Outpatient laparoscopic sacrocolpopexy: Feasibility and patient satisfaction.

STUDY OBJECTIVE: To assess the feasibility and patient satisfaction of outpatient management of laparoscopic sacrocolpopexy. DESIGN: Observational study. SETTING: Multicentric study in four French centers: La Conception University Hospital, Marseille; Simone Veil Hospital, Cannes; Simone Veil Hospital, Eaubonne; and Jules Verne Clinic, Nantes. PATIENTS: A total of 125 patients required laparoscopic sacrocolpopexy and accepted outpatient surgery. INTERVENTIONS: Assessment of outpatient surgery success, patient satisfaction, and self-evaluated symptom improvement after surgery. MEASUREMENTS AND MAIN RESULTS: During the study period, 574 patients required laparoscopic sacrocolpopexy, and 21.8% (125) of them met the inclusion criteria for outpatient surgery. The success rate for outpatient surgery was 95.2% (119/125). The perioperative complication rate was 4% (5/125). Among the successfully discharged outpatients, 2.5% (3/119) of them had an unscheduled visit within seven days. Among the discharged patients, 84% (105/125) answered the satisfaction questionnaire, and 88.5% (93/105) declared themselves as "satisfied" or "very satisfied" with the procedures. Patients who declared their conditions to have been "very improved" or "improved" compared to their preoperative symptomatology were 76.9% (83/108) of cases. CONCLUSION: A high success rate for outpatient laparoscopic sacrocolpopexy associated with a high satisfaction rate were found in our study. The development of outpatient options for laparoscopic sacrocolpopexy was supported by our data.

Interest of cervical ripening using double balloon catheters for labour induction in term nulliparous women.

OBJECTIVE: To compare the efficiency of double balloon catheters with that of intravaginal prostaglandins alone for the labor induction of unfavourable cervices in term nulliparous women. METHODS: 50 nulliparous patients induced with a double balloon device were compared to 53 patients induced using intravaginal prostaglandins alone. The main outcome measure was labour induction failure, characterized by the absence of active labour. The secondary outcome measures were the improvement of the Bishop score, the average durations of ripening and labour induction, the average time to active labour, the need for a second cervical ripening agent, the total dose of prostaglandins used in each group, the use of oxytocins, as well as the rates of vaginal delivery, abnormal foetal heart rate during labour and perinatal maternal infection. RESULTS: The rate of failed labour induction was of 28% in the double balloon group, against 13% in the prostaglandins group. The average durations of ripening and labour induction, as well as the time to active labour were higher in the double balloon group. The improvement of the Bishop score was significantly lower in the double balloon group. DISCUSSION AND CONCLUSION: In our study, the use of double balloon catheters does not seem to reduce the rate of failed labour induction in nulliparous women when compared to the use of prostaglandins alone. In addition, it could lengthen the labour induction duration, although more powerful studies would be necessary not to recommend its use for nulliparous women.

The value of pelvic MRI in the diagnosis of posterior cul-de-sac obliteration in cases of deep pelvic endometriosis.

OBJECTIVE: The objective of our study was to define relevant MRI signs allowing preoperative diagnosis of posterior cul-de-sac obliteration in patients with deep pelvic endometriosis. MATERIALS AND METHODS: This retrospective study included patients who underwent pelvic MRI completed by a laparoscopic examination. Three radiologists performed the MRI review blinded and recorded the following signs: sign 1, retroflexed uterus; sign 2, retrouterine mass; sign 3, displacement of intraperitoneal fluid; sign 4, elevation of the fornix; and sign 5, adherence of bowel loops. Laparoscopic results provided the criterion standard for diagnosis of posterior cul-de-sac obliteration. The performance of MRI was evaluated by calculating the average sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MRI results of the two more experienced radiologists for each sign and for combinations of signs. Interobserver agreement for each sign and impression for posterior cul-de-sac obliteration were calculated for all radiologists. RESULTS: Sixty-three patients were included in the study. Posterior cul-de-sac obliteration was diagnosed in 43 patients at laparoscopy. The mean sensitivity, specificity, and accuracy of each sign and impression of posterior cul-de-sac obliteration were, respectively, as follows: sign 1, 24.4%, 77.5%, 41.3%; sign 2, 97.1%, 83.7%, 92.8%; sign 3, 95.0%, 88.7%, 93.1%; sign 4, 30.2%, 97.5%, 51.6%; sign 5, 83.7%, 91.2%, 86.1%; and impression of posterior cul-de-sac obliteration, 91.9%, 91.2%, 91.7%. Interobserver concordance varied from 0.26 to 0.81 with best results obtained with the combination of signs 2, 3, and 5. Best concordances for junior radiologist evaluations were obtained with assessment of sign 3. CONCLUSION: MRI allows posterior cul-de-sac obliteration diagnosis. Pelvic fluid displacement may be the sign with greatest utility when considering both diagnostic accuracy and interobserver agreement.

MRI characteristics of the uterine junctional zone: from normal to the diagnosis of adenomyosis.

OBJECTIVE: MRI was the first imaging technique to permit the visualization of the uterine junctional zone and remains the imaging method of choice to evaluate it and its associated pathology. CONCLUSION: Adenomyosis can be diagnosed using MRI with a diagnostic accuracy of 85%. The most important MR finding in making the diagnosis is thickness of the junctional zone exceeding 12 mm. The principal limitation of MRI is the absence of a definable junctional zone on imaging, which occurs in 20% of premenopausal women.

Anatomic and functional results of laparoscopic-perineal neovagina construction by sigmoid colpoplasty in women with Rokitansky's syndrome.

BACKGROUND: The Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is a rare congenital cause of primary amenorrhea, due to utero-vaginal agenesis. Several surgical techniques have been used to create a neovagina. Neovagina construction with a sigmoid graft appears to be the best option, as it offers adequate length and natural lubrication, allowing early intercourse. However, few data are available on the complications, anatomic and functional results of laparoscopic-perineal neovagina construction by sigmoid colpoplasty. METHODS: From September 1995 to November 2002, seven women with the MRKH syndrome underwent laparoscopic-perineal neovagina construction by sigmoid grafting. RESULTS: The mean operating time was 312 min (range 220-450 min). The mean fall in haemoglobin was 3.6 g/dl (range 2-4.4 g/dl). Blood transfusion was never necessary. The only perioperative complications were one urinary tract infection and one vulvar haematoma not requiring drainage. The mean hospital stay was 7.7 days (range 6-12 days). The mean length of the neovagina was 11.5 cm (range 7-15 cm), and no shrinkage occurred during follow-up. The neovaginal introitus admitted two fingers in breadth in five of the seven patients. Dilation of the introitus was required in the other two women. None of the four women who had intercourse experienced dyspareunia or discomfort. CONCLUSION: Our results confirm the feasibility of laparoscopic-perineal neovagina construction by sigmoid colpoplasty, when performed by surgeons with extensive experience in both gynaecological and gastrointestinal laparoscopic surgery. The anatomic and functional results were good.