From open radical hysterectomy to robot-assisted laparoscopic radical hysterectomy for early stage cervical cancer: aspects of a single institution learning curve.

We analysed the introduction of the robot-assisted laparoscopic radical hysterectomy in patients with early-stage cervical cancer with respect to patient benefits and surgeon-related aspects of a surgical learning curve. A retrospective review of the first 14 robot-assisted laparoscopic radical hysterectomies and the last 14 open radical hysterectomies in a similar clinical setting with the same surgical team was conducted. Patients were candidates for a laparoscopic sentinel node procedure, pelvic lymph node dissection and open radical hysterectomy (RH) before August 2006 and were candidates for a laparoscopic sentinel node procedure, pelvic lymph node dissection and robot-assisted laparoscopic radical hysterectomy (RALRH) after August 2006. Overall, blood loss in the open cases was significantly more compared with the robot cases. Median hospital stay after RALRH was 5 days less than after RH. The median theatre time in the learning period for the robot procedure was reduced from 9 h to less that 4 h and compared well to the 3 h and 45 min for an open procedure. Three complications occurred in the open group and one in the robot group. RALRH is feasible and of benefit to the patient with early stage cervical cancer by a reduction of blood loss and reduced hospital stay. Introduction of this new technique requires a learning curve of less than 15 cases that will reduce the operating time to a level comparable to open surgery.

[Oral contraception and hypertension]. / Orale anticonceptie en hypertensie

PIP: Oral contraceptive (o.c.) use has been observed to cause increases in blood pressure. The increases are not markedly great among normotensive users during the first year of o.c. use, but the increase in systolic and, later, diastolic pressure are greater with the length of o.c. use. This o.c. induced hypertension has been shown to be reversible. The estrogen component is responsible for the increase in blood pressure, but the exact mechanism is unknown. O.c.s affect the renin-angiotensin system, kidney function, pituitary gland and adrenal gland function, and cause hemodynamic changes, all of which could be involved in the hypertension. Family history of hypertension, kidney disorders, age, and weight are all predisposing factors to o.c. induced hypertension. O.c. use is contraindicated for patients with preexistent hypertension or who show a substantial increase in blood pressure during o.c. use, except under exceptional circumstances.^ieng