RESUMO
STUDY OBJECTIVE: To analyze indications for preoperative selection of patients with cystic adnexal masses to be treated by laparoscopic surgery. DESIGN: Retrospective analysis (Canadian Task Force classification II-2). SETTING: University and military hospitals. PATIENTS: Three hundred sixteen women with adnexal masses. INTERVENTION: Before laparoscopy, 214 patients underwent evaluation (size of adnexal mass, ultrasonographic image, CA 125, suspicious clinical diagnosis); in 102 women laparoscopies were performed without taking these factors into account. MEASUREMENTS AND MAIN RESULTS: In the first center 99% of women were treated by laparoscopic surgery. One (0.4%) tumor of low malignant potential detected by deferred biopsy was operated on. In the second center 98% of cases were performed laparoscopically. In 3.9% of women carcinomas were detected intraoperatively and were treated by laparotomy (p = 0.04). CONCLUSION: Laparoscopy is appropriate management of cystic adnexal masses, with a very low risk of unintentionally operating an ovarian carcinoma if a thorough preoperative evaluation is conducted. Only in centers where surgeons have enough training to cope with ovarian cancer may this evaluation be deferred, since conversion to laparotomy should be considered a second therapeutic step, and not an incorrect indication for laparoscopy. In centers where surgeons have no such training, strict preoperative selection of patients is mandatory
Assuntos
Doenças dos Anexos/cirurgia , Cistos/cirurgia , Laparoscopia , Seleção de Pacientes , Doenças dos Anexos/diagnóstico , Adulto , Antígeno Carcinoembrionário/análise , Feminino , Humanos , Laparotomia , Pessoa de Meia-Idade , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/cirurgia , Estudos RetrospectivosAssuntos
Humanos , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Cisto Dermoide , Neoplasias Ovarianas/diagnóstico , UltrassonografiaAssuntos
Humanos , Feminino , Adulto , Endometriose/diagnóstico , Endometriose/patologia , Endometriose/terapiaAssuntos
Humanos , Feminino , Adulto , Endometriose/diagnóstico , Endometriose/patologia , Endometriose/terapiaRESUMO
OBJECTIVE: To determine whether the use of a central assisted reproduction laboratory, with gamete transport to the facility (transport assisted reproduction), would decrease oocyte quality or performance in IVF-ET and intracytoplasmic sperm injection (ICSI). DESIGN: Retrospective clinical study. SETTING: Public and private fertility clinics. PATIENT(S): A total of 467 couples underwent transport IVF, whereas 108 underwent transport ICSI. A group of 60 couples underwent conventional IVF during the same period. All methods and protocols used were similar among centers. Oocyte pick-up was performed by ultrasound-guided vaginal puncture. INTERVENTION(S): Oocytes were transported under controlled conditions, from the site of follicular aspiration to a central laboratory. MAIN OUTCOME MEASURE(S): The fertilization and cleavage rates and clinical pregnancies were compared among the study populations. RESULT(S): The differences between the fertilization and cleavage rates of ova and the rates of clinical pregnancies produced by transport and conventional methods were not statistically significant. CONCLUSION(S): Gamete transport to a central laboratory was not harmful for oocytes or for the outcome of assisted reproduction. Transport makes the use of IVF and ICSI available to physicians who are not affiliated with an assisted reproduction program, reduces costs, and increases acceptability of the procedures to patients.