Utility of indocyanine green as a single tracer for sentinel node biopsy in endometrial cancer.

AIM: Our study aims to investigate the safety and effectiveness of sentinel lymph node biopsy using indocyanine green (ICG) for the surgical staging of early-stage endometrial cancer in comparison to technetium-99 m use. METHODS: We conducted an observational retrospective study with patients diagnosed of endometrial cancer and FIGO stages I-II. All participants were injected technetium-99m the day prior to the surgery and underwent lymphoscintigraphy along with single-photon emission computed tomography. In addition, all patients were administered intraoperatively ICG injection to detect sentinel lymph node biopsy. The surgical staging was then completed according to the European Society for Medical Oncology preoperative risk category. Data obtained from the analysis of technetium-99m detection was compared to ICG detection. RESULTS: A total of 53 women with endometrial cancer were included in the study, 49 (92.5%) of them showed drainage preoperatively in the single-photon emission computed tomography and/or lymphoscintigraphy. The intraoperative bilateral detection rate for technetium-99 m was 26 (49.1%) patients compared to 40 (75.5%) patients with ICG (p = 0.013). We observed a 42.5% increase in the mean number of lymph nodes retrieved by ICG compared to technetium-99m (2.85 vs 2,0 nodes; p = 0.002). We intraoperatively identified 164 lymph nodes, 104 (63.4%) located in both obturator areas and external iliac vessels. CONCLUSION: The use of ICG for the performance of sentinel node biopsy in patients with endometrial cancer seems safe and could be superior to technetium-99 m, since it offers a higher bilateral detection rate and nodal retrieval, resulting in the possibility to perform safely less full staging lymphadenectomies.

Direct trocar insertion without previous pneumoperitoneum versus insertion after insufflation with Veress needle in laparoscopic gynecological surgery: a prospective cohort study.

The aim of this study was to determine whether direct trocar entry without prior pneumoperitoneum at umbilical level (DTI) can be a safe alternative to access the abdominal cavity in gynaecological laparoscopic surgery. We present a prospective observational analytical study of cohorts, comparing DTI with umbilical entry with trocar after previous insufflation with a Veress needle at umbilical level (V). The study period was performed from June 2013 to April 2016; data was collected on 600 patients who underwent gynaecological laparoscopic surgery. There were no significant differences in the risk of suffering a complication during the access manoeuvres between DTI (6.49%) and V (7.39%), OR 0.89 (95% CI: 0.42-1.81). The duration of the access manoeuvres was 69 s in DTI and 193 s in V (p < .001). The percentage of patients in whom two or more access attempts were performed was lower in DTI (7.8%) than in V (12.3%) (p > .05). We concluded that DTI is at least as safe as V, regarding the risk of suffering complications arising from access into the abdominal cavity. DTI has advantages with regard to V, such as: the shorter duration of access manoeuvres or the lesser number of unsuccessful entry or insufflation attempts. Impact statement What is already known on this subject? There are few international publications comparing DTI and V. When we conducted a search in PubMed for the terms 'Veress needle and direct trocar insertion', 51 publications were obtained. When we increased the restriction and added the terms 'laparoscopic entry and laparoscopy complications', 27 publications were obtained; thus, the uniqueness of our study. What do the results of this study add? We present a 3-year observational prospective study of cohorts that included 600 patients. The aim of this study was to determine that in laparoscopic gynaecological surgery, DTI is an access method to the abdominal cavity at least as safe as V, with respect to the risk of complications. On the other hand, DTI has some advantages such as the shorter duration of access manoeuvres or the lower number of failed entry attempts. What are the implications of these findings for clinical practice and/or further research? Given the limited number of publications that compared both techniques, our study indicates that DTI can be a safe alternative for access to abdominal cavity in gynaecological surgery, compared to the traditional V.

Safety and patients' satisfaction after hysteroscopic sterilisation.

The aim of this study was to understand the potential complications of the Essure® device as well as the factors influencing its onset and patient satisfaction. We present a 9-year descriptive prospective study that included 1068 patients. The device was placed in 1056 of them (98.8%); 894 had no pain or mild pain during the insertion and only 12 patients experienced pain greater than menstrual pain. The proportion of patients without pain was greater in the group that took NSAIDs or NSAIDs and BZD and the unmedicated group had the highest rate of severe pain (p = .00). In all, 161 of the 1064 patients who had the Essure® inserted reported having an adverse effect during the 3-months post-insertion (pelvic pain or discomfort). The mean score out of 10 attributed to this method was 9.06 (S = 1.11). We concluded that the Essure® shows a low rate of complications and users showed a high degree of satisfaction. Impact statement What is already known on this subject: There are few international publications on Essure®. When we conducted a search in PubMed for the term 'Essure', we obtained 221 publications. When we added the terms 'Essure and complications', we obtained 20 publications, and when we increased the restriction including 'satisfaction', we obtained seven; thus, the uniqueness of our study. What the results of this study add: We present a 9-year descriptive prospective study that included 1068 patients. The aim of this study was to understand the potential complications of the Essure® device (Bayer, Whippany, NJ), as well as factors that can influence its onset and the patient satisfaction. The device was placed in 1056 of the patients (98.8%); 894 had no pain or mild pain during the insertion and only 12 patients experienced pain greater than menstrual pain. The proportion of patients without pain was greater in the group that took NSAIDs or NSAIDs and BZD and the unmedicated group had the highest rate of severe pain (p=.00). What the implications are of these findings for clinical practice and/or further research: Our study shows a low rate of complications with Essure®, mild and transient in most cases, as well as a high degree satisfaction. Nevertheless, given the few published studies on this device, we believe that long-term follow-up is needed.

[Definitive contraception with Essure device: Single institutional experience on 517 procedures]. / Anticoncepción definitiva con Essure: experiencia unicéntrica de 517 procedimientos.

OBJECTIVES: To analyse the outcomes of patients undergoing Essure sterilization in a single institution, interns of complications and technique failure. PATIENTS AND METHODS: Retrospective descriptive study of 517 patients underwent definitive contraception with Essure device in outpatient hysteroscopy office without anesthesia and controlled at 3 months with abdominal radiography, ultrasonography and hysterosalpingography in selected cases. RESULTS: The success rates of the insertion of Essure was 96.8%, similar to data reported in the literature with 3.7% of vagal reactions, as most prevalent complication. 7 (1.35%) unintended pregnancies were observed. CONCLUSIONS: Essure is a permanent birth control device, with high rate of successful insertion and a low rate of complications. Unintended pregnancies in our study are high and we must change the protocols of placement and monitoring, considering hysterosalpingography as a routine control test.

[Node status in 454 ductal breast cancers cases according to the association with in situ component]. / Afectación ganglionar en 454 casos con carcinoma ductal infiltrante de mama según el hallazgo de componente intraductal asociado.

BACKGROUND: Studies have shown that breast infiltrating ductal carcinoma develops from precursor lesions or pre-invasive. It is accepted that the risk of invasive ductal carcinoma increased slightly in hyperplasia, but especially in cases of atypical hyperplasia and intraductal carcinoma. OBJECTIVES: To evaluate and compare the nodal status between ductal breast cancer with in situ component (group 1) or without it (group 2). MATERIAL AND METHOD: Descriptive and retrospective study that included 454 ductal breast cancers. Data concerning clinical and pathological variables was collected. All data was compared between both groups. RESULTS: Among all cases, 176 (38.8%) showed positive lymph nodes, 136 patients (39.5%) from group 1 and 40 cases (36.4%) from group 2. Among group 1 cases, high-grade subgroup showed higher positive lymph node rate (82 cases, 55.4%) than the extensive in situ carcinomas subgroup (84 cases, 49.7%). Both of them had a significant higher rate than group 2 cases (p = 0.003 y p = 0.028, respectively). Moreover, the low-grade in situ carcinomas without cellular necrosi had positive lymph nodes just in 30 cases (24%), significantly lower (p = 0.034) than group 2. CONCLUSIONS: We did not find overall statistical differences between groups depending on in situ associated component. But when we analyzed in situ subgroups, we found differences with higher positive lymph node rate in high grade carcinomas and extensive in situ carcinomas subgroups, while lower affectation rates were observed in low grade carcinomas (without cellular necrosis), compared to the group of breast cancers without in situ component associated.

[Sonographic ovarian vascularization and volume in women with polycystic ovary syndrome treated with clomiphene citrate and metformin]. / Vascularización y volumen ovárico ecográfico en mujeres con síndrome de ovario poliquístico tratadas con citrato de clomifeno y metformina.

OBJECTIVE: To measure the vascularization and ovarian volume with three-dimensional sonography in patients diagnosed of polycystic ovary syndrome with stimulated ovulation treatment, and to analyse the differences between the patients treated with clomiphen citrate versus clomiphen citrate and metformin. MATERIAL AND METHOD: Therty patients were studied. Twenty ovulation cycles were obtained with clomiphen citrate and 17 with clomiphen citrate plus merformin (added in case of obesity or hyperglucemy/hyperinsulinemia). Ovarian volumes and vascular indexes were studied with 3D-sonography and results were analysed by treatment. RESULTS: There were no statistical differences of ovarian volume by treatment along the cycles, although bigger volume were found in ovulatory cycles compared to non-ovulatory ones (20,36 versus 13,89 ml, p = 0,026). No statistical differences were also found concerning vascular indexes, neither by treatment nor by the obtention of ovulation in the cycle. CONCLUSIONS: Ovarian volume and vascular indexes measured with three-dimensional sonography in patients diagnosed of polycystic ovary syndrome do not show differents values in patients treated with clomiphen citrate alone versus clomiphen citrate plus metformin.

[Reproducibility of the fetal nasal bone measurement by means of bidimensional and three-dimensional ecography during the second trimester of the pregnancy]. / Reproducibilidad de la medición del hueso nasal fetal mediante ecografía bidimensional y tridimensional durante el segundo trimestre del embarazo.

AIMS: The utility of the valuation-measurement of the nasal bone in the prognosis of chromosomopaties during the second trimester of the pregnancy is demonstrated. OBJECTIVE: To evaluate the repeatability of nasal bone measurement during second trimester with bidimensional and three-dimensional sonography. MATERIAL AND METHOD: Nasal bone was measured in 50 single pregnancies. First observer carried out two measures of nasal bone with bidimensional sonography, and 1 measure with three-dimensional sonography. Second observer carried out just one measure with bidimensional sonography (2D) and just another one with three-dimensional sonography (3D). We studied the intraobserver variability with 2D sonography, and the interobserver variability with 2D and 3D sonography. RESULTS: 2D-sonography: nasal bone measurement showed excellent intraobserver correlation with a correlation coefficient of 0,87 (CI 95%: 0,78-0,93) and a little means difference of 0,18 (SD: 0,74). Indeed, there was a good interobserver correlation with a correlation coefficient of 0,92 (CI 95%: 0,85-0,95), and a means difference of 0,14 (SD: 0,56). 3D-sonography: there was a acceptable interobserver correlation with correlation coefficient of 0,70 (CI 95%: 0,52-0,82). CONCLUSION: Nasal bone measurement is highly reproducible by means of bidimensional sonography while using three-dimensional sonography, the results are just acceptable.

[Urogenital prolapse repair using polypropylene mesh]. / Reparación del prolapso urogenital con malla de polipropileno.

BACKGROUND: Urogenital prolapse is a condition that affects 1 to 43% of post-hysterectomized patients. Since several years some synthetic meshes have been used to repair pelvic floor, and apparently they have advantages over them predecessors. OBJECTIVE: To evaluate the efficacy and security of polypropylene meshes in the repair of urogenital prolapse. MATERIAL AND METHOD: Retrospective and non-randomized study in 106 patients that had different kinds of urogenital prolapse repaired using polypropylene meshes. The follow-up was carried out by two visits to the hospital, 2 and 6 months after surgery. The variables analyzed were age, parity, menopause presence, kind of surgical technique, surgical time, time at hospital and complications. Afterwards, the information was analyzed descriptively. RESULTS: Average age was 64.4 years. The rate of multiparity and menopause women was 91.51% and 92.45% respectively. The most used surgical technique was the anterior mesh with tension-free band (34,90%) to repair the associated urinary incontinence. The rate of intraoperatory complications was 2.8%, immediate complications was 37.7% and late complications was 21.6%. The success rate after 6 months was 80 to 100%, depending on the technique. CONCLUSIONS: There is a low rate of intraoperatory and medium-term complications in the reconstructive surgery of pelvic floor for the urogenital prolapses using polypropylene meshes, which makes this technique a secure and effective option for the treatment of this problem.

[Fetal chylothorax. Is prenatal treatment beneficial?]. / Quilotórax fetal: es benéfico su tratamiento prenatal?

We report a case of fetal chylothorax handled with intrauterine treatment, which finally died. Diagnosis, treatment and evolution are reviewed. Characteristics of the disease are described and treatment options are discussed.

Mallas en la cirugía del prolapso genital / Meshes for genital prolapse surgery

El objetivo de esta revisión es analizar la información científica disponible sobre la utilización de las mallas en la cirugía del prolapso genital, evaluando eficacia, efectos adversos y complicaciones. La utilización de mallas en la reparación del compartimento anterior se asocia con mejores resultados anatómicos que las técnicas clásicas, mientras que no hay datos suficientes que avalen su utilización en el compartimento posterior. En el compartimento apical, la colposacropexia abdominal ha demostrado tener tasas de recurrencia menores que los procedimientos por vía vaginal, ya sea mediante técnicas clásicas o mediante el uso de mallas. Las mallas se asocian con efectos adversos a corto y a largo plazo, que pueden implicar la necesidad de nuevos procedimientos quirúrgicos.