[Description of a vaginoplasty technique using a peritoneal flap harvested by coelioscopic approach for male-to-female gender affirmations (MtF)]. / Description d'une technique de vaginoplastie utilisant un lambeau péritonéal prélevé par voie cœlioscopie pour les affirmations de genre homme-à-femme (HtF).

AIM: The aim of this article is to provide a comprehensive description of the peritoneal flap technique in male-to-female (MtF) gender affirmation surgery, particularly in cases of insufficient depth after penile inversion vaginoplasty. RESULTS: Our short-term results reveal that the peritoneal flap vaginoplasty, adapted from the Davydov procedure, has shown significant potential for improving functional and aesthetic outcomes, including the creation of a self-lubricating neovagina. However, the complexity of the procedure requires advanced surgical expertise and appropriate postoperative care. Patient selection also plays an essential role as not all patients are ideal candidates for this procedure. CONCLUSION: Despite its promises, the widespread adoption of the peritoneal flap technique in male-to-female (MtF) gender affirmation surgery is hindered by several challenges, including the need for specialized training and potential postoperative complications. Thus, this technique should be considered as an alternative or complement to traditional methods, depending on individual patient factors. Further research and extensive clinical trials are needed to better understand its potential and limitations in order to enhance the arsenal of effective surgical options for MtF gender affirmation surgery.

Use of an Endoloop Ligature and a 2-Portal Coelioscopic Approach for the Removal of an Arrowhead Foreign Body in a Red-Tailed Hawk (Buteo jamaicensis).

A juvenile red-tailed hawk (Buteo jamaicensis) was presented to the Ontario Veterinary College from a wildlife rehabilitation facility for the assessment of an arrowhead foreign body injury. The hawk was found on the ground with the left wing in a dropped position. Radiographic images revealed an arrowhead foreign body superimposed over the left lung and thoracic air sacs, immediately medial to the ribs on the ventrodorsal view, and ventral to the scapulae on the right latero-lateral view. A coelioscopy was performed using a left lateral approach with a 2.7-mm rigid endoscope into the left caudal thoracic air sac, with an additional instrument port through the left abdominal air sac. The arrowhead was visualized adjacent to the left lung, separated from the cranial thoracic air sac cavity by a membrane of fibrous tissue. The tissue membrane was radiosurgically incised. Forceps were then used to guide an Endoloop around the arrowhead. The arrowhead was secured by tightening the Endoloop, and the body wall incision was extended to facilitate the arrowhead extraction.

Evaluation of the effects of two anaesthetic protocols on oxidative status and DNA damage in red-eared sliders (Trachemys scripta elegans) undergoing endoscopic coeliotomy.

The aim of this study was to assess how red-eared sliders (Trachemys scripta elegans) respond to anaesthesia itself and coelioscopy. For that purpose, the turtles were anaesthetised with ketamine-medetomidine or propofol, and the activities of superoxide dismutase (SOD), catalase (CAT) and glutathione S-transferase (GST) and the level of malondialdehyde (MDA) were determined by spectrophotometry. The possible genotoxic effects of the anaesthetic agents were estimated by comet assay. A total of 24 turtles were included in this study. The animals were divided into four groups according to the anaesthetic protocol and according to whether endoscopy would be performed. Significantly decreased activities of CAT were found only in the propofol group and in turtles undergoing coelioscopy. Both anaesthetic protocols induced significantly increased MDA levels, while no differences were observed after the intervention. A significant increase in GST activity was detected in turtles after both anaesthetic protocols, but after coelioscopy significant changes in GST activity were found only in the propofol group. However, no differences in SOD activity and no DNA damages were detected in either group. These findings suggest that ketamine-medetomidine may be more suitable anaesthetic agents in red-eared sliders than propofol.

Intestinal-peritoneal Coelioscopy for the Diagnosis of a Mesothelioma in a Pet Chicken.

An adult female chicken, from a small backyard flock, was presented to the Ontario Veterinary College Avian and Exotics Service for evaluation of dyspnea and recurrent ascites. An antemortem diagnostic evaluation included a coelomocentesis, coelomic ultrasound, and a coelioscopy procedure. A sample of the fluid collected during the coelomocentesis was submitted for analysis and was determined to be a nonspecific modified proteinaceous transudate. The coelomic ultrasound examination identified numerous coalescing fluid-filled and solid nodules throughout the coelom. However, no site of origin of the nodules could be identified. A coelioscopy of the intestinal-peritoneal cavity was performed by a ventral midline approach, and biopsies collected during the procedure were submitted for histologic examination. The pathologic diagnosis of the biopsy samples was a disseminated neoplasia, presumptively coelomic adenocarcinoma. The chicken received palliative treatment which included periodic coelomocentesis, meloxicam, antibiotics, and deslorelin following the diagnosis of a disseminated neoplasia. Three months following initial presentation the patient was euthanatized. A postmortem examination with histopathology confirmed the tissue biopsy results of coelomic neoplasia. Further immunohistochemistry supported mesothelioma as the definitive diagnosis. This case documents the usefulness of intestinal-peritoneal coelioscopy in identifying neoplasia as the cause of ascites in a pet chicken as well as describing the clinical features and progression of a mesothelioma in this species.

[Nursing procedures carried out with an intestinal obstruction]. / Soins infirmiers lors d'une occlusion intestinale.

In addition to the evacuation of the liquid which has accumulated above the intestinal obstruction, the nurse performs various tasks such as the monitoring of the patient's hydration status. She also follows up the patient in the event of complications and if the doctor decides to perform a coelioscopy or laparotomy.

Temperature along an elevation gradient determines Galapagos tortoise sex ratios.

Climate change threatens endemic island ectothermic reptiles that display small population sizes and temperature-dependent sex determination (TSD). Studies of captive Galapagos tortoises demonstrate type A TSD with warmer incubation temperatures producing females. However, there are few published data from free-living Galapagos tortoises on incubation temperature regimes, and none on hatchling sex ratios in the wild or the potential impacts of climate change on future sex ratios. We sought to address these deficits by quantifying incubation temperatures of nests and sex ratios of juvenile tortoises along an elevation gradient on Santa Cruz Island. We focused on three geographically separated nesting zones with mean elevations of 14 m (lower), 57 m (middle), and 107 m (upper) above sea level. Nest temperatures in 54 nests distributed across the three nesting zones were measured every 4 h throughout the incubation period using iButton thermochrons. We used coelioscopy to conduct visual exams of gonads to determine the sex of 40 juvenile tortoises from the three nesting zones. During the middle trimester of incubation, the period during which sex is determined in turtles, mean nest temperatures were 25.75°C (SD = 1.08) in the upper zone, and 27.02°C (SD = 1.09), and 27.09°C (SD = 0.85) in the middle and lower zones, respectively. The proportion of juveniles that was male increased from 11.1% in the lower zone and 9.5% in the middle zone, to 80% in the upper zone. A ca. 50 m increase in elevation induced a decrease of >1.25°C in mean nest temperature during the second trimester of incubation. Over the same elevation change, the proportion of males in the juvenile tortoise population increased by ca. 70%. Temperatures on Galapagos are predicted to increase by 1-4°C over the next 50 years, which is likely to increase the frequency of female tortoises across the archipelago.

Coelioscopic-assisted prefemoral ovariosalpingectomy in a d`Orbigny slider (Trachemys dorbigni) using a digital otoscope.

The purpose of this study was to assess the unilateral prefemoral coelioscopic-assisted approach for ovariosalpingectomy in a d`Orbigny slider (Trachemys dorbigni) using a digital otoscope. Twenty healthy turtles were randomly assigned to one of two groups, for right (GR; n=10) or left (GL; n=10) prefemoral access, for coelioscopic-assisted ovariosalpingectomy. Anesthesia and surgery times, body weight, and ovary/oviduct weight data were recorded. Anesthesia and surgery times did not differ significantly between the groups. Wound closure was the most time-consuming surgical step. Ovary and body weights significantly affected the exposure time of the ipsilateral and contralateral ovaries, respectively. Two intraoperative complications were reported. All the animals recovered uneventfully. The digital otoscope can be safely and effectively used for coelioscopic-assisted single-access, unilateral prefemoral ovariosalpingectomy in d`Orbigny slider.

Comparison of Lateral and Dorsal Recumbency during Endoscope-Assisted Oophorectomy in Mature Pond Sliders (Trachemys scripta).

Ovariectomy via the prefemoral fossa is a well-described technique for sterilization in chelonians. The choice between lateral and dorsal recumbency is generally left to the surgeon's preference, with no data supporting an objective superiority of one over the other. Twenty-four sexually mature female pond sliders (Trachemys scripta) were enrolled for elective prefemoral endoscope-assisted oophorectomy, and were randomly divided in two groups: 12 animals were placed in right lateral recumbency with a left fossa approach (Group A), and 12 in dorsal recumbency with a right fossa approach (Group B). Scoring systems were applied to assess the ease of access to the coelomic cavity, and the ease of identification of the ovary opposite to the surgical incision. A negative correlation was found between the body weight of the animals and the ease of access to the coelom (p = 0.013), making the access easier in smaller animals. No significant difference was found between the two groups in terms of ease of access to the coelomic cavity, first ovary removal time, ease of identification of the second ovary, second ovary removal time, or total surgery time.

Endometriosis surgery and preservation of fertility, what surgeons should know.

Colorectal surgeons often participate in the multidisciplinary management of young females with endometriosis. Complications of endometriosis as well as its management often result in infertility since they can involve all pelvic organs including the procreative organs: uterus, ovaries and fallopian tubes. Complete excision of all endometriotic lesions should not be performed at the expense of irreversible destruction of the procreative organs; definitive infertility should not be the price to pay in order to obtain an improvement of the painful symptoms caused by endometriosis. Surgery for ovarian endometriomas should be specifically adapted to the patient's desire for future conception and to her preoperative ovarian reserve. Two main techniques are used to treat ovarian endometriomas: ovarian cystectomy excises the wall of the cyst while ablation consists of destruction of the internal surface of the cyst. The use of mono polar or biolar coagulation for cyst ablation is strongly contra-indicated. Ablation using laser or plasma energy has resulted in comparable rates of post-operative pregnancy to those obtained by ovarian cystectomy. Patients who wish to delay their attempt to conceive for some period of time, should be placed on long-term oral contraception with prevention of menstruation to reduce the risk of recurrent endometriosis. When surgery for colorectal endometriosis is necessary, the laparoscopic approach increases the chances of spontaneous conception compared to laparotomy. Surgery for deep-seated endometriosis has been accompanied by a high rate of spontaneous conception and successful pregnancy and does not seem to decrease the chances for conception by in vitro fertilization.

[Epidemio-clinical features of genital tuberculosis among Tunisian women: a series of 47 cases]. / Caractéristiques épidémio-cliniques de la tuberculose génitale chez la femme tunisienne: une série de 47 cas.

This study aimed to identify the epidemio-clinic, diagnostic, therapeutic and evolutionary features of genital tuberculosis (GT) among Tunisian women. We conducted a retrospective, descriptive study in the Department of Infectious Diseases at the La Rabta Hospital, Tunisia, over a period of 15 and a half years (January 2000 - June 2014). All patients hospitalized for genital TB were included in the study. The study focused on 47 cases. The average age of patients was 42.2 years. Eighteen women were from rural areas. Tuberculous contact was found in five cases. In all cases, the onset was insidious. Twenty-three patients showed one or several signs of TB infection. Tuberculin intradermal reaction (IDR) test was performed in 35 women (74.8%), it was positive in 26 cases (74%). Thirty-nine patients (83%) had undergone radiological examination using abdomino-pelvis ultrasound and/or CT scan. Diagnostic coelioscopy was performed in 37 cases (75.5%). Anatomopathological examination helped to confirm the diagnosis of GT in 42 cases (89.3%), showing epithelioid and giant-cell granuloma. We identified 21 cases of isolated GT, the remaining 26 cases had peritoneal involvement. All patients received specific antibiotic therapy combining isoniazid, rifampicin, pyrazinamide and ethamubutol with an average treatment duration of 12 months. No patient received corticosteroids or secondary surgery. Patients' outcome was favorable in 39 cases, 8 patients were lost to follow-up. Genital tuberculosis is rare, representing only 0.5% of extra-pulmonary tuberculosis, but it accounts for a high prevalence of clinical polymorphism. Diagnostic confirmation is difficult and it is based on bacteriological and/or histological examinations. Diagnosis should be suspected in patients with chronic abdominopelvic symptoms, in women with infertility associated with suggestive epidemioclinical manifestations.

La grossesse hétérotopique spontanée: à propos de deux cas: Spontaneous heterotopic pregnancy: about 2 cases.

Heterotopic pregnancy is defined as the coexistence of intrauterine pregnancy (IP) and ectopic pregnancy (EP), regardless of its location. It is a type of bi-ovular dizygotic twin pregnancy, its occurrence in a spontaneous cycle is rare. This is a rare and serious pathology which may compromise maternal prognosis. We report two cases of heterotopic pregnancy treated in the Department of Gynecology and Obstetrics I at the University Hospital Hassan II of Fez, over a one-year period. Clinical, ecographic and therapeutic data of this pathology were reported. Pelvic pain was the main reason for consultation. The diagnosis of heterotopic pregnancy was suspected on ultrasound in both cases. The first patient underwent conservative treatment by laparoscopy while the second patient underwent salpingectomy by mini-transverse laparotomy. IP outcome was favorable both cases.

Coelioscopic and Endoscope-Assisted Sterilization of Chelonians.

Elective sterilization is a safe and well-established surgical procedure performed in dogs and cats worldwide. Conversely, chelonian sterilization has been mostly performed therapeutically, because of the intricate anatomy and difficult access to the reproductive organs, and consequently, reproductive problems and diseases remain common. With the advance of veterinary endoscopy, novel techniques of soft tissue prefemoral coelioscopic and endoscope-assisted sterilization have been published, and preventative chelonian sterilization is now a reality. Nevertheless, extrapolations between species should be carefully considered, and further studies are warranted. This article summarizes and describes the current coelioscopic and coelioscope-assisted sterilization techniques for chelonia.