[Laparoscopic management of genital prolapse by lateral suspension using mesh: a series of 377 patients]. / Prise en charge laparoscopique des prolapsus génitaux par suspension latérale au moyen d'une prothèse: une série de 377 cas.

Genital prolapse is frequent and can be found in about 50% of parous women. Its etiology is complex and multifactorial. Predisposing factors include: genetics (connective tissue disorders, family history); general state (age, parity, weight, smoking, obstructive pulmonary disease); trauma (carrying heavy loads, intense physical exercise); or iatrogenic (post hysterectomy). Treatment can be conservative or surgical and depends mainly on the severity of symptoms. Developments in surgical techniques and synthetic material in the last 20 years enabled us to use minimally invasive procedures with improved post operative course and decreased recurrence rates.

[Gynecology/Obstetrics. Magnesium sulfate for fetal neuroprotection in preterm delivery. Latest advances in contraception.]. / Gynécologie - obstétrique.

Morbidity of neonates born before 32 weeks remains significant. Cerebral palsy is found in up to 8 to 10% of survivors. Three randomized controlled trials evaluated the effectiveness of magnesium sulphate given to mothers with a risk of imminent very preterm delivery to prevent perinatal death or cerebral palsy in children. These studies suggest a reduction of the risk of cerebral palsy by magnesium sulphate from 6.5% to 4.8% (relative risk 0.71, 95% CI 0.55-0.91). These results remain controversial, but warrant information to the parents and the implementation of treatments protocols for selected cases.

[LESS, NOTES and robotic surgery in gynecology: an update and upcoming perspectives]. / Chirurgie LESS, NOTES et robotique en gynécologie: mise au point et perspectives.

Laparoscopy revolutionized the gynecological surgical world during the 1980's and 1990's and has changed the approach to surgical procedures ever since. Minimal invasive surgery procedures are now the standard of care for many gynecological operations. At the beginning of the 21st century, robotic gynecological surgery, laparo-endoscopic single site surgery (LESS) and natural orifice transluminal endoscopic surgery (NOTES) may be on the threshold of another such revolutionary breakthrough. In this article, we review the present place of these new techniques in gynecological surgery and discuss their future perspective.

[Endometriosis: review of the literature and clinical management]. / Prise en charge de l'endométriose.

Despite numerous studies, endometriosis remains unclear concerning the etiopathogenesis, the natural history and optimal treatment. It occurs preferentially in young women and may be associated with a series of painful symptoms very disabling, together with infertility and significant psychological problems. Because of the multiple consultations, operations and disability it can cause, endometriosis takes an increasing part in health costs. Delays between onset and diagnosis are still long, and it is important to diagnose as early as possible to stop this disease so as to maintain or restore fertility and quality of life for patients. That is why a careful listening and clinical examination with appropriate investigations will improve our global care.

[Laparoscopy in the management of endometrial cancer]. / Place de la laparoscopie dans le traitement du cancer de l'endomètre.

Recent advance in laparoscopy have changed the surgical approach of endometrial cancer patients. The Swissendos Center, Fribourg, in collaboration with AGO (Groupe de travail pour la gynécologie oncologique) and AGE (groupe de travail pour la gynécologie endoscopique) have established a consensus based on the available evidence for the use of laparoscopy in the management of patients with endometrial cancer The main objective was to define Swiss clinical practice guidelines appropriate to the country and consistent with the needs of the physicians.

Sphincter incontinence: is regenerative medicine the best alternative to restore urinary or anal sphincter function?

Incontinence is a major public health concern in aging societies. It is caused by age-dependent spontaneous apoptosis of muscle cells in the urinary and fecal sphincters, and is aggravated in women due to birth trauma. Compared to other currently employed invasive surgical management techniques associated with morbidity and recurrence, replacement or regeneration of dysfunctional sphincter through stem cell therapy and tissue engineering techniques hold great promise. This review focuses on the pathophysiological analysis of urinary incontinence and the possible application of muscle-derived-stem cells, satellite cells, chondrocytes and adipose-derived-stem cells in restoring sphincter functions.

[Laparoscopic lateral suspension, another way to treat genital prolapse]. / La suspension latérale cœlioscopique, une autre façon de traiter les prolapsus génitaux.

The laparoscopic sacrocolpopexy is the treatment of choice of pelvic organ prolapses since more than twenty years. The laparoscopic lateral suspension with mesh is an alternative technique. Its originality is the subperitoneal passing of the lateral arm of the mesh in the lateral abdominal wall, leaving the skin above the iliac crest, in a place without risks of vascular, nerve, bowel injuries. We report in this article the results of the three main publications on the subject. The indications are cystocele and apical descent. It can be envisaged when the access of the promontory is difficult; for instance in the presence of obesity, adhesions, sigmoid megacolon, or low position of the left common iliac vein, partially covering the promontory. It is also a practical technique for surgeons having a moderate experience of the promontory access.

Laparoscopic Adnexectomy for Ovarian Torsion during Late Pregnancy: Case Report of a Non-Conservative Treatment and Literature Analysis.

Diagnosis of adnexial torsion is difficult during pregancy (1). The time of decision and laparoscopy is that of the risk of necrosis of the adnexa and, therefore, of the ovarian prognosis. The loss of an ovary can compromise the following fertility. Even if concerns related to laparoscopy in pregnant patients include a limited surgical field, with a risk of uterine injury and negative fetal effects of CO2 insufflation. Evidence base suggests that minimally invasive surgery can be safe and better than laparotomy for management of adnexal masses during late pregnancy with good postoperative and obstetric outcomes. If for most authors laparoscopy appears to become the best approach for ovarian torsion during pregnancy (2), nonetheless, the ideal surgical laparoscopic approach of adnexa in late pregnancy remains controversial. Since there is no technical gold standard to overcome surgical difficulties which could make laparoscopic procedures as real challenge in patients in second and third trimester (3); at least, in case of radical and non-conservative treatment, the risk for a first trimester of pregnancy is to remove the corpus luteum (1).

Verrucous Carcinoma of the Vulva: A Case Report and Review of the Literature.

Verrucous carcinoma of the vulva is a rare lesion (1). Affecting essentially postmenopausal women, this lesion is a distinct and particular entity in vulval carcinoma classification and its scalability is uncertain and unpredictable. Here, we present a case concerning a 48-year-old patient, without follow-up after a condyloma acuminate of the vulva (large left lip). The origin of this case will be discussed in this article. The treatment decided was only surgical. A review of literature shows the rarity of this lesion of the female genital tract.

[Female urinary incontinence: a review]. / L'incontinence urinaire de la femme: mise au point.

Female urinary incontinence is a frequent problem. The diagnosis is quite easy, but a precise interview and often an urodynamic exam have to be performed to assess the aetiology. Multiple pathologies cause incontinence. The therapeutic possibilities are various, especially for stress incontinence and urge. Stress, urge and mixed incontinence are the most frequent types. The diagnosis is clinical and in certain circumstances, paraclinic investigations and a specialised consultation are mandatory. Therapeutic success depends from a thorough diagnosis with a treatment based on several parameters, depending on the type of incontinence. The treatment will be medical, physiotherapy or surgery. Success rates varies in function of the type of incontinence. With new surgical techniques, the success rate for stress incontinence is as high as 90%.

[Practice guidelines: conservative treatment of fibroids]. / Traitement conservateur des fibromes: recommandations pour la pratique.

The conservative treatment of uterine fibroids is essentially based on symptomatology and patient's choice of treatment. The gynaecologist must develop a clear therapeutic protocol based on clinical examination, available test results and consideration of patient preference. The therapeutic options include close surveillance, hormonal treatments, conservative operative endoscopy and arterial embolization.

Place and modalities of laparoscopy in surgical management of suspected adnexal masses.

Only benign adnexal masses are suitable for treatment by operative laparoscopy. Ovarian cancer must always be managed by midline laparotomy. In our experience the preoperative workup (clinical examination, study of past history, trans vaginal ultrasonography, doppler, tumoral markers etc.) together with the diagnostic phase of laparoscopy provide a sensitivity value of 100%, a positive predictive value of 50% and a negative predictive value of 100% for diagnosis of malignancy. Provided a strict selection, laparoscopy is reliable both for the diagnosis and the management of benign ovarian masses.

Laparoscopic myomectomy. Operative procedure and results.

Myomectomy was performed by laparoscopy in 102 patients, according to a precise technique using the monopolar hook for the uterine incision and intraperitoneal sutures. Myomas were mostly removed through the suprapubic puncture site after fragmentation or by colpotomy. Conversion to laparotomy during the laparoscopic procedure was necessary in 2 cases. No complications were observed. A second-look laparoscopy was performed in 17 cases. Postoperative adhesions were noted in 2 cases. In our experience, operative laparoscopy has several advantages over laparotomy and the risk of complications is low in selected cases.

Management of deep endometriosis.

Deep endometriosis is defined as an endometriotic lesion that penetrates the retroperitoneal space for a distance of > or =5 mm. Deep endometriosis is extremely active, occurs in phase with eutopic endometrium, evolves progressively with age, and is most often located in the pouch of Douglas, the rectovaginal septum, the uterosacral ligaments, and occasionally in the uterovesical fold. These lesions are associated with pelvic pain, the intensity of which is proportional to the depth of penetration. It is clear that choice of treatment depends on the location of the endometriotic lesion. In this paper we describe our methods for the initial diagnosis and subsequent treatment of deep endometriosis. These include consultation and clinical examination protocols, use of rectal endoscopic ultrasonography (EUS), magnetic resonance imaging (MRI), and transvaginal ultrasonography techniques in diagnosis and surgical treatment approaches.

Laparoscopic myomectomy fertility results.

The appearance of uterine myomas has been linked to infertility. It has been suggested that surgical management of myomas by laparoscopic myomectomy improves fertility rates in these group of patients. In this paper we initially describe specific aspects of the surgical technique of laparoscopic myomectomy including the set-up, precise technique for hysteroromy, enucleation of the myoma, suturing of the uterus, and extraction of the myoma. We detail recent findings that demonstrate improved fertility rates in women undergoing laparoscopic myomectomy. We recommend that, when criteria for selection of patients is strictly adhered to and patients present with no other associated infertility, laparoscopic myomectomy be used to increase the implantation rate.

EndothelinA receptors in human uterine leiomyomas.

OBJECTIVE: To determine if there are endothelin receptors on human uterine leiomyomas. METHODS: Samples of leiomyomas from eight patients were analyzed for [iodine (I)-125]endothelin-1 binding. Several subtype-selective ligands were used to determine the endothelin receptor population. RESULTS: Binding of [125I]endothelin-1 to uterine leiomyoma membranes was specific and saturable, with a mean +/- dissociation constant 85.5 +/- 8.4 pM. Competition binding studies showed that the order of potency was endothelin-1 > endothelin-3, which was consistent with the presence of the endothelinA receptor subtype. Binding of [125I]endothelin-1 was displaced by an endothelinA-selective antagonist, but not by sarafotoxin 6c, an endothelinB-selective agonist. An endothelins-selective ligand was not specifically bound to leiomyoma. CONCLUSION: These results indicate that only endothelinA receptors are present in human uterine leiomyomas. We speculate that endothelin-1 may act through these endothelinA receptors to influence the development or regulation of hypertrophy and proliferation of the human myometrium during pregnancy and in uterine disorders like leiomyomas.

Role of gonadotrophin-releasing hormone agonists in the treatment of external genital endometriosis: review of 77 cases.

Peritoneal and ovarian endometriosis are anatomically highly polymorphous and can give rise to pain and sterility. Endometriosis can be recognized and evaluated by means of laparoscopy and an appropriate therapeutic strategy determined. Surgical laparoscopy using lasers (CO2, KTP and argon) produces excellent results. More than 80% of cases can be treated by coelioscopy, bearing in mind that severe endometriosis can require classic surgery and remains difficult to perform. However, one basic idea should not be forgotten, ie, that endometriosis is a progressive disease. Restoration of anatomic pelvic integrity (with free pouch of Douglas, mobility of appendages and functional ovaries) is the only guarantee of good fertility, achievable by interruption of progression of the disease. Following therapeutic trials with danazol, norsteroidal progestagens, gonadotrophin-releasing hormone agonists have opened up wide perspectives for use and we use them in combination with coeliac surgery. Our experience has paralleled that of Donnez and Bruhat, with almost identical results.

Gonadotrophin-releasing hormone agonist and laparoscopic myomectomy.

The indications for operative laparoscopy have expanded greatly over the past decades, as its many advantages over laparotomy have been recognized. We report our techniques and short-term results concerning myomectomy by laparoscopy. From January 1, 1990 to October 1, 1991, 147 intraperitoneal myomectomies were performed in 70 patients: 46 of 70 were treated preoperatively with a depot gonadotrophin-releasing hormone agonist. No complications were observed. In selected cases, with the advantages of laparoscopic surgery, laparoscopic myomectomy appears to be a safe technique.