[Celioscopic ovariectomy. Retrospective study of 56 ovariectomies]. / Ovariectomie coelioscopique. Série rétrospective de 56 ovariectomies.

OBJECTIVE: To describe a technique of laparoscopic oophorectomy, and evaluate its feasibility, limits and complications. DESIGN: We performed a retrospective study of 34 patients who underwent laparoscopic oophorectomy, from 1 December 1992 to 28 February 1995. SETTING: Centre Hospitalier Intercommunal, Créteil, and Institut Gustave Roussy, Villejuif. SUBJECTS: Mean age was 58 years (range: 42 to 74 years). In post-menopausal patients with ovarian cyst, a systematic oophorectomy was performed (33 patients). Among post-menopausal women, a systematic contro-lateral oophorectomy was done in 77% of cases. Castration was preconized in one woman with previous breast carcinoma. TECHNIC: Removal of the ovary was performed by dessication and division of the utero-ovarian junction and of the mesovarium. RESULTS: Among the 34 women, 32 (94%) had an exclusive laparoscopic procedure, 2 had laparo-conversion. The reasons of laparo-conversion were the presence of adhesions in one case and presumption of ovarian malignancy (Border-line ovarian tumor) in the other case. For the 32 women with laparoscopic treatment, 22 (65%) had bilateral oophorectomy. Per-operative complication rate was 6.2% (an epigastric vessel injury in one case and an hemorrhage during laparoscopic adhesiolysis in an other case). The post-operative time was uneventful. CONCLUSION: This technique of laparoscopic oophorectomy is simple, rapid and has a low rate of per and post-operative complications. In addition, this technique has the advantage to prevent the risk of ureteral injury.

Failure of laparoscopic treatment for peritoneal trophoblastic implants.

We report on two cases of peritoneal trophoblastic tissue implants, one after salpingostomy, and one after salpingectomy for ectopic pregnancy. During each secondary laparoscopy, simple excision of implants with laparoscopic biopsy forceps resulted in persistent elevated beta-human chorionic gonadotrophin (beta-HCG) levels. Methotrexate therapy was used. Removal of all trophoblastic tissues present and avoidance of trophoblastic spillage during the laparoscopic procedure should prevent such an uncommon complication.

Myomectomy by laparoscopy: a preliminary report of 43 cases.

OBJECTIVE: To evaluate the technique and short-term results of intraperitoneal (IP) myomectomies. DESIGN: From January 1, 1990, to March 1, 1991, IP myomectomies were performed in all cases in which it appeared feasible. SETTING: This study was conducted in a tertiary care center, the Port-Royal University Hospital. PATIENTS, PARTICIPANTS: Among 49 consecutive patients with interstitial or subserous myomas, 6 patients with voluminous, multiple myomas had laparotomies. Intraperitoneal myomectomy was performed in 43 patients. The indication for laparoscopy was a pelvic mass in 29 cases, infertility in 13, and severe endometriosis in 1 case. INTERVENTIONS: Thermocoagulation or monopolar coagulation was used for the uterine incision. Myometrium and serosa were sutured in 23 of 43 patients. Myomas were removed through the suprapubic puncture site after fragmentation of large myomas. MAIN OUTCOME MEASURE(S): We evaluated the length of the procedures, blood loss, and postoperative course. RESULTS: Ninety-two myomas were removed laparoscopically. No complication was observed. CONCLUSIONS: In selected cases, IP myomectomy appears to be a safe technique with the advantages of laparoscopic surgery.