Radiofrequency Ablation: A Promising Treatment Method for Abdominal Wall Endometriosis.

PURPOSE: To evaluate the application of radiofrequency ablation (RFA) as a treatment method for abdominal wall endometriosis (AWE). MATERIALS AND METHODS: The characteristics of the AWE lesions in the patients were obtained using ultrasound (US). The patients received general and local anesthesia, and then, AWE lesions were divided into 1 cm3 sections visually, and each of these sections underwent US-guided RFA using the moving shot technique. Follow-up included outpatient appointments, including a US examination 1, 3, and 6 months after the treatment to assess the volume of the lesions. In addition, the level of pain experienced by the patients was measured using a visual analogue scale (VAS) before and the day after the procedure, as well as at each follow-up appointment. RESULTS: Ten patients were treated with RFA. The procedural success was achieved in all of the patients. The median volume of the lesions decreased from 7.3 cm3 (IQR = 4.39,23.75) to 2.95 cm3 (IQR = 1.65,9.09) (P = 0.005). All patients reported reduced pain levels, and the median of their VAS score decreased from 9 (IQR = 8,9) to 0 (IQR = 0,1.25) (P = 0.004) at the end of the follow-up period. None of the patients experienced complications related to RFA treatment. CONCLUSION: Based on the study's findings, RFA appears to be a promising minimally invasive treatment for AWE. However, larger studies with longer follow-up periods are required for a more comprehensive understanding of its efficacy and safety. LEVEL OF EVIDENCE: Level 4, Case Series.

Effects of sensate focus technique and position changing on sexual function of women with deep-infiltrating endometriosis after surgery: A clinical trial study.

Background: Endometriosis is a disease that affects women throughout their sexual life. Sexual health is, therefore, a major concern for these women. Objective: This study aimed to assess the effects of the sensate focus technique and position changing on the sexual function of women with deep-infiltrating endometriosis 3-6 months after surgery. Materials and Methods: This clinical trial study was performed on 80 women with deep endometriosis, aged 18-45 yr, who were referred to the endometriosis clinic of Avicenna fertility center, Tehran, Iran for follow-up after surgery from January to September 2021. They were divided randomly into 2 groups. In the intervention group, 2-hr virtual training sessions were held and the control group only completed the questionnaires without any intervention. Sexual function was evaluated after 4 and 8 wk. Results: 8 wk after the intervention, the mean score of sexual function in the intervention group was significantly improved (p < 0.001). The mean total score of sexual function in the pre-intervention period reached from 24.16 to 28.31 in 4 wk after the intervention and 29.85, 8 wk after the intervention. The mean score of sexual pain during the follow-up periods was significantly improved in the intervention group (p < 0.001). Conclusion: Sensate focus technique and sexual position changing improved sexual function in women with deep endometriosis after surgery.

Transvaginal sonography and surgical findings in the diagnosis of endometriosis individuals: A cross-sectional study.

Background: Endometriosis is a challenging gynecological disease and a debilitating condition that profoundly affects the individual's quality of life. Besides pathological confirmation, diagnostic laparoscopy has been internationally accepted as the standard method to identify the accurate mapping of endometriosis. Transvaginal sonography (TVS) is the first non-invasive imaging modality to estimate the severity of endometriosis. Objective: This study aimed to evaluate the accuracy of TVS in affected women compared with surgical findings. Materials and Methods: This retrospective cross-sectional study surveyed 170 women with deep infiltrating endometriosis (DIE) referred to the endometriosis part of the Avicenna Infertility Center, Tehran, Iran and they underwent TVS followed by laparoscopy. Recorded data of individuals under study in the medical database system were reviewed. Finally, the agreement rate was calculated for ultrasound reports and intraoperative (IO) findings regarding ovarian endometrium, ovarian adhesion, involvement of cul-de-sac, rectovaginal septum, and bowel and ureter. Results: 170 women with DIE entered the study. The agreement of TVS and IO findings were 86.76% for left ovarian endometriosis and 70.86% for right ovarian endometriosis, 93.90% for left ovarian adhesion, and 88.90% for right ovarian adhesion, 88.90% for a cul-de-sac, and 84.82% for bowel nodules. The findings, based on a laparoscopic assessment of the pelvic floor, were completely compatible with ultrasound reports (100%). Conclusion: TVS allows a preoperative evaluation in planning the surgical policy associated. TVS is beneficial for dedicated mapping of DIE; thus, an expert radiologist can aid the surgeon in preoperative evaluation and IO management.

PEComa-A Rare Uterine Neoplasm: A Case Report.

Background: Perivascular Epithelioid Cell Tumors (PEComas) are rare mesenchymal tumors originating from perivascular epithelioid cells. The second common affected organ is uterine. Most of PEComas are benign and patients have good prognosis. At the present time, surgery is the main treatment and adjuvant chemotherapy is used in malignant cases, although the best diagnostic and management method is yet to be discovered considering the rarity of this neoplasm. Case Presentation: The patient was a 53 year old lady with a history of two vaginal deliveries and no previous surgery. She had severe pelvic pain and underwent MRI with the primary impression of sarcoma. In MRI, she had a 7 cm mass in lower segment of uterus. The patient underwent laparoscopic hysterectomy, bilateral oophorectomy, lymphadenectomy, and omental biopsy in Jam Hospital. Pathologic report of the patient revealed malignant PEComa without lymph node and omentum involvement. Conclusion: Diagnosis of PEComa before surgery is difficult and its differential diagnoses form uterine leiomyoma or leiomyosarcoma. Final diagnosis can be made after surgical biopsy and immunohistochemistry evaluation. Surgery is still the main treatment and adjuvant therapy is used in high risk patients.

Laparoscopic excision of deeply infiltrating endometriosis: a prospective observational study assessing perioperative complications in 244 patients.

PURPOSE: To examine peri-operative complications in patients undergoing laparoscopic excision of deeply infiltrating endometriosis (DIE). METHODS: This was a prospective study of a case series of women having laparoscopic excision of deeply infiltrating endometriosis from September 2013 through August 2016 in a tertiary referral center for endometriosis and minimally invasive gynaecological surgery in Iran. Data collected included demographics, baseline characteristics, intraoperative and postoperative data up to 1 month following surgery. RESULTS: We analysed data from 244 consecutive patients, who underwent radical laparoscopic excision of all visible DIE. Major postoperative complications occurred in 3 (1.2%) and minor complications in 27 (11.1%) of patients. 80.3% of our patient group had Stage IV endometriosis. Segmental bowel resection was performed in 34 (13.9%), disc resection in 7 (2.9%), rectal shave in 53 (21.7%). Joint operating between a gynaecologist and colorectal and/or urological colleague was required in 29.6% of cases. The mean operating time was 223.8 min (± 80.7 standard deviation, range 60-440 min) and mean hospital stay was 2.9 days (± 1.5 standard deviation, range 1-11). The conversion to laparotomy rate was 1.6%. CONCLUSIONS: A combination of different laparoscopic surgical techniques to completely excise all visible DIE, within the context of a tertiary referral center offering multi-disciplinary approach, produces safe outcomes with low complication rates.

Fertility outcome after laparoscopic treatment of advanced endometriosis in two groups of infertile patients with and without ovarian endometrioma.

OBJECTIVE: To evaluate the result of laparoscopic endometrioma excision in fertility outcome of advanced endometriosis patients. STUDY DESIGN: The study was designated as historical cohort, in a private referral center of advance laparoscopy. 111 infertile patients, diagnosed as endometriosis, were divided in two groups: DIE (deep infiltrative endometriosis) and endometrioma (case group), and patients with only DIE (without endometrioma ((control group). All patients underwent global laparoscopic resection of DIE lesion (both groups) and laparoscopic excisional cystectomy of endometrioma (case groups). Patients were followed for fertility outcomes and data were analyzed by Kaplan-Meier test and COX regression using SPSS software. RESULTS: After adjusting covariates, the Kaplan-Meier analysis of cumulative pregnancy rates (CPR) did not show any statistical significance between cases (35.6%) and controls (39.5%) (Log-rank P-value=0.959). The COX regression analysis of covariates showed there is no significant relationship between cystectomy and fertility outcome. It showed statistical significance effect of age (hazard ratio [HR]=0.772), years of infertility (HR=0.224), and previous endometrioma surgery (HR=0.180), on fertility chance. CONCLUSION: In advanced endometriosis with DIE and infertility, fine excision and stripping of the endometrioma along with radical resection of DIE improves fecundity without any significant adverse effect in comparison with patients with intact ovaries.

Oral clonidine premedication reduces nausea and vomiting in children after appendectomy.

OBJECTIVE: Clonidine is an α2-agonist which is used as a sedative premedication in children. There are conflicting results in the published literature about the effect of clonidine on the incidence of post operative nausea and vomiting (PONV). We therefore decided to evaluate the effect of oral clonidine given preoperatively on the incidence of PONV in children after appendectomy. METHODS: Sixty children, 5-12 years old, classified as American Society of Anesthesiologists physical status I and II, who were scheduled for appendecectomy were enrolled in this randomized double blinded clinical trial. Patients were randomly assigned into two groups of 30 patients. Patients in clonidine group were given 4 µg.kg -1 clonidine in 20 cc of apple juice and patients in control group were given only 20 cc of apple juice 1 hour before transporting to operating room. The protocol of general anesthesia and postoperative analgesia was the same for two groups. Incidence of PONV and antiemetic usage of patients were assessed during 0-24 hours after anesthesia. FINDINGS: The patients' characteristics were similar in two groups. Patients who had received clonidine had significantly less episodes of PONV and also less rescue antiemetic usage than patients in control group. CONCLUSION: We showed that oral clonidine at a dose of 4 µg.kg -1 administered preoperatively is associated with a reduced incidence of postoperative vomiting in children who have undergone appendectomy.