Robot-assisted laparoscopy for deep infiltrating endometriosis: a retrospective French multicentric study (2008-2019) using the Society of European Robotic Gynecological Surgery endometriosis database.

OBJECTIVE: This study aimed at assessing perioperative results of robot-assisted laparoscopy (RAL) in the context of deep infiltrating endometriosis (DIE). METHODS: This retrospective French multicentric study included all patients with DIE who underwent surgical treatment managed by RAL (Da Vinci® System). From November 2008 to June 2019, patients were included in a single European database, in Robotic Assisted Laparoscopic Gynecologic Surgery, with Society of European Robotic Gynecological Surgery collaboration. Patients had different DIE sites as follows: gynecological, urological, or digestive, or combinations of these. Surgical procedures and perioperative complications were evaluated. To assess complications, patients were divided into the following four groups according to surgical procedure and DIE site: gynecological only; gynecological and urological; gynecological and digestive; and gynecological, urological, and digestive. RESULTS: A total of 460 patients treated at one of eight health-care facilities from November 2008 to June 2019 were included. Median operative time was 245 min (IQR 186-320), surgeon console time was 138 ± 75 min and estimated blood loss was 70.0 mL ± 107 mL. Among this patient sample, 42.1% had a multidisciplinary surgical approach with a digestive or urology surgeon in addition to gynecology surgeon (25.5% and 16.6% of cases, respectively). Among those with intraoperative complications (n = 25, 5.4%) were primarily conversion to laparotomy (n = 6, 2.0%), transfusion (n = 2, 0.6%), and organ wounds (n = 8, 1.7%). Overall, 5.6% had severe postoperative complications (Clavien-Dindo classification ≥ Grade 3). CONCLUSION: This is among the largest published series addressing RAL for DIE. Interest in this procedure appears promising, with no observed increases in blood loss or in peri- or post-operative complications. DIE laparoscopic surgery can require complex surgical procedures performed by multidisciplinary surgical teams. Thus, it may be one of the best candidates for RAL within gynecology surgery.

Identification of a group with high risk of postoperative complications after deep bowel endometriosis surgery: a retrospective study on 164 patients.

PURPOSE: Identify a group with a high risk of postoperative complications after deep bowel endometriosis surgery. METHODS: We conducted a retrospective study on patients treated from 2012 to 2018 in two departments of gynecological surgery at the Toulouse University Hospital, France. The postoperative complications were evaluated in relation to the surgical management, associated with or without non-digestive surgical procedures, initial disease and patient's characteristics. RESULTS: 164 patients were included. A postoperative complication occurred in 37.8% (n = 62) of the cases and required a secondary surgery in 18.3% (n = 30) of the cases. In the univariate analysis, the risk of postoperative complications increased significantly in the presence of segmental resection, disease progression, and associated urinary tract procedure or vaginal incision. In the multivariate analysis, the risk of overall postoperative complications was associated with the surgical management (p = 0.013 and 0.017) and particularly in the presence of segmental resection [Odds Ratio (OR): 20.87; CI 95% (1.96-221.79)]. The risk of rectovaginal fistula increased in the presence of segmental resection [OR: 22.71; CI 95% (2.74-188.01)] as well as in vaginal incision [OR: 19.67; CI 95% (2.43-159.18); p = 0.005]. CONCLUSION: The risk of overall postoperative complications and rectovaginal fistula in particular increases significantly in the presence of vaginal incision, segmental resection and urinary tract procedures after deep bowel endometriosis surgery.

[Sexual function and quality of life in locally advanced cervical cancer]. / Qualité de vie sexuelle et cancer du col localement avancé

OBJECTIVES: Sexual dysfunction is currently the most common complication of cancer. Most of the time, patients who are concerned by locally advanced cervical cancer are in a period of sexual activity. The primary objective of this study was to assess the quality of life and sexual function of patients with locally advanced cervical cancer who were in remission. The secondary objective was to correlate the prognostic factor with sexual dysfunction. PATIENTS AND METHODS: This multicentric and prospective study included the patients with locally advanced cervical cancer diagnosis from three centres. Thirty-one patients with diagnosis of locally advanced cervical cancer were enrolled from February 2007 to October 2008. The mean age was 49years old. Inclusion criteria were to have received the standard therapy by chemoradiotherapy and have been in remission for 2years. Both self-administered questionnaires BISF-W and EORTC QLQ-CX24 allowed scoring quality of life and sexual function. RESULTS: The rate of completion was 42%. The results confirmed that sexual function was impaired in accordance with sexual satisfaction. After therapy, the frequency of sexual activity was decreased. The functional quality of life was significantly correlated with sexual function. Marital status was a significant prognostic factor. Age, stage and the type of centre were not. DISCUSSION AND CONCLUSION: This preliminary study suggests that after 2years of remission of the disease after treatment, patients and their partners need to be helped as regards their sexual function. We propose to perform a prospective study on a larger cohort.

[Solitary fibrous tumor of the vulva: a case report]. / Tumeur fibreuse solitaire de la vulve : à propos d'un cas.

Solitary fibrous tumors of the genital tract female are extremely rare. We reported a case of solitary fibrous tumor originating in the vulva of a 37-year-old woman. The histological analysis revealed a conjunctiva tumourous proliferation, with variable cellularity, the morphology feature and the immunohistochemistry profile of which entailed us to infer on a solitary fibrous tumor. No recurrence was observed 16 months after surgery with flap reconstruction. Because of their possible pejorative evolution, it is very important to know these tumors. A long term follow-up must be advised.

[Hurt eczematiforme column (chronicle) of the breast after implementation of a surgical clip]. / Lésion eczématiforme chronique du sein après mise en place d'un clip chirurgical.

We report a case of atopic dermatitis in relation with a surgical titanium clip. Such a complication has only been reported once in the literature. We advocate to ask the patients about query atopic manifestations especially contact dermatitis to metal before any procedure involving metallic implants.

Predictors of recurrence in high-grade cervical lesions and a plan of management.

UNLABELLED: PRÉCIS: Positive endocervical margins are an important predictor of recurrence in high-grade cervical lesions, and though they do not always warrant retreatment, closer surveillance is recommended. OBJECTIVE: To identify predictors of recurrence and persistence of high-grade cervical dysplasia and to determine appropriate follow-up. DESIGN: prospective pilot study. SETTING: Gynaecological surgical center. POPULATION: Three hundred fifty-two patients were treated between 1999 and 2002 for high-grade lesions. METHODS: According to the accessibility of the transformation zone and the degree of dysplasia, patients were treated either by conization or by loop electrosurgical excision procedure (LEEP). Follow-up comprised colposcopy and Pap-smear screening 4-6 months after treatment as well as high-risk human papillomavirus (HR-HPV) testing before and after treatment. MAIN OUTCOME MEASURES: underscore predictors of recurrence and propose a treatment flowchart for both management and follow-up. RESULTS: Of the 352 patients, 37 (10.5%) had true recurrence 6 months after initial surgical treatment and 6 patients (1.7%) had persistent lesions. Overall, 43 patients (12.2%) were considered as having recurrent disease. Patients were followed up for 5 years with a mean of 73 months. The most important predictor of recurrence was a positive HR-HPV test at 6 months postoperatively (odds ratio 38.8, 95% confidence interval 14.09, 107.05). The second significant predictor was positive endocervical margins and the third was positive pre-treatment HPV typing. A positive post-treatment HPV test had a more significant influence on risk than a positive test before treatment. CONCLUSION: In agreement with recent findings, our study supports the usefulness of the HR-HPV test in the follow-up of treated high-grade lesions, especially when excision margins were positive.

[Construction of a neo-vagina by sigmoidocolpoplasty]. / Reconstruction vaginale par sigmoïdoplastie pour aplasie utérovaginale: Technique chirurgicale et avantages.

Construction of a neo-vagina by sigmoidocolpoplasty has been effective in the treatment of vaginal aplasia, a condition most commonly seen with the Mayer Rokitansky Syndrome. This article describes the surgical technique and principal complications, and reviews the literature to compare this technique with other methods of repair, particularly the Davydov technique.