Conservative management of placenta accreta: hysteroscopic resection of retained tissues.

STUDY OBJECTIVE: To evaluate the feasibility and the results of hysteroscopic removal of tissue after conservative management of retained placenta accreta. DESIGN: Retrospective study (Canadian Task Force classification II-3). SETTING: Tertiary care university hospital. PATIENTS: Twelve consecutive patients with hysteroscopic resection of retained tissues after conservative management of placenta accreta. INTERVENTION: Hysteroscopic removal of retained placenta tissue using a 24F bipolar resectoscope. MEASUREMENTS AND MAIN RESULTS: Twelve patients with retained placenta tissue, complete in 2 and partial in 10, were included. Mean retained placenta size on magnetic resonance imaging was 54 mm (range, 13-110 mm). Complete removal was achieved in all but 1 patient who underwent a secondary hysterectomy after the first incomplete hysteroscopic resection. Complete evacuation of the uterus was completed after 1 procedure in 5 patients, after 2 procedures in 2 patients, and after 3 procedures in 4 patients. All but 2 patients had normal menstrual bleeding after hysteroscopy. Four pregnancies occurred in our series, resulting in 1 ectopic pregnancy, 1 miscarriage, and 2 deliveries. CONCLUSION: Hysteroscopic resection of retained placenta seems to be a safe and effective procedure to prevent major complications and to preserve fertility in cases of conservative management of placenta accreta.

Evaluation of the two intraoperative examination methods for sentinel lymph node assessment: a multicentric and retrospective study on more than 2,000 nodes.

BACKGROUND: Intraoperative frozen section (FS) and imprint cytology (IC) are currently used to detect sentinel lymph node (SLN) metastasis, allowing for complete dissection when necessary. MATERIALS AND METHODS: A 2-year retrospective chart review was performed for patients who underwent SLN procedure in five French hospitals. The FS and IC results were compared to the definitive histology in order to calculate the sensitivity, specificity and false-negative rate. These results were studied from both the surgeon's and the pathologist's point of view. RESULTS: The comparison of the FS group (n=672) and IC group (n=576) showed a lack of sensitivity for both techniques, even if it was better for FS (59.3% vs. IC=33.3%). The false-negative rate (among patients with metastases) was very high in the two groups (FS=40.7% vs. IC=66.6%), leading to high re-intervention rates (FS=40.7% vs. IC=30.2%). False-negative nodes were more often small metastases and lobular carcinoma type. CONCLUSION: The interest in intraoperative examination is questionable. To avoid intraoperative examination failures, we think that complete staging of the disease before surgical treatment would be more relevant.