Medialization Laryngoplasty After Endoscopic Laser Cordectomy. Our Experience.

PURPOSE: Medialization laryngoplasty can be performed to treat glottic incompetence after endoscopic laser cordectomy. The aim of this study is to evaluate vocal outcome after this phonosurgical procedure and to analyze the critical aspects of the Montgomery and Gore-Tex laryngoplasty technique. METHODS: A retrospective observational study of patients with glottic incompetence after endoscopic laser cordectomy, underwent medialization laryngoplasty with Montgomery or Gore-Tex implant between January 2013 to December 2018 at the Bufalini Hospital of Cesena, Italy. The pre- and postphonosurgery evaluation included videolaryngostroboscopy, perceptual, evaluation of dysphonia with the GRBAS (grade, roughness, breathiness, asthenia, strain) scale, Voice Handicap Index-10, Maximum Phonation Time. The outcome was evaluated 6 months after the phonosurgical treatment. RESULTS: We treated 22 patients, 19 males and 3 females. Eight cases were treated with Montgomery implant and fourteen with Gore-Tex implant. The postphonosurgical videolaryngostroboscopy showed an improvement of the glottic closure in all patients; the scores of the Voice Handicap Index-10 and of the Maximum Phonation Time showed a statistically significant improvement after phonosurgery. The GRBAS scale scores showed a statistically significant improvement of Global Grade, Breathiness, and Asthenia; the parameter Strain remained unaltered both in pre- and postoperative evaluations, because the voice was never pressed due to glottic insufficiency, especially in preoperative observation. The parameter Roughness (R) did not show a significant difference between pre- and postoperative evaluation. CONCLUSION: Medialization laryngoplasty is an effective phonosurgical procedure to improve voice outcome, after extended endoscopic laser cordectomies, in patients with unacceptable results after voice therapy and injection laryngoplasty. In our experience the Gore-Tex implant allows the surgeon to perform a safer and more "tailored" phonosurgery in cases of cordectomies type IV and V, associated or not with radiotherapy and in revision surgery.

Patients' satisfaction following laparoscopic cornuectomy for removal of hysteroscopic sterilization devices.

OBJECTIVES: To evaluate patients' satisfaction and evolution of pre-operative symptoms at 6 months following laparoscopic cornuectomy for hysteroscopic sterilization implants removal. MATERIAL AND METHODS: Retrospective study including all patients undergoing laparoscopic cornuectomy for implants removal in a tertiary care setting from January 2017 to October 2018. All women suffered from persistent and treatment-resistant gynecologic and non-gynecologic complaints since sterilization procedure. Patents' satisfaction was evaluated with the PGI-I questionnaire at 2 and 6 months following surgery. RESULTS: Overall, 104 patients were enrolled. Main symptoms comprised asthenia (n = 80), chronic pelvic pain (n = 80), arthralgia (n = 70), abnormal uterine bleeding (n = 42) and headache (n = 40). Cornuectomy was feasible in all cases and led to complete devices removal in 101 women. Mean length of stay was 1.8 days, while outpatient management was feasible in 45.2 % of cases. One grade 3 complication occurred along the study period (hemoperitoneum requiring reoperation). Surgery was associated with a significant decrease in symptom occurrence, except for alopecia and weight loss. Patients' satisfaction was high: 91 % at 2 months and 97.6 % at 6 months reported an improvement in their health status compared to baseline situation. Satisfaction regarding each symptom was consistent with overall assessment, with most patients reporting significant improvement at both 2 and 6 months. CONCLUSION: Laparoscopic cornuectomy is feasible and associated with high mid-term satisfaction in patients suffering from adverse effects attributed to hysteroscopic sterilization implants.

Symptom related to Essure® and evolution after removal: Outcomes of retrospective cohort.

INTRODUCTION: The number of requests for Essure removal has grown continually over recent years. The objective is to describe the symptoms reported after Essure sterilization, methods of removal and results. MATERIAL AND METHODS: Retrospective and single-centre cohort (Regional university hospital of Lille, France) was conducted. All women, having consulted from December 2016 to February 2019 for symptoms related to Essure insertion, were included. All the symptoms were noted. A second group was created that included patients who underwent Essure removal to evaluate the benefits of surgery on these symptoms. RESULTS: The study included 98 patients. Most frequent symptoms were musculoskeletal pain (75 %), asthenia (63 %) and pelvic pain (55 %). Fifty-nine patients (60 %) underwent surgery. Surgery appeared beneficial with reduction of symptoms in 60 % of these patients, complete resolution in 33 % and no reduction of symptoms in 7%. Many symptoms were relieved by surgery with an overall decline of 96 % in menorrhagia, 94 % in metrorrhagia and 93 % in dyspareunia. However, other symptoms were not relieved by surgery like 100 % of sleep disorders, 70 % of abdominal pain cases and 57 % of memory impairment cases. CONCLUSION: Symptoms related to Essure insertion are numerous. Although surgery appears beneficial, some adverse effects remain. Therefore, a preoperative aetiologic assessment and information about risk of surgery failure are important.