Stress Experienced by Obstetrics and Gynecology Residents during Planned Laparoscopy: A Prospective, Multicentric, Observational, Blinded, and Comparative Study.

AIMS: To describe heart rate (HR) variations in surgical residents during laparoscopy and to assess their intraoperative stress. METHODS: We performed a prospective, multicentric, observational, blinded, and comparative analysis of the HR in 75 obstetrics and gynecology residents during planned laparoscopy for infertility in five teaching hospitals with assisted reproductive technology centers. The surgical residents had neither heart disease nor were under medical treatment or using tobacco or drugs. We describe HR variations at 9 preselected operative steps using real-time noninvasive measures of the HR during laparoscopy. RESULTS: Residents performed 124 laparoscopies for unexplained infertility. Their HR increased significantly during the introduction of the Palmer needle, umbilical port and second port, and during abdominopelvic exploration and dye test compared to the baseline HR, the HR after hand washing, at the end of surgery and during skin suture (91.6 ± 1.9, 104.8 ± 2.3, 95.3 ± 2.2, 93.7 ± 2.5, 90.7 ± 1.7 vs. 83.2 ± 1.6, 88.6 ± 1.9, 87.4 ± 2.1, 88.2 ± 1.9 bpm, respectively, p < 0.02). CONCLUSION: Our results point to a potential stress for the surgeon assessed by HR variations during planned laparoscopy compared to the baseline HR before surgery. This 'static' stress can be repeated on the same day.

Hydrosalpinx and infertility: what about conservative surgical management?

OBJECTIVE: The aim of this study was to assess and validate a management protocol for infertile patients affected by at least one hydrosalpinx. STUDY DESIGN: Eighty-one consecutive infertile normo-ovulatory patients with uni or bilateral hydrosalpinx planed to be surgically managed were included in the protocol from November 2003 to May 2007. During laparoscopy, a systematic evaluation of the tubes was firstly conducted and the local management protocol based on validated tubal prognostic scores was applied. Surgery for hydrosalpinx was either conservative by neosalpingostomy or radical by salpingectomy. The primary end-point was the cumulative clinical pregnancy rate. RESULTS: 115 hydrosalpinges out of 153 present tubes were confirmed during laparoscopy. Neosalpingostomy was possible in 35 patients featuring 50 hydrosalpinges (43.2% and 43.5%, respectively). Salpingectomy was necessary for the others (46 patients representing 65 hydrosalpinges). The mean follow-up period was 31.8 ± 12.4 months. The overall cumulative pregnancy rate was 61% per couple who completed the protocol (33/54 patients). The cumulative pregnancy rate was 50% after IVF in patients who underwent bilateral salpingectomy. Among patients with at least one functional tube, the overall cumulative pregnancy rate was 63.3%, with a spontaneous pregnancy rate of 30.4%. CONCLUSION: Hydrosalpinx management can be conservative with a tubal conservative of 43.5% and fair chances for spontaneous conception. An integrated management of hydrosalpinx including ART actually leads to a cumulative pregnancy rate of 61% per patient.

Vaginal delivery after tension-free vaginal tape procedure.

To treat genuine stress urinary incontinence, the surgical technique of choice at present is suburethral tension-free vaginal tape (TVT) procedure. Because of its good results and low morbidity, TVT is now offered to younger women still of childbearing age. We describe a patient who delivered vaginally 2 years after undergoing a retropubic TVT procedure. The woman remained continent throughout her pregnancy and at 6 months postpartum, with normal urodynamic parameters.