCLUSION: The outpatient laparoscopy in gynaecology seems feasible with a high level of satisfaction. It can be proposed to patients after good information.

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OBJECTIVES: To report a prospective evaluation of women's satisfaction after a day care gynecologic surgery. MATERIALS AND METHODS: Prospective unicentric study from June to October 2013 in a teaching hospital. Women planned for a day care gynecologic surgery were enrolled after giving their consent. Three phone questionnaires were done on day 1, 7 and 30 after surgery. RESULTS: One hundred and eighty-five women were included and 90.3% had finally a day care surgery. Response to the phone questionnaire was 75.2% with a satisfaction on day 1 of 94.2% and on day 7 and 30 of 96.4%. CONCLUSION: A high satisfaction rate is observed in this study. These data are consistent with a promotion of day care surgery in gynecology.

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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.

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CONTEXT: In order to control health spending, health authorities encourage medical staffs to develop day care surgery. Gynecologic day care surgery can easily be developed. However, consequences of the reduction of hospital stay on the rate of postoperative consultation with the attending physician have not been evaluated. Will day care surgery lead to an increase in postoperative consultation with attending physician rate? OBJECTIVE: Assessment of the impact of day care gynecological surgery on attending physician postoperative consultation rate. METHODS: This prospective study included 250 women who have gynecologic surgery in the gynecologic unit of a teaching hospital, from April to June 2012. Postoperative consultations with attending physician were identified with a phone questionnaire. Postoperative consultation rate with attending physician was compared between women supported in day care surgery versus conventional surgery. RESULTS: Two hundred and fifty women were included in the study, 166 (66.5%) had a day care surgery while 84 (33.5%) had a traditional hospitalisation for surgery. Mean age of women was significantly lower in the group of day care surgery (42.08 years [40.14-44.03] versus 54.15 years [50.45-57.86], P<0.01). Out of the 166 women with a day care surgery, 49 (30%) went to the attending physician while 25 out of 84 (30%) in the traditional hospitalization group. Postoperative consultation rate with attending physician was not significantly different between women supported in day care surgery compared to those supported in conventional surgery (P>0.05). CONCLUSION: This study did not find any difference in the postoperative consultation rate with the attending physician after a day care surgery versus surgery in conventional hospitalization in gynecology. This result should be interpreted cautiously as women are different between the two groups (different surgeries, older women with more associated pathologies in the conventional hospitalization group). Vigilance must be maintained on this risk of increasing postoperative consultation rate with attending physician after day care surgery.

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OBJECTIVE: Study feasibility of outpatient management for gynaecologic surgery. MATERIALS AND METHODS: Monocentric cohort analysis to study outpatient management in a gynaecologic department from January 2010 to December 2011. Number of second hospitalization in the month following ambulatory care was collected. RESULTS: Two thousand eight hundred and three interventions were performed including 1425 (51%) in outpatient management. Four women had a second hospitalization in the month following ambulatory care and none of them had a second surgery. For gynaecologic "tracer act", that required an 80% rate of outpatient management in France (operative hysteroscopy, conisation and breast tumorectomy), the rate of outpatient management was 86%. CONCLUSION: Outpatient care is feasible in gynaecologic surgery and objective of an 80% rate of ambulatory care for some specific gynaecologic interventions is reasonable without additional risk. A large outpatient management is feasible keeping in mind that it is women that are concern with ambulatory care and not interventions. Choosing an outpatient care is based on the risk-benefit balance.

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