[Laparoscopic ultrasound-guided radiofrequency ablation of uterine fibroid: A retrospective study]. / Myolyse des fibromes utérins par radiofréquence cœlioscopique sous contrôle échographique : à propos d'une série rétrospective.

OBJECTIVE: To assess clinical and radiological efficacy and safety of laparoscopic ultrasound-guided radiofrequency ablation of uterine leiomyomas. MATERIAL AND METHODS: Thirty-three patients with symptomatic uterine leiomyomas FIGO type 2 to 7, have undergone a laparoscopic ultrasound-guided radiofrequency ablation at Croix Rousse University Hospital Center (Hospices civils de Lyon) and at Saint-Vincent de Paul Hospital in Lille, between June 2020 and December 2022. The characteristics of each myoma and the symptoms were assessed with pelvic MRI and with Higham score, SSS and HRQL scores preoperatively and at 6 months. RESULTS: A total of 54 fibroids have been treated in 33 patients. We observed a significant decrease of the volume 6 months after the surgery, on average 21mL (55.97 vs. 74.37mL, 95% CI [7.13-34.88], P=0.001). The maximum diameter of each fibroid was also significantly reduced on average 11.78mm (41.89 vs. 52.06, 95% CI [8.83-14.73], P<0.05). We noticed a significant decrease of the NRS for dysmenorrhea on average 2.79 points (2.1 vs. 4.89, 95% CI [1.14-4.42], P<0.05). There was also a trend to improvement of menorrhagia, assess by Higham score. Indeed, 70.8% of the patients had menorrhagia. Menorrhagia was improved of 108,3 points with an average Higham score before surgery of 197.3 versus 87.9 after surgery (95% CI [47.9-168.8], P=0.001). Concerning UFS-QOL score: the symptom severity score (SSS) decreased on average 33 points, testifying of symptom improvement (27.04 vs. 60.89, 95% CI [22.92-43.39], P<0.001) and the HRQL score increased on average 20 points testifying quality of life improvement (65.57 vs. 42.7, 95% CI [15.83-37.85]. P<0.001). No severe adverse event has been reported. CONCLUSION: In this first French study about radiofrequency ablation. We confirm its efficiency for improvement of symptoms and quality of life but other study is mandatory to confirm the safety of this procedure in particular in patients with a wish to conceive.

Vaginal and laparoscopic myomectomy for large posterior myomas: results of a pilot study.

OBJECTIVE: To evaluate the feasibility and complications of vaginal and laparoscopic myomectomy, and analgesic drug consumption. METHODS: We conducted a pilot study involving 24 women with single, large (>5cm) symptomatic posterior uterine leiomyomas. Twelve women underwent vaginal myomectomy and 12 laparoscopic myomectomy. The main outcome measures were the operating time, peri- and post-operative complications, and analgesic drug consumption. RESULTS: There was no difference in mean age, the rate of nulliparity, and the mean size of myomas between the two groups. The mean operating time was shorter in the vaginal group (96+/-38min versus 166+/-78min; P<0.01). There was no difference in mean blood loss or fibroid weight between the two groups. One of the 12 patients in the vaginal myomectomy group required laparoscopic conversion for an inaccessible fundal myoma. Post-operative morphine consumption was lower in the vaginal group (37.2+/-64mg versus 150.8+/-42mg; P<0.003). No post-operative complications occurred in either group. Gas and stool recovery, the length of hospital stay, and the time required to return to normal activity were similar in the two groups. CONCLUSION: Vaginal myomectomy is feasible and safe, and was associated with a shorter operating time and lower morphine consumption than laparoscopic myomectomy.

Epithelioid angiomyolipoma of the uterus: a case report.

BACKGROUND: Epithelioid angiomyolipoma is a recently recognized pathologic entity. The occurrence of epithelioid angiomyolipoma in thefemale genital tract is rare. CASE: A case of uterine epithelioid angiomyolipoma occurred in a young woman without tuberous sclerosis and underwent an early recurrence with lymph node metastasis. CONCLUSION: Uterine epithelioid angiomyolipoma should be considered in young women with a tumor exhibiting high intratumoral linear vascularity and aneurysmal dilation.

Prevention of de novo adhesion by ferric hyaluronate gel after laparoscopic surgery in an animal model.

BACKGROUND AND OBJECTIVE: Adhesions remain a major cause of severe long-term complications. Attempts have been made to prevent adhesion formation by using endogenous or exogenous materials with controversial results. Our aim was to evaluate the efficacy of 0.5% ferric hyaluronate gel in the prevention of adhesion formation after laparoscopic surgery. METHODS: This was a prospective, randomized, experimental study (animal model). The study population comprised 75 female rabbits (Fauve de Bourgogne) weighing over 3 kg. The rabbits were randomized into 3 groups of 25 (hyaluronate, saline, and control) by using a predetermined computer-generated randomization code. All rabbits underwent a peritoneal laparoscopic resection, and the main outcome measure was the adhesion formation after laparoscopic surgery. RESULTS: The laparoscopic operating time and the mean interval before second-look surgery were not different among the 3 groups. The number of rabbits with adhesions did not differ among the 3 groups. The bowel adhesion rate was higher at the 10-mm trocar site than at the 5-mm trocar site (P=0.01). The adhesion scores did not differ among the 3 groups. A strong correlation was found between the values of the different adhesion scoring systems used. CONCLUSION: These results obtained in a rabbit model suggest that routine intraperitoneal application of hyaluronate gel does not prevent adhesion formation after laparoscopic surgery.

Feasibility and clinical outcome of laparoscopic colorectal resection for endometriosis.

OBJECTIVE: This study was undertaken to evaluate the feasibility and complications of laparoscopic segmental colorectal resection for endometriosis and its efficacy on gynecologic and digestive symptoms. STUDY DESIGN: After magnetic resonance imaging and rectal endoscopic sonographic evaluation of symptomatic colorectal endometriosis, 40 consecutive women requiring colorectal resection were included in this study. Symptom questionnaires were completed before and after the procedure. Perioperative complications and linear intensity scores for several gynecologic and digestive symptoms were recorded. RESULTS: Thirty-six women (90%) underwent laparoscopic segmental colorectal resection and 4 required laparoconversion. Major complications occurred in 4 cases (10%), including 3 rectovaginal fistulae and 1 pelvic abscess. Transient urinary dysfunction occurred in 7 women (17.5%). Median follow-up after colorectal resection was 15 months (3-22 months). Median overall preoperative and postoperative pain scores were 8 +/- 1 (range 4-10) and 2 +/- 2 (0-10), respectively ( P < .0001). Nonmenstrual pelvic pain ( P = .0001), dysmenorrhea ( P < .0001), dyspareunia ( P = .0001), and pain on defecation ( P < .0005) were improved by colorectal resection. Lower back pain and asthenia were not improved. CONCLUSION: Our results suggest that laparoscopic segmental colorectal resection for endometriosis is feasible but carries a risk of major postoperative complications. Colorectal resection improved gynecologic and digestive symptoms, and the overall pain score.

Treatment of genital prolapse by hammock using porcine skin collagen implant (Pelvicol).

INTRODUCTION: To assess the feasibility and efficacy of the hammock using a porcine skin collagen (Pelvicol) implant for the treatment of genital prolapse by the vaginal route. A total of 47 women with Stage III or IV genital prolapse underwent surgical treatment with porcine skin collagen implantation using anterior transobturator and posterior bilateral sacrospinous fixations. Genital prolapse treatment was combined with hysterectomy in 34 patients (72%). TECHNICAL CONSIDERATIONS: Porcine skin collagen implantation was feasible in every case. The surgical procedure lasted a median of 90 minutes (range 80 to 150). No vessel injuries, one bladder injury, and one rectal injury not requiring additional surgery occurred. One pararectal hematoma required a second procedure. The median follow-up was 24.6 +/- 8.5 months (range 6 to 42). No rejection of the porcine grafts occurred. Of the 47 women, 39 (83%) had optimal anatomic results, 5 had asymptomatic Stage I prolapse, and 2 had Stage II prolapse. The subjective cure rate was 93.6% (44 of 47 patients). The postoperative scores for lifestyle and urinary discomfort improved significantly after the procedure (P < 0.0001 and P < 0.0002, respectively). Of the 18 patients who were sexually active, an improvement in sexual discomfort occurred (P = 0.04). CONCLUSIONS: These short-term results suggest that hammock using porcine skin collagen implantation by the transobturator route and bilateral sacrospinous fixation is a safe and effective treatment for genital prolapse.

Serum and cyst fluid levels of interleukin (IL) -6, IL-8 and tumour necrosis factor-alpha in women with endometriomas and benign and malignant cystic ovarian tumours.

BACKGROUND: Altered expression of cytokines has been suggested as a specific event for the maintenance and progression of endometriomas. Few data exist on cytokine expression in endometriomas compared with benign and malignant ovarian tumours. Hence, serum and cyst fluid levels of interleukin (IL)-6, IL-8 and tumour necrosis factor-alpha (TNF-alpha) were evaluated in women with endometriomas and compared with those in women with benign or malignant ovarian tumours. METHODS: Investigations included immunoradiometric determination of serum and cyst fluid concentrations of IL-6, IL-8 and TNF-alpha in 34 women with endometriomas, 30 women with benign and 13 women with malignant cystic ovarian tumours. RESULTS: Serum IL-6 levels were higher in ovarian cancer than in endometriomas (P<0.01) or benign tumours (P<0.01). Serum TNF-alpha levels differed between benign tumours and endometriomas (P<0.01), but not between endometriomas and malignant tumours. Cyst fluid levels of IL-8 were higher in endometriomas than in benign tumours (P<0.001) and lower than in malignant tumours (P=0.03). Cyst fluid levels of TNF-alpha differed between malignant tumours and endometriomas (P<0.01) and benign tumours (P<0.01), but not between endometriomas and benign tumours. In the endometriomas group, a positive correlation was found between serum and cyst fluid levels of IL-6 (P=0.003, rho=0.633), and between serum levels of IL-6 and IL-8 (P=0.03, rho=0.415). CONCLUSIONS: Endometriomas were associated with serum TNF-alpha levels similar to those found in women with ovarian cancer, while serum IL-6 levels and cyst fluid IL-8 levels were intermediate between those observed in benign and malignant ovarian tumours.

Transvaginal sonography and rectal endoscopic sonography for the assessment of pelvic endometriosis: a preliminary comparison.

BACKGROUND: Endometriosis and possible rectal involvement are difficult to assess by physical examination. Previous studies have shown the diagnostic value of magnetic resonance imaging and rectal endoscopic sonography (RES) in this setting, but not that of transvaginal sonography (TVS). The aims of this study were to compare the accuracy of TVS and RES for the diagnosis of pelvic endometriosis, and to compare the results with histological findings. PATIENTS AND METHODS: In a prospective study, 30 consecutive patients referred with clinical signs of endometriosis underwent TVS and RES; the images were interpreted blindly with regard to physical findings. RESULTS: Endometriosis was confirmed histologically in 28 (93%) of the 30 patients. Endometriomas were also present in 67% of cases. For the diagnosis of uterosacral endometriosis, the sensitivity, specificity, and positive and negative predictive values of TVS and RES were 75 and 75%, 83 and 67, 95 and 90%, and 45 and 40% respectively. For the diagnosis of rectosigmoid endometriosis, the sensitivity, specificity, and positive and negative predictive values of TVS and RES were 95 and 82%, 100 and 88%, 100 and 95%, and 89 and 64% respectively. CONCLUSION: Despite the large proportion of our patients who had intestinal endometriosis, representing a possible source of bias, our results suggest that TVS is as efficient as RES for detecting posterior pelvic endometriosis and should therefore be used as the first-line examination.

Massive ovarian edema revealing gastric carcinoma: a case report.

Tumor-like enlargement of the ovaries due to accumulation of edema fluid within the ovarian stroma is referred to as massive ovarian edema (MOE). The pathogenesis of MOE is thought to be intermittent torsion of the ovary on its pedicle, causing partial obstruction of venous and lymphatic drainage. The diagnosis of MOE is based on imaging techniques. The case described here due to ovarian lymphatic vessel obstruction by carcinoma cells shows that metastatic disease may be a cause of MOE.

Symptoms before and after surgical removal of colorectal endometriosis that are assessed by magnetic resonance imaging and rectal endoscopic sonography.

OBJECTIVE: The purpose of this study was to evaluate the impact of colorectal resection for endometriosis on symptoms and quality of life or on potential side effects. STUDY DESIGN: After magnetic resonance imaging and rectal endoscopic sonographic evaluations of symptomatic colorectal endometriosis, 27 consecutive women who underwent colorectal resection were included in this prospective study. They completed symptom questionnaires before and after the procedure. Linear pain scores for several gynecologic and digestive symptoms and impact on quality of life were recorded. RESULTS: The sensitivity and positive predictive value of magnetic resonance imaging and rectal endoscopic sonographic evaluation for the diagnosis of colorectal endometriosis were 92.6% and 100% and 89% and 100%, respectively. Nonmenstrual pelvic pain (P = .001), dysmenorrhea (P < .0001), dyspareunia (P = .0002), and pain on defecation (P < .005) were improved by colorectal resection. No correlation was found between symptom intensity and lesion size, as evaluated by magnetic resonance imaging, rectal endoscopic sonographic evaluation, or histologic examination of the surgical specimen. Respectively, the conditions of 14, 11, 0, and 2 women were cured, improved, unchanged, or worsened. Median overall pre- and postoperative quality-of-life scores were 9 (range, 4-10) and 0 (range, 0-10), respectively (P < .0001). CONCLUSION: Colorectal resection for endometriosis appears to relieve some symptoms. However, women should be informed that some symptoms may persist and that there is a risk of urinary and digestive side effects.