Functional results of robotic total intersphincteric resection with hand-sewn coloanal anastomosis.

BACKGROUND: In recent decades there has been an increasing trend toward sphincter-preserving procedures for the treatment of low rectal cancer. Robotic surgery is considered to be particularly beneficial when operating in the deep pelvis, where laparoscopy presents technical limitations. The aim of this study was to prospectively evaluate the functional outcomes in patients affected by rectal cancer after robotic total intersphincteric resection (ISR) with hand-sewn coloanal anastomosis. METHODS AND PROCEDURES: From March 2008 to October 2012, 23 consecutive patients affected by distal rectal adenocarcinoma underwent robotic ISR. Operative, clinical, pathological and functional data regarding continence or presence of a low anterior resection syndrome (LARS) were prospectively collected in a database. RESULTS: Twenty-three consecutive patients were included in the study: 8 men and 15 women. The mean age was 60.2 years (range 28-73). Eighteen (78.3%) had neoadjuvant radiochemotherapy. Conversion rate was nil. The mean operative time was 296.01 min and the mean postoperative hospital stay was 7.43 ± 1.73 days. According to Kirwan's incontinence score, good fecal continence was shown in 85.7% of patients (Grade 1 and 2) and none required a colostomy (Grade 4). Concerning LARS score, the results were as follows: 57.1% patients had no LARS; 19% minor LARS and 23.8% major LARS. CONCLUSIONS: Robotic total ISR for low rectal cancer is an acceptable alternative to traditional procedures. Extensive discussion with the patient about the risk of poor functional outcomes or LARS syndrome is mandatory when considering an ISR for treatment of low rectal cancer.

Transport in vitro fertilization and intracytoplasmic sperm injection: results of a collaborative trial.

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.

Valor del análisis de la fase folicular en las pacientes tratadas con clomifeno / Value of the analysis of follicular phase in patients treated with clomiphene

Se destaca la importancia de la duración de la fase folicular en relación al número de embarazos logrados con la medicación con clomifeno. Se enfatiza la necessid de regular la dosis diaria en relación con la duración de la fase folicular

Hallazgos en infertilidad, valoracion etiologica y prospectiva diagnostica. / Findings in infertility, ethiologic evaluation and diagnostic perspectives

Nuestra serie comprende 165 parejas con un logro obstetrico previo extremadamente bajo (8,7%). A posteriori de las investigaciones diagnosticas de rutina concibieron 92, con o sin tratamiento; esto indica un significativo aumento en la tasa de exitos (83,7%) si lo relacionamos con la cifra anterior. En el grupo tratado hubo 56 embarazos (85,7%) de los cuales 8 terminaron en abortos espontaneas; en el grupo de pacientes no tratadas la incidencia de embarazos fue 80,5% con 7 abortos. No existio diferencia significativa entre los dos grupos; esto significaria que las diversas terapeuticas empleadas son de dudosa efectividad. Pensomas que todas las parejas cuyo ultimo embarazo termino en aborto deben entrar dentro de la metodologia de estudio que empleamos en el aborto habitual.Creemos que todos los factores etiologicos las anormalidades anatomicas y las aberraciones cromosomicas son sin duda alguna causas probadas y responsables del aborto recurrente