[Feasability and morbidity of apical and anterior mesh repair, a multicenter cohort study]. / Suspension utérovaginale prothétique par fixation obturatrice et sacrospinofixation bilatérale, étude multicentrique.

OBJECTIVE: To assess safety anatomic results, satisfaction patient and to report short-term results of a new surgical approach for a combined treatment of pelvic organ prolapse (POP) of anterior and medium compartments. MATERIAL AND METHODS: A longitudinal case series of 83 consecutive patients operated between January 2012 and April 2014 in four tertiary centers by 8 surgeons. Potential complications have been reported. The satisfaction of patients was conducted at 6 weeks post-procedure. The anatomical evaluation was conducted at 6 weeks and 6 months post-procedure. Anatomic success was defined as prolapse stage<1 (POPQ) for both anterior and apical compartment. RESULTS: Mean age was 69.2±8.6 years. There were two intraoperative complications: a bladder injury and an ureteral injury. Postoperative complications were 14/83 (16.8%) transient urinary retentions. Seventy-three patients out of 83 (87.9%) were available for anatomic evaluation at 6 months. Anatomical success at 6 months for both anterior and apical compartments was 68/73 (93.1%). Patient satisfaction rate at 6 months was 79/83 (95.1%). Four subjects/73 (5.5%) experienced mesh exposure treated conservatively. CONCLUSION: In the current series, uterovaginal suspension anterior using a mesh Nuvia® was associated with correct anatomical results and a good satisfaction of patients. This technique seems reproducible and associated with few complications. Prospective, comparative and long-term data are required to confirm these results. LEVEL OF EVIDENCE: 4.

[Influencing factors on surgical duration of ovarian cystectomy by single-port access]. / Facteurs influençant la durée opératoire de la kystectomie ovarienne par accès endoscopique unique.

OBJECTIVES: To evaluate the factors influencing the operative duration of ovarian cystectomy by single-port access (SPA). MATERIALS AND METHODS: Observational monocentric study from June 2010 to September 2012. Inclusive patients were patients with an indication of ovarian cystectomy may be done by laparoscopy. The procedures were performed by the SPA system LESS®. Factors evaluated were BMI of the patient, histological nature and size of the cyst. RESULTS: We performed 54 cystectomy in 49 patients. SPA surgery was successfully completed in 53 patients. The median operative time was statistically longer for endometriotic cysts than dermoid cysts or serous-mucinous cysts (P=0.003). Cases exceeding 60minutes were significantly higher in the endometriosis group (P=0.005). There wasn't correlation found between the BMI of the patient and operative time (P=0.5). The operating time wasn't increased according to the size of the cyst (P=0.9). CONCLUSION: Endometriotic cysts nature appears to be the only limiting factor of cystectomy by SPA. Further studies are needed to evaluate the factors that may limit the SPA actions.

[Single laparoscopic access: initial experience]. / Chirurgie laparoscopique par accès unique : expérience initiale.

OBJECTIVE: To evaluate feasibility of single laparoscopic access with LESS(®) system. PATIENTS AND METHODS: We conducted an open study from 1/7/2009 to 1/10/2010 in a single gynaecologic department. All procedures were performed by four operators. Procedures evaluated were total hysterectomy, adnexectomy and ovarian cystectomy. Feasibility, per- and postoperative data were reported. RESULTS: We performed completely 24/25 (96 %) total hysterectomies by single laparoscopic access. Traditional laparoscopy and finally laparotomy was necessary for one patient. Bladder injury repaired by vaginal approach was reported in one patient. We performed 29 adnexectomies in 19 patients (nine unilaterals et 10 bilaterals) and six ovarian cystectomies in four patients (four unilaterals et two bilaterals). All procedures were performed successfully by single laparoscopic access. Parietal haematoma were reported in two patients. DISCUSSION AND CONCLUSION: Laparoscopic gynaecologic surgery by single access seems feasible with LESS(®) system for these procedures. Further study including larger number of patients and operators were necessary to confirm risks and advantages of this technique.