Gynecological Surgery (Gynecol Surg)

Publications in this journal

• Article: Spontaneous intramyometrial pregnancy mimicking an intramural myoma: a diagnostic challenge

  Maria-Laura Marotta, Jacques Donnez, Nathalie Michaux, Michaël Dupont, Monique Delos, Olivier Donnez
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  ABSTRACT: This study describes the diagnosis and treatment of a spontaneous intramyometrial pregnancy by a case report and review of the literature at a university hospital center. A 24-year-old woman presented with a spontaneous intramyometrial pregnancy without any previous uterine surgery. Successful laparoscopic resection and myometrial correction were performed. The presence of trophoblastic tissue was confirmed and the myometrium revealed complete healing at postoperative MRI. Intramyometrial pregnancy can occur without previous uterine surgery or uterine manipulation and may be difficult to diagnose. Conservative laparoscopic excision is possible without damage to myometrial integrity.
  Gynecological Surgery 02/2013;
• Article: The relevance of endometrial polyps: a bibliometric study.

  Pietro Gambadauro, Rafael Torrejón
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  ABSTRACT: The aim of this study was to explore and describe the status and trends of scientific literature on endometrial polyps. We have conducted a systematic search for publications related to endometrial polyps from 1982 to 2012 using Scopus. The original search was refined with the additional keywords: “infertility”, “bleeding”, and “cancer”. We have collected and analyzed quantitative data on number of pub- lications, journals, language, and origin of each article. Descriptive statistics and charts were used to analyze data and provide information on publication trends. Out of a database of 12,125,345 articles published in the past 30 years, our systematic search retrieved 1,144 relevant publications. The amount of articles/year related to endome- trial polyps has been significantly growing throughout the study period (1982–1996, 14 ± 11.988; 1997–2012, 58.38 ± 11.506; p < 0.0001). A similar positive trend is observed for relative number of yearly publications (% retrieved/indexed; 1982–1996, 0.0044 % ± 0.0035; 1997– 2012, 0.0127 % ± 0.0025; p < 0.0001). The proportion of arti- cles related to “infertility” and “bleeding” has been growing more than that of papers related to “cancer”. English is the dominant language (79 %), and the USA is the most prolific country (19 %), followed by Italy (8 %) and the UK (7,8 %). During the last 5 years, Gynecological Surgery has been the journal with the highest proportion of publications on endo- metrial polyps (2.11 % of all its articles). In conclusion, the publications related to endometrial polyps have increased steadily during the last 30 years, particularly those related to bleeding and infertility. Not all the journals publishing regularly on “endometrial polyps” are indexed in Medline/Pubmed. Scholars interested in this field should con- sider comprehensive bibliographic search strategies.
  Gynecological Surgery 01/2013; 10(2):103-108.
• Article: Vaginal vault dehiscence with evisceration after total laparoscopic hysterectomy

  Rakesh Sinha, Pratima Kadam, Meenakshi Sundaram, Chaitali Mahajan, Parul Shah, Smita Lakhotia, Gayatri Rao
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  ABSTRACT: KeywordsTotal laparoscopic hysterectomy–Evisceration–Vault dehiscence
  Gynecological Surgery 05/2012; 8(2):175-176.
• Article: Retained term tubal ectopic pregnancy

  Ismail A. Al-Badawi, Togas Tulandi
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  ABSTRACT: KeywordsEctopic pregnancy–Tubal pregnancy–Term tubal ectopic pregnancy
  Gynecological Surgery 05/2012; 8(3):363-364.
• Article: Endometrial cancer presenting as a snowball in the pelvis

  Rakesh Sinha, Meenakshi Sundaram, Smita Lakhotia, Pratima Kadam
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  ABSTRACT: KeywordsEndometrial carcinoma
  Gynecological Surgery 05/2012; 8(3):325-326.
• Article: Laparoscopic surgical approach for a borderline ovarian tumour of more than 25 cm

  S. Tamburro, E. Nohuz, G. Mage, M. Canis
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  ABSTRACT: Guidelines for surgical treatment of borderline ovarian tumours include peritoneal washing, hysterectomy with bilateral salpingo-oophorectomy, omentectomy and multiple peritoneal biopsy. Several authors indicate the laparoscopy as possible standard approach to treat women with benign ovarian tumours. We describe a 58-year-old menopausal woman consulting for bleeding and abdominal volume; pelvic pain occurred occasionally. Magnetic resonance and ultrasound evidenced a big ovarian tumour as more than 23cm in diameter with an intracystic mass of 5cm. Laparoscopic treatment was exhaustively performed. No surgical complication occurred and no treatment was necessary after surgery. KeywordsLarge borderline-Ovarian tumour-Laparoscopy
  Gynecological Surgery 05/2012; 7(3):267-269.
• Article: Erosion of mesh after repair of rectocele

  J. Putran, M. A. Khaled, D. Vinayagam
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  ABSTRACT: Genital prolapse is a common problem in women. Surgical repair is one of the management options. Traditional repair consists of midline plication of endopelvic fascia to reduce the prolapse and create support. A mesh has also been used to augment and repair such defects in the pelvic floor. Data on the efficacy and safety of mesh repair for genital prolapse are limited in literature. We present a rare case of mesh erosion 18years after a rectocele repair.
  Gynecological Surgery 05/2012; 7(1):39-40.
• Article: Feasibility and long-term efficacy of hysteroscopic myomectomy for myomas with intramural development by the use of non-electrical “cold” loops

  Francesco Paolo Giuseppe Leone, Stefania Calabrese, Carmelo Marciante, Irene Cetin, Enrico Ferrazzi
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  ABSTRACT: This study aimed to assess the feasibility and the short- and long-term efficacy of hysteroscopic myomectomy for submucous myomas with intramural development [grade 1 (G1) and grade 2 (G2)] by using non-electrical “cold” loops and to verify the role of preoperative variables on surgical outcomes. Symptomatic (bleeding and infertility) premenopausal patients with the diagnosis of submucous myoma at transvaginal sonography, and with G1 and G2 grading at sonohysterography, were included in this prospective study. Hysteroscopic myomectomy was performed by the combined monopolar electrical slicing and traction-and-leverage manoeuvres by non-electrical “cold” loops. One hundred fifty-nine patients were recruited, and 169 procedures were performed. Operating time, fluid deficit, complications and complete resection at first procedure (perioperative outcomes) and persisting symptoms and additional surgery for persisting symptoms (long-term outcomes) were not significantly different for G1 vs. G2 myomas. Perioperative outcomes were significantly different when comparing myoma mean diameter <3.0 vs. ≥3.0cm (75th percentile). Multivariate analysis and multiple regression analysis proved that myoma mean diameter was the only significant variable for surgical outcomes. Hysteroscopic myomectomy by non-electrical “cold” loops is an effective and efficient treatment for submucous myomas with intramural development. Myoma mean diameter is the only significant preoperative variable for perioperative outcome, while myoma grading loses its role as a prognostic factor. KeywordsHysteroscopic myomectomy–Non-electrical “cold” loops–Submucous myoma–Long-term follow-up–Hysteroscopic complications
  Gynecological Surgery 05/2012; 9(2):155-161.
• Article: Management of severe complications following radical vaginal trachelectomy

  Michele Mazzola, Vincenzo Miceli, Sarah Tardino, Luigi Marsala, Roberto Tozzi
  Gynecological Surgery 05/2012; 8(1):111-113.
• Article: Recent advances of laparoscopic approach in adnexal torsion of premenarcheal girls

  Costas Panayotidis, Michelle Nisolle
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  ABSTRACT: The adnexal torsion is an uncommon gynaecological emergency; however, it must be excluded in young girls in order to conserve their future ovarian function and fertility. The diagnosis of adnexal torsion is particularly difficult in girls before the menarche during which time the clinical examination is very delicate. We review the recent literature and laparoscopic advances in this domain and propose a management algorithm.
  Gynecological Surgery 05/2012; 4(3):155-160.
• Article: Avoiding the bowel: a report of a mature cystic teratoma displaying fully developed intestinal tissue protruding from an ovarian tumor

  David B. Nelson, Barbara L. Hoffman, Yuri Lemeshev, Larry E. Word
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  ABSTRACT: We present a previously unreported case of a grossly visible, fully developed intestinal segment protruding from an ovarian teratoma. KeywordsMature cystic teratoma–Intestine
  Gynecological Surgery 05/2012; 8(2):223-225.
• Article: Suspicious myometrial mass on ultrasonography and MRI does not necessarily mean a sarcoma on histology

  Jean-Christophe Lousse, Mathieu Jouret, Etienne Marbaix, Latifa Fellah, Jean Squifflet, Jacques Donnez
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  ABSTRACT: We report an unusual ultrasonographic and magnetic resonance imaging (MRI) presentation of a myometrial mass in a 38-year-old woman hoping to conceive. Hysterectomy had been proposed elsewhere because of the suspicious nature of the mass, but the patient was seeking a second opinion. This atypical formation looked consistent with either hydropic degeneration of a uterine myoma or leiomyosarcoma, but preoperative differential diagnosis was impossible. Laparoscopic tumorectomy was performed and histology confirmed a degenerating uterine myoma. We, therefore, show that unusual ultrasonographic and MRI findings do not necessarily require radical surgery, even if sarcoma cannot be excluded preoperatively, especially in patients who wish to conceive. KeywordsUterine myoma-Leiomyosarcoma-Ultrasonography-MRI-Laparoscopic myomectomy
  Gynecological Surgery 05/2012; 7(3):263-265.
• Article: Early postoperative discharge following radical vulvectomy and bilateral inguinal lymphadenectomy for vulvar carcinoma

  Nikolaos Burbos, Mazen Abu-Freij, Mercedes Perez-Morales, Joaquin J. Nieto
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  ABSTRACT: Currently, no robust evidence exists for the optimal period for maintaining the suction drainage in the groin incisions for women who undergo inguinal lymphadenectomy for vulvar carcinoma. In many cases, this may take more than 2weeks. Some authorities advocate early drain removal at 72h after surgery, but this approach is associated with increased risk of lymphocyst formation. We attempted to discharge women with suction drains in situ within 48 to 72h following the surgery. Four patients that underwent vulvectomy and bilateral inguinal lymphadenectomy for vulval cancer were discharged home within 48 to 72h postoperatively with suction drains in situ. The mean age was 61.5years. The average number of groin lymph nodes removed was 9.12 per patient. Only one patient had nodes positive for disease (bilaterally). Drains were removed within 7 to 10days following the discharge. Wound healing was satisfactory in all cases. No cases of wound breakdown were recorded. There was only one case of a small lymphocyst (<3cm) that resolved spontaneously within 8weeks. Early postoperative discharge with suction drains in situ appears safe for women that undergo inguinal lymphadenectomy for vulvar carcinoma. KeywordsVulvar–Carcinoma–Inguinal–Lymphadenectomy–Discharge
  Gynecological Surgery 05/2012; 8(1):89-91.
• Article: Surgical treatment of rectovaginal endometriosis with rectal involvement

  Vicente Payá, Juan José Hidalgo-Mora, Cesar Diaz-Garcia, Antonio Pellicer
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  ABSTRACT: Rectovaginal endometriosis (RVE) is one of the most serious and incapacitating forms of presentation of this disease. Traditionally, medical treatment has not been considered effective for the majority of patients, being surgery the only reasonable and therapeutic choice in these cases. This exposes patients to a potentially serious morbidity, thus a careful evaluation should be done by a surgical board considering the impact of the disease as well as the quality of life of the patients. The main surgical techniques used are the shaving of the rectal wall affected by the endometriosic implants, the discoid excision of the front rectal wall, and the segmental intestinal resection, and there is no consensus concerning which is the most effective and suitable between them. The bibliography published in the last 10years relating to the surgical treatment of RVE is being reviewed with the intention of updating the knowledge base about the topic and looking for common ground between different studies, allowing us to come closer to reaching a consensus about treatment for this pathology. KeywordsDeep endometriosis–Deeply infiltrating endometriosis–Laparoscopy–Rectovaginal endometriosis–Surgery–Surgical management
  Gynecological Surgery 04/2012; 8(3):269-277.
• Article: Abdominal cerclage after failed transvaginal cervical cerclage

  Anwar Moria, Nouf Aljaji, Louise Miner, Togas Tulandi
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  ABSTRACT: This study aimed to evaluate the efficacy of abdominal cerclage by laparotomy and by laparoscopy among women who had failed transvaginal cerclage. We evaluated all women with cervical insufficiency that underwent abdominal cerclage between the years 2000 and 2010. Of a total of 20 patients, 12 patients underwent abdominal cerclage by laparoscopy and 8 others by laparotomy. The procedure was done in the pregnant state in four patients in the laparoscopy group and in all patients in the laparotomy group. There was no significant difference in the operative time between the laparoscopy and the laparotomy group. The median duration of hospitalization in the laparoscopy group was 6h and in the laparotomy group was 96h. Of 18 pregnancies, 16 resulted in a live birth (88.9%). Abdominal cerclage in women who have failed a transvaginal cervical cerclage is associated with a high live birth rate. KeywordsCervical incompetence–Cervical insufficiency–Cervical cerclage–Abdominal cerclage–Cervicoisthmic cerclage
  Gynecological Surgery 04/2012; 9(2):219-222.
• Article: The hysteroscopic view of infertility: the mid-secretory endometrium and treatment success towards pregnancy

  A. Santi, R. Felser, N. A. Bersinger, D. M. Wunder, B. McKinnon, M. D. Mueller
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  ABSTRACT: The purpose of this study was the analysis of a correlation, in infertile patients, between the quality of the endometrium based on its vascularisation and the chances of conception. Hysteroscopy was carried out to determine the quality of the endometrial surface using the Sakumoto–Masamoto classification (“good” vs. “poor” endometrium) in the secretory phase of the menstrual cycle. The results were set in relation to the outcome of the subsequent infertility treatment, i.e. the establishment of a pregnancy within the study period (4years). In 108 (67%) of the 162 followed-up patients, the endometrium was endoscopically classified as “good”, while in 54 (33%) the result was “poor”. The overall pregnancy rate was 37% (60 patients); 47 of all pregnancies (78%) occurred in women with a “good” endometrium while 13 (22%) had a “poor” classification. This positive association between the establishment of a pregnancy in the follow-up and a "good" classification of the endometrial vasculature in the group with a "good" endometrium was significant (P = 0.0165, Fisher's exact test). This study confirms the usefulness of endometrial evaluation by hysteroscopy as a diagnostic instrument for providing a prognosis of the chance for the patients to become pregnant. KeywordsEndometrium–Embryo implantation–Infertility–Hysteroscopy
  Gynecological Surgery 04/2012; 9(2):147-150.
• Article: Uterine manipulation in operative laparoscopy by suction disposable uterine device

  S. Tamburro, E. Nouhz, F. Calonaci, A. Wattiez, M. Canis, G. Mage
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  ABSTRACT: The uterine mobilization is important to expose correctly the vesico-uterine plane, the adnexae, and the posterior cul-de-sac. Several studies compared different types of uterine manipulator and their maneuvrability, underlining the limitations or advantages related to the head and shaft when they are fixed together, limiting exposition or in the other, once there is dye injection capability. A new model of uterine manipulator by suction of endometrial cavity has been studied. Patients were not selected by uterine dimension or by gynecological disease; only the cases of endometrial cancer were excluded. In ten patients, we performed an hysteroscopic study associated to an endometrial specimen before installing the uterine device. No endometrial modification was found between normal endometrial specimen before surgery and after surgical treatment. The Vectec uterine manipulator has been demonstrated to be easy and safe to use. KeywordsLaparoscopy–Uterine manipulator–Suction–New device
  Gynecological Surgery 04/2012; 8(3):343-346.
• Article: Is the presence of endometrioma always associated with more severe disease?

  M. Setälä, P. Härkki, P. Suvitie, J. Fraser, J. Jalkanen, J. Kössi, A. Perheentupa, J. Mäkinen
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  ABSTRACT: The aim of this prospective study was to estimate whether the presence of endometrioma was associated with more severe disease, and with operative findings that were considered to make surgery more demanding in patients with deeply infiltrating endometriosis located in the posterior fornix of the vagina. Ninety-eight patients scheduled for primary surgery underwent complete excision of all visible endometriotic lesions and adhesions by laparoscopy (86 patients, 87.8%) or by laparotomy (12 patients, 12.2%) in four hospitals specialized in the surgical treatment of endometriosis. Endometrioma was detected in 46 patients (47.0%). No statistically significant difference was detected between patients with and without an endometrioma, in the presence of six studied operative findings: total obstruction of the pouch of Douglas (28% vs. 27%, p = 0.88), attachment of a posterior deep lesion to the ureter (52% vs. 44%, p = 0.43), peritoneal endometriotic lesions (80% vs. 75%, p = 0.52), other deep lesions (24% vs. 33%, p = 0.34), attachment of bowel to the uterosacral ligament deep lesion (65% vs. 69%, p = 0.71), and attachment of the rectum to a rectovaginal deep lesion (81% vs. 84%, p > 0.99). Endometrioma did not seem to be associated with operative findings that were considered to represent more severe disease, and make surgery more demanding in patients with deep endometriotic lesions in the posterior fornix of the vagina and with no previous pelvic surgery. KeywordsEndometriosis–Endometrioma–Deeply infiltrating endometriosis–Surgery
  Gynecological Surgery 04/2012; 8(3):299-304.