Analysis of clinical data associated with Essure® sterilization devices: An expanded case series.

OBJECTIVES: To evaluate clinical data in women who underwent Essure® hysteroscopic sterilization and to determine whether this sterilization technique plays a role in developing new-onset symptoms. STUDY DESIGN: An observational, retrospective, single-center study. It was conducted in a secondary level hospital. It included 804 women who had Essure® hysteroscopic sterilization from 2009 to 2017. Charts from these women were reviewed from June 2009 to November 2019, searching for the development of gynecological symptoms (pelvic pain and bleeding disorders) and non-gynecological symptoms (bloating, joint pain, fatigue, headache, alopecia, allergy and depression). The sample was divided into two groups depending on whether they had developed gynecological symptoms (symptomatic group) or not (asymptomatic group), and a descriptive and comparative analysis was made between them. The impact of the global social alarm in 2015 regarding adverse events attributed to the devices, the development of non-gynecological symptoms, and the treatments required, including conservative and surgical options, were also described. RESULTS: Out of 804 women who had Essure® devices placed, 541(67.29%) remained asymptomatic, 263(32.71%) developed gynecological symptoms, and 41 of these (15.5% of the total sample) requested Essure® surgical removal. Pelvic pain was the most frequent symptom and the main reason for surgical removal. Bleeding alterations were the second most frequent symptom. Up to 55.89% described the symptoms after the social alarm. Non-gynecological symptoms were statistically significantly more frequent in the symptomatic group. CONCLUSIONS: More than a half of the women who underwent Essure® sterilization remained asymptomatic. The new-onset symptoms attributed to the devices are the minority and causality is difficult to establish. IMPLICATIONS STATEMENT: Our research provides new follow-up data about Essure® hysteroscopic sterilization. Association between gynecological symptoms and Essure® devices is difficult to demonstrate and some confounding factors may be implicated. The results we described, may guide and counsel medical-patient decisions for the treatment of symptoms related to the devices, including surgical removal.

Role of single-site and mini-laparoscopy in gynecologic surgery.

INTRODUCTION: Laparoscopy is a surgical procedure that has been used widely in medicine over the last thirty years. In gynecology, laparoscopy is the "gold standard" for the majority of gynecological procedures, as its superiority over laparotomy has been widely demonstrated. In recent years, the current trend of gynecologists is to make laparoscopy surgery even less invasive by reducing the number of incisions in the skin, as it happens with laparoendoscopic single-site surgery, or by reducing the size of them as in mini-laparoscopy. The aim of this work was to perform an extensive review and update of the evolution of single-port surgery and mini-laparoscopic surgery in gynecology as well as to evaluate its current role in this field. EVIDENCE ACQUISITION: A systematic review was performed during April and May 2020. PRISMA guidelines were followed for the literature search. EVIDENCE SYNTHESIS: The main objective of performing less invasive procedures is to reduce both intraoperative complications (decreased risk of bleeding or damage to internal organs), and postoperative ones (hernias through the trocar) and improve cosmetic results. Results of studies about LESS and mini-LPS showed encouraging results, being both of them safe with a similar perioperative and postoperative outcome. They have the approval of the international surgical community as well as patients' satisfaction with cosmetic results. CONCLUSIONS: Minimally invasive surgery is the present and future in gynecological surgery. More prospective randomized trials are needed in order to obtain valid results and affirm that both LESS and Mini-LPS are superior to conventional laparoscopy.

Tumor de células de la granulosa: neoplasia estromal de los cordones sexuales: revisión de la literatura, a propósito de dos casos clínicos / Granulosa cell tumor: stromal neoplasm of the sexual cords: review of the literature and clinical cases

Los tumores de las células de la granulosa, hacen referencia a un conjunto de neoplasias derivadas del tejido estromal de los cordones sexuales, secretores de estrógenos, que corresponden al 1-5% de todos los tumores malignos del ovario, aunque pueden presentar localizaciones extraováricas. Son tumores raros e infrecuentes, cuya incidencia general varía de 0,4 a 1,7 casos por cada 100.000 mujeres al año. Se clasifican en dos grupos diferenciados en función de la edad de las pacientes, su historia natural y sus características patogénicas: tumores de células de la granulosa tipo adulto (TCGA) o tipo juvenil (TCGJ). El diagnóstico de esta rara patología se basa en cuatro pilares fundamentales, por un lado, las manifestaciones clínicas y la confirmación mediante pruebas de imagen, y, por otro lado, los marcadores tumorales y el estudio inmunohistoquímico de las muestras biológicas. En el manejo terapéutico de los estadios iniciales de la enfermedad (supervivencia a los 5 años superior al 90% en los estadios I), se recomienda el tratamiento quirúrgico mediante histerectomía con anexectomía bilateral en pacientes con TCGA y deseos genésicos cumplidos, reservando la anexectomía unilateral para los casos de TCGJ o para aquellas pacientes sin descendencia (aunque con posterioridad se recomienda completar el tratamiento). La quimioterapia sistémica postoperatoria se incluye cuando existe extensión extraovárica o recurrencia de la enfermedad. La tasa de recidiva (considerado uno de los principales factores de mal pronóstico), es alta en estadios avanzados, aunque la probabilidad de desarrollar metástasis a distancia es baja.

Tumors of the granulosa cells refer to a set of neoplasms derived from the stromal tissue of the sex cords, secretory of estrogens. They correspond to 1-5% of all malignancies of the ovary, though they may have extraovarian locations. These tumors are rare and uncommon, whose general incidence may vary from 0.4 to 1.7 cases per 100,000 women per year. They are classified into two groups depending on the age of the patients, their natural history and their pathogenic characteristics: adult type tumors of the granulosa cell (AGCT) or juvenile type (JGCT). The diagnosis of this rare pathology is based on the study of clinical manifestations and confirmation through image tests, and also on tumor markers tests and the immunohistochemical study of biological samples. In the therapeutic handling of the early stages of the disease (5-year survival greater than 90% in stage I), surgical treatment via hysterectomy with bilateral adnexectomy in patients with AGCT and met genesic perspectives is recommended; for the cases of JGCT or for those patients without progeny, preserving the unilateral adnexectomy is justified (although completion of the treatment is recommended at later stages). Postoperative systemic chemotherapy is practiced when there is extraovarian extension or recurrence of the disease. The rate of relapse (considered one of the main factors of poor prognosis), is high in advanced stages, although the probability of developing distant metastasis is low.

Impacto económico de la histeroscopia quirúrgica en consulta. Modelo con escenarios progresivos / Economic analysis of outpatient versus day-case operative hysteroscopy. A progressive-scenario model

Objetivo. Analizar el coste de la histeroscopia en consulta frente al de la histeroscopia en régimen de cirugía mayor ambulatoria. Sujetos y métodos. Sobre la base de las 1.695 histeroscopias realizadas entre 2010 y 2012, se analiza el coste de los procedimientos en consulta y en quirófano de cirugía mayor ambulatoria. Se recrea un modelo con 10 escenarios progresivos según el número de procedimientos quirúrgicos realizados en consulta y se analizan el impacto económico y las horas de quirófano liberadas. Resultados. La realización en consulta de todos los procedimientos histeroscópicos posibles representó un ahorro de 177.971 Euros y se liberaron 85,16 jornadas de 7 h en quirófano. Conclusiones. La histeroscopia quirúrgica en consulta es una técnica segura, eficiente, con un importante impacto económico y altas tasas de satisfacción para las pacientes. Debe sustituir, en la medida de lo posible, a la histeroscopia quirúrgica en quirófano y ser difundida ampliamente en los centros asistenciales (AU)

Objective. To analyze the cost of outpatient versus day-case operative hysteroscopy. Subjects and methods. The average cost of outpatient and day-case procedures were analyzed, based on the 1695 hysteroscopies performed between 2010 and 2012. A model with 10 progressive scenarios was built according to the number of outpatient procedures performed. The economic saving and the number of operating room sessions avoided were analyzed. Results. Performing as many procedures as possible in the outpatient setting represented a saving of 177,971 Euros and avoided 85.16 seven-hour sessions in the operating room. Conclusions. Outpatient operative hysteroscopy represents a safe, efficient and cost saving procedure with a high degree of patient satisfaction. This procedure should replace day-case hysteroscopy and should be widespread in the health service (AU)

Cystosarcoma phyllodes of the breast: a case report in a 12-year-old girl.

Breast tumors in adolescents are very rare and mostly benign. Fibroadenomas are the most frequent, but within the extensive differential diagnosis, the phyllodes tumor must be mentioned, which accounts for about 1% of breast tumors and the diagnosis of which is very rare in patients younger than 20 years. There are no specific symptoms or radiological images to distinguish phyllodes tumor from fibroadenoma; therefore, histological examination is mandatory for diagnosis. Histology also allows the classification of phyllodes tumor into benign, borderline, or malignant types for appropriate surgical treatment: freemargin excision in benign tumors and mastectomy in the other two types. Fortunately, the majority of these tumors are benign, and treatment maximizes breast conservation with free infiltration margins surgery, given that this fact is the most important factor to prevent local recurrence. In this article, we describe a rare case of borderline cystosarcoma phyllodes in a 12-year-old girl.