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ABSTRACT: A recent study indicated that left-handed women have more than twice the risk of developing breast cancer before reaching the menopause than right-handed women (1). As a potential explanation, the authors suggest the existence of a common prenatal intrauterine hormonal exposure that determines both cerebral lateralization and risk of breast cancer. The hypothesis that increased concentrations of estrogens during pregnancy increase the probability of future occurrence of breast cancer was earlier discussed. © 2013 The Authors Acta Obstetricia et Gynecologica Scandinavica © 2013 Nordic Federation of Societies of Obstetrics and Gynecology.
Acta Obstetricia Et Gynecologica Scandinavica 02/2013; · 1.77 Impact Factor
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ABSTRACT: OBJECTIVES: To describe the outcomes of laparoscopic surgery for severe ureteric endometriosis. STUDY DESIGN: Retrospective descriptive study of the clinical and surgical outcomes for patients who underwent laparoscopic surgery for severe ureterohydronephrosis due to endometriosis. The surgery consisted of laparoscopic ureterolysis, ureteric end-to-end anastomosis and ureteral stenting at the Department of Obstetrics and Gynecology, Strasbourg Hospitals, between June 2004 and June 2009. Data were collected from patients' notes and also included telephone interview. Normally distributed data are presented as mean±SD, and skewed data as median (range). Categoric variables are reported as absolute values and percentages. Continuous variables are compared using the paired samples t-test. Statistical significance was set at P<0.05. RESULTS: Thirteen patients had severe disease. Two patients had non-functioning kidneys. Left sided lesions were more common (76.9%). All patients had associated deep infiltrative endometriosis (DIE) elsewhere in the pelvis. Laparoscopic treatment was feasible in all cases without the need to convert. Ureterolysis was performed in seven patients (53.8%) and segmental resection with end-to-end anastomosis in six (46.2%) patients. Ureteric wall endometriotic infiltration was present in four cases (30.8%). Median follow up duration was 24 months. All patients had improvement of their pain symptoms. There were no intraoperative complications. Major postoperative complications were seen in three patients (23%). CONCLUSIONS: Ureteric involvement is usually asymptomatic, and therefore in patients with evidence of deep endometriosis it must be excluded by ultrasound or magnetic resonance imaging. Laparoscopic treatment of ureteric endometriosis is feasible. Intrinsic ureteric endometriosis is quite frequent in severe ureterohydronephrosis. Complete excision of the disease is essential to improve pain symptomatology and to prevent recurrence of disease. Long term follow up is required to exclude any stenosis.
European journal of obstetrics, gynecology, and reproductive biology 07/2012; · 1.97 Impact Factor
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ABSTRACT: To report on the prevalence, surgical management, and outcome of urinary tract endometriosis (UTE) in a cohort of 221 patients undergoing laparoscopic surgery for severe endometriosis. UTE can cause significant morbidity, such as silent kidney or progressive renal function loss. Its frequency is underestimated and data on laparoscopic management are scarce.
Between 2007 and 2010, 43 patients were eligible for this single-center, retrospective study. The inclusion criterion was the presence of UTE (ie, bladder and/or ureteral endometriosis). All patients were operated laparoscopically.
The prevalence of UTE was 19.5% (43/221). There was no correlation between bladder and ureteral endometriosis (P >.05). Ureteral endometriosis was associated with patient's age (P <.01). Patients with bladder, but not ureteral, involvement complained more frequently about dysuria, hematuria, and urinary tract infections. Intraoperative and magnetic resonance imaging (MRI) findings revealed a moderate to good correlation. UTE was not associated with rectovaginal or bowel endometriosis, but rather with involvement of the uterosacral ligaments (P <.01). Twenty-two patients with bladder endometriosis were treated by mucosal skinning and 11 patients underwent partial cystectomy. Superficial ureteral excision was performed in 4 patients, whereas resection with ureteroureterostomy was done in 9 patients. There was no difference regarding the intra- and postoperative complications in patients with or without UTE.
In severe pelvic endometriosis, involvement of the urinary tract is quite common. Laparoscopic management is feasible and safe. Because of the lack of specific symptoms, the preoperative diagnosis of ureteral endometriosis still remains a challenge. Pelvic MRI represents a useful preoperative diagnostic tool.
Urology 09/2011; 78(6):1269-74. · 2.43 Impact Factor
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ABSTRACT: Urinary retention after radical laparoscopic surgery for severe endometriosis is a clinically relevant complication. We hypothesized a relationship between the amount of resected nerves and the occurrence of urinary retention.
We evaluated, retrospectively, a cohort of 221 patients. The expression of nerves in the resected specimens was investigated in patients with urinary retention and matched controls using standardized immunohistochemistry techniques.
The prevalence of urinary retention was 4.6% (n = 10). Importantly, there was no difference between cases and controls regarding the quantity of nerves in the resected specimens. The cumulative probability of 50% to overcome urinary retention was reached after 5.6 months. Age was the main risk factor for persistent retention (40.3 years with vs. 31.6 years without, p = 0.01).
In older endometriosis patients, surgical radicality should be balanced against preservation of organ function. There is a fairly good chance to recover, even after 6 months, which is important for patient counseling.
International Urogynecology Journal 07/2011; 23(1):111-6. · 1.83 Impact Factor
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ABSTRACT: Laparoscopic sacrocolpopexy (LSC) was first described almost 20 years ago. This technique aims to provide the outcomes of the gold standard abdominal approach while offering the benefits of minimally invasive surgery. However, the widespread diffusion of LSC in the management of pelvic organ prolapse (POP) is hampered by its presumed length and technical difficulties due to the inherent need for laparoscopic suturing skills.
In this article, we highlight the current status of LSC based on a historical overview and in the paradigm of an interrelationship between the three different approaches to POP correction.
The enormous changes over the past 15 years have contributed to a better understanding of the pathologies and their treatment, which has enabled us to refine LSC, to simplify it, and to make it much more reproducible.
In the future, we will need more prospective studies to compare LSC with vaginal reconstructive surgery.
International Urogynecology Journal 03/2011; 22(9):1165-9. · 1.83 Impact Factor
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ABSTRACT: Laparoscopy was considered marginal to surgical specialties before 1990. Rare innovations in instruments were done. With the realization of the first laparoscopic hysterectomy, this surgical route gained wide acceptance during the 1990s. Technical advances were made by instrument companies offering a wide variety of instruments to surgeons and by surgeons themselves to cope with problems during laparoscopic procedures. Manipulators are among the first instruments that surgeons suggested to ameliorate laparoscopic performance. Instruments that have multiple functions (i.e., grasping, cutting, coagulating) are more and more appreciated because surgeons can avoid changing instruments during surgery. Manipulators offer multifunctional assistance during gynecologic surgical procedures. They are useful for exposure purposes and also for reproductive surgery (and hysterectomy). This article explains the benefits and help that a manipulator can provide, especially in total laparoscopic hysterectomy. In the latter intervention, the manipulator will help to expose the pelvis by moving the uterus in any direction, to identify structures and find anatomical landmarks such as the vaginal fornices for culdotomy, and to avoid complications by pulling the ureter away from the operative field. Also, it is useful to avoid carbon dioxide leakage at the vaginal opening and to retrieve the surgical specimen. Each step is shown in a photograph with the specific hand movements corresponding to the manipulator's handling. We think that the use of manipulators during laparoscopic surgery is very useful and helps to reduce operative time.
Surgical technology international 10/2010; 20:225-31.
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ABSTRACT: Although main obstacles for entry routes (transgastric, transvesical, and transrectal) in natural orifices transluminal endoscopic surgery are closure of the incision and infection issues, the transvaginal route seems to be the most used. There is no doubt that classic colpotomy is a valid option. Nevertheless, this approach can be difficult and time consuming. From our experience with fertiloscopy via vaginal access and using an existing disposable trocar, we describe a new safe and simple technique for transvaginal natural orifices transluminal endoscopic surgery.
Surgical laparoscopy, endoscopy & percutaneous techniques 06/2010; 20(3):e92-4. · 1.23 Impact Factor
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ABSTRACT: The widespread diffusion of laparoscopic sacrocolpopexy in the management of female genital organ prolapse is hampered by its presumed length and technical difficulties. The aim of our study was to analyse the learning curve of a senior urogynecologic surgeon who was initiated into this technique.
The first 48 laparoscopic sacrocolpopexies performed by the same surgeon were analysed retrospectively for pre-operative, operative and post-operative data. At the time of the study, patients were asked about their degree of satisfaction by an anonymous questionnaire. To discover a turning point, the duration of each procedure was reported and the study population was divided into 8 equal groups of 6 interventions each, classed chronologically. Statistical analysis was carried out by Mauchly's sphericity test and then by Student-Newman-Keul's test. Other descriptive statistics were computed with the use of standard methods for means, medians and proportions.
The mean operative time was of 236.9 min. The learning curve showed a linear decrease in the duration of surgery with a turning point after 18-24 procedures (p<0.001). It was marked by 2 (4.1%) minor operative complications (2 cystostomies) and 2 immediate post-operative ones: one port-site hernia and one case of urinary retention. At 1 month, 1 patient (2.2%) presented an erosion of the posterior mesh. The mean follow-up was of 15.8 months. During this period, 2 patients (4.1%) presented with a recurrence of prolapse and 6 (12.5%) with de novo stress urinary incontinence. Forty-five patients (93.7%) answered an anonymous questionnaire regarding satisfaction: 40/45 (88.8%) were totally satisfied, 4 (8.8%) moderately and 1 (2.2%) not satisfied.
The learning curve of laparoscopic sacrocolpopexy shows a steady decrease in the duration of surgery. A turning point is observed after 18-24 procedures. During the learning curve there is no increased morbidity. Anatomical and functional results at short and medium terms are similar to those reported in the literature.
European journal of obstetrics, gynecology, and reproductive biology 04/2010; 149(2):218-21. · 1.97 Impact Factor
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ABSTRACT: To report a case of hematometra following laparoscopic resection of rectovaginal endometriosis extending to the cervix.
Case report.
University hospital.
A 31-year-old woman with endometriosis and infertility.
Combined laparoscopic and vaginal surgery.
The cervix had retracted into the vaginal scar after surgery, preventing the escape of menstrual blood. The hematometra was drained, and the cervix was repositioned into the vagina with use of a combined vaginal and laparoscopic approach.
Retraction of the cervix into the cul-de-sac can occur as a complication of excision of rectovaginal nodules that extend onto the posterior surface of the cervix. Excision of the posterior cervix should avoid deep excision of the posterior lip and should be limited only to the ectocervical margin to avoid such complications.
Fertility and sterility 04/2010; 93(6):2074.e11-2. · 3.97 Impact Factor
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ABSTRACT: The gold standard of Evidence Based Medicine remains the randomised controlled trial (RCT), which is the only tool that allows an approach to the "therapeutic truth". To reach credible conclusions, these trials need to be perfect in methodological and ethical quality. The purpose of this study is to evaluate methodological quality (MQ), ethical quality (EQ) and compliance with ethical requirements in phase III randomized clinical trials of breast cancer treatment.
MQ was evaluated by the Jadad-scale and EQ by the Berdeu-score for all the randomised controlled clinical trials (RCT) (n = 137), published between January 2001 and December 2005 in 11 international journals.
Mean MQ was 9.88 +/- 1.43. MQ was insufficient (Jadad score pound 9) for 49 RCT (35,8%). Mean EQ was 0.45 +/- 0.12. Mean EQ for RCT with insufficient MQ (n = 49) was 0.43 +/- 0.12; Mean EQ for RCT with good MQ (Jadad score > 9)(n = 88) was 0.46 +/- 0.11. There was significant improvement in MQ depending on the year in which the study was started (p = 0.002). EQ was independent of the year of study's start (p = 0.134).There was no relationship between MQ or EQ and the number of patients included in the study (p = 0.53 and p = 0.1). There was a tendency towards correlation between MQ and EQ (p = 0.052), but the correlation between these two variables could not be considered as significant (r = 0.67). Informed consent from patients (ICP) was not obtained in 5.8% (n = 8) of the RCTs and the approval of a research ethics committee (REC) was not mentioned in 26.3% (n = 36) of the RCTs.
Good MQ and reporting of ethical requirements (EQ) reflects the respect shown to the patients during the whole research process. There are still deficiencies in EQ and MQ. Quality improvement requires education and appropriation by the scientific community, in particular, medical staff, of methodological and ethical basic rules concerning trials involving human beings.
Medicine and law 12/2009; 28(4):637-48.
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ABSTRACT: Retroperitoneal pelvic and lomboartic lymphadenectomy is widely used as a staging and/or prognostic procedure in gynecologic malignancies. Associated morbidity ranges from 2 to 13% of cases. This study assesses the feasibility of extraperitoneal lymphadenectomy using Natural Orifices Transluminal Endoscopic Surgery (NOTES) in porcine survival model.
Six female pigs weighing 25 to 30 kg were used. Using a transvaginal access to the retroperitoneum, we performed three pelvic lymph node excision and three others in the laterocaval, interaorticocaval and lateroaortic regions. Colpotomy was closed with interrupted absorbable sutures.
Retroperitoneal lymphadenectomies were performed successfully in all six pigs. We experienced one accidental peritoneal perforation, one diffuse anterior abdominal wall emphysema, one abdominal wall bleeding secondary to electrical muscle stimulation and two pneumoperitoneums evacuated by Veress needle insertion. All animals thrived until three weeks after the initial intervention. On laparoscopic second look there were no abscess, no infection and no adhesions even with the accidental peritoneal perforation. On laparotomy, no retroperitoneal abscess was found, but there was a small amount of fibrosis at the lymphadenectomy sites. All colpotomies were inspected and showed good healing.
This study demonstrated the technical feasibility and safety of extraperitoneal lymphadenectomy by totally NOTES technique and provided the first report on survival porcine model. Cadaver experiments would test its feasibility in humans. Sentinel lymph node could be an application of NOTES lymphadenectomy in humans. NOTES endoscopic instruments are urgently needed for further advances in the technique. Further studies are mandatory to evaluate its future indications.
Gynecologic Oncology 12/2008; 112(2):405-8. · 3.89 Impact Factor
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ABSTRACT: To determine the incidence of equipment failure in gynecologic endoscopy and investigate causes and consequences.
A prospective observational single-center study between January and April 2006.
Gynecologic surgery department of a university hospital.
In all, 116 endoscopic interventions were included: 62 laparoscopies, 51 operative hysteroscopies, and 3 fertiloscopies. Emergency and equipment testing procedures were excluded.
Equipment malfunctions were divided into 4 categories with regard to imaging, transmission of fluids and light, the electric circuit, and surgical instruments. We also found cases with faulty connections between elements. Factors including human error, loss of time, and actual or potential consequences were analyzed. At least 1 equipment failure was noted in 38.8% of operative procedures, 41.9% of laparoscopies, and 37.3% of hysteroscopies. Fluid, gas, and light transmission was faulty in 36.2%, surgical instruments in 29.3%, the electric circuit in 22.4%, and imaging in 12.1%. Of malfunctions, 46.6% were a result of faulty connection between 2 elements. The most common cause for concern was bipolar forceps and cables in laparoscopy (42.3%) and the assembly of small parts in hysteroscopy (47.4%). Personnel were implicated in 43% of cases (nurses in 72%, surgeons in 12%, both in 16%). One equipment failure increased the total duration of laparoscopy by 7% and of hysteroscopy by 20%. The mean delay was 5.6+/-4.0minutes by equipment failure. Of the incidences, 19% could have led to serious complications for the patient; however, no morbidity or mortality actually occurred in this series.
Equipment malfunction is common in endoscopic surgery and concerns both laparoscopy and hysteroscopy. Consequences are potentially serious. It is mandatory to identify and rectify causes of equipment failure so as to optimize the daily use of endoscopic instruments and improve patient safety. The implementation of systematic checklists is currently under evaluation.
Journal of Minimally Invasive Gynecology 12/2008; 16(1):28-33. · 1.74 Impact Factor
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ABSTRACT: The purpose of this retrospective study was to evaluate the accuracy of MRI using pelvic-phased-array and endocavitary coils in detecting intestinal wall invasion by an endometriotic nodule.
Forty-seven patients (32.1 +/- 4.2 years) who were planned for a surgical cure of deep endometriosis underwent MRI with conventional sequences using both coils. A thin bright layer on T(2)-w with enhancement on post-Gd T(1)-w defined our MR pattern for muscular layer involvement. MR results were correlated with surgical and pathological findings of the removed nodule.
MR results for Group 1 (both coils) achieved a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 100-63%, 96-92%, 90-70%, 100-85%, and 97-83% for endovaginal coil and phased-array coil, respectively. Group 2 (phased-array coil) had a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 73%, 93%, 84%, 88%, and 87% for this coil, respectively.
Combined pelvic-phased-array and endovaginal coils are better than phased array alone in the detection of intestinal wall invasion. Easy to perform, it has to be considered as a preoperative staging for deep posterior endometriosis to orientate the surgical management.
Abdominal Imaging 02/2008; 34(2):251-9. · 1.73 Impact Factor
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ABSTRACT: Natural orifice transluminal endoscopic surgery (NOTES) provides the potential for performance of incisionless operations. This would break the physical barrier between bodily trauma and surgery, representing an epical revolution in surgery. Our group at IRCAD-EITS (Institut de Recherche contre les Cancers de l'Appareil Digestif [Institute of Digestive Cancer Research]-European Institute of TeleSurgery) has been actively involved in the development of NOTES since 2004 with a dedicated project created to develop feasibility and survival studies and new endoscopic technology.
NOTES cholecystectomy in a woman via a transvaginal approach.
University hospital. Patient The patient was a 30-year-old woman with symptomatic cholelithiasis.
The procedure was carried out by a multidisciplinary team using a standard double-channel flexible videogastroscope and standard endoscopic instruments. The placement of a 2-mm needle port, mandatory to insufflate carbon dioxide and to monitor the pneumoperitoneum, was helpful for further retraction of the gallbladder. At no stage of the procedure was there need for laparoscopic assistance. All of the principles of cholecystectomy were strictly adhered to.
The postoperative course was uneventful. The patient had no postoperative pain and no scars, and was discharged on the second postoperative day.
Transluminal surgery is feasible and safe. NOTES, a radical shift in the practice and philosophy of interventional treatment, is becoming established and is enormously advantageous to the patient. With its invisible mending and tremendous potential, NOTES might be the next surgical evolution.
Archives of Surgery 10/2007; 142(9):823-6; discussion 826-7. · 4.24 Impact Factor
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ABSTRACT: To identify any relationship between cyclooxygenase-2 expression and the intensity of severe, endometriosis-related dysmenorrhea.
Prospective study.
University hospital.
Patients with deep endometriosis.
During surgery, paired samples of tissue representing deep endometriosis and eutopic endometrium were obtained from 46 patients. Control endometrial tissue samples were obtained from 34 fertile women who underwent laparoscopic tubal ligation or reversal of tubal sterilization. Pain assessment for dysmenorrhea was done with a 10-point linear analogue scale.
The percentage of surface immunostained for Cox-2 was determined by an immunohistochemical technique. Relationships between pain score for dysmenorrhea and Cox-2 expression were analyzed.
Cox-2 expression was significantly higher in eutopic endometrial stromal cells from patients with deep endometriosis than in stroma from controls during the early, mid, and late secretory phases. In endometriosis patients, Cox-2 expression in eutopic endometrial stromal cells was significantly higher in women with more severe dysmenorrhea (pain score > or =7 vs. <7) during early and mid secretory phases.
Elevated Cox-2 expression in stromal cells in eutopic endometrium from patients with deep endometriosis may play a role in severe, endometriosis-related dysmenorrhea.
Fertility and Sterility 11/2004; 82(5):1309-15. · 3.56 Impact Factor
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ABSTRACT: To discover the prevalence of adnexal torsion after laparoscopic hysterectomy.
Retrospective analysis (Canadian Task Force classification II-3).
A tertiary referral hospital.
One thousand thirty-three women underwent laparoscopic hysterectomies between the years 1995 and 2002. The mean age (+/- SD) of the women at the time of hysterectomy was 43.87 +/- 4.28 years. Intervention. Laparoscopic hysterectomy in which at least one adnexa was left intact.
The files of all women with adnexal torsion diagnosed by laparoscopy from 1995 to 2003 were retrospectively reviewed. In seven women, adnexal torsion occurred after laparoscopic hysterectomy. Torsion occurred 2.64 (+/- 1.79) years (mean +/- SD) after hysterectomy. Torsion was treated by laparoscopy in all of the women; either oophorectomy or detorsion and ovariopexy was performed. We calculated the prevalence of this complication to be 7.91/1000.
Adnexal torsion can occur after laparoscopic hysterectomy.
The Journal of the American Association of Gynecologic Laparoscopists 09/2004; 11(3):336-9.
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ABSTRACT: To study the usefulness of and applications for frozen section in the laparoscopic management of adnexal masses.
Historical prospective study (Canadian Task Force classification II-3).
Large tertiary care hospital with university affiliation.
One hundred forty-one women undergoing laparoscopy for a suspicious adnexal mass.
Adnexal masses suspicious on ultrasound were managed by laparoscopy. After laparoscopic diagnosis, frozen sections were used to confirm a diagnosis of malignancy. Treatment was performed by laparoscopy whenever feasible.
The results of frozen section were compared with the results of permanent sections, and the consequences of the intraoperative diagnosis on the surgical management were evaluated. The frozen section diagnosis was correct in 125 of the 141 patients (88.7%). In one patient, the result was false negative. Specifically, frozen section diagnosis was correct in 96.8% of cases when a cyst or biopsy was sent for pathologic examination and in 86.4% when the whole adnexa was sent. It was correct in 93% of the cases involving tumors smaller than 100 mm and in 74% of larger tumors. It was correct in 92.3% of the women younger than 50 years and in 81.6% of women older than age 50. Intraoperative pathologic diagnosis was correct in 95.5% of benign tumors, 77.8% of low-malignancy tumors, and 75% of cancer cases.
Frozen section is a useful examination for surgical management decision making; however, the limitations and the difficulties should be taken into account.
The Journal of the American Association of Gynecologic Laparoscopists 09/2004; 11(3):365-9.
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ABSTRACT: Currently, the two laparoscopic techniques available and described in the literature for the treatment of vaginal vault prolapse are uterosacral ligament vault suspension and sacrocolpopexy. These two techniques are opposing each other fundamentally. While the first is reconstructive, the second is essentially palliative.
In both methods the surgeon starts with the identification and dissection of the pubocervical and rectovaginal fascia. In the first technique however, the new vaginal vault, made by re approximation of the two fasciae, is attached to the uterosacral complex, while in the second one, each fascia is suspended from the sacral promontorium, using a mesh. In review of the existing literature, it seems that the palliative surgical approach is more successful in the long term, giving a cure rate of approximately 92%, probably as it involves using mesh instead of the native tissue.
In this article we discuss the laparoscopic techniques available currently, analyse their results, discuss their differences and compare them with other non-laparoscopic techniques. Finally, we discuss the different options described, and offer some guidelines for the future of laparoscopic treatment of pelvic prolapse.
Current Opinion in Obstetrics and Gynecology 09/2003; 15(4):315-9. · 2.38 Impact Factor
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ABSTRACT: In this review we intend to describe the recent developments and experience gained in recent years with the different types of laparoscopic hysterectomies, and to compare results with those of abdominal hysterectomy.
In the United States, in the last decade, there has been clear trend towards laparoscopic hysterectomy. An increase from 0.3% to 9.9% was observed within a 7-year period from 1990 to 1997. High costs and lack of appropriate educational systems for residents and fellows slows the anticipated spread of this relatively new modality. From some retrospective publications it seems that complication rates have increased in laparoscopic hysterectomies, especially those involving the urinary system. However, a recent analysis revealed a reasonable complication rate for the procedure, compared with abdominal hysterectomy, if the surgeon passes a learning curve of the first 30 procedures. A conflict arises in regard to preservation of the uterine cervix during laparoscopic hysterectomy. Alternative procedures, such as supracervical laparoscopic hysterectomy or classic intrafascial supra-cervical hysterectomy, have been proposed. However, careful long-term analysis of results demonstrates a high complication rate requiring further operations in 24% of patients.
Less intraoperative bleeding, shorter hospital stay with less morbidity and shorter convalescence period remains the obvious advantages of laparoscopic in comparison with abdominal hysterectomy.
Current Opinion in Obstetrics and Gynecology 09/2002; 14(4):417-22. · 2.38 Impact Factor
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ABSTRACT: To review recent literature on the laparoscopic management of adnexal masses, when this approach may be considered as a gold standard.
Cyst rupture was recently demonstrated to be a significant prognostic factor in stage I invasive epithelial carcinoma, and it was recommended to restrict the laparoscopic approach to patients with preoperative evidence that the cyst was benign. The laparoscopic approach is still highly controversial in masses suspicious at ultrasound. The limits of the laparoscopic approach are discussed reviewing recent literature and our experience. The laparoscopic management of adnexal masses appears to be safe in most hospitals even in developing countries. This approach is being used with increasing frequency in unusual indications such as newborns, children, adolescents and pregnant women. The learning curve for endoscopic surgery appears to be longer than expected. Many patients with benign adnexal masses, such as ovarian endometrioma, are still treated by laparotomy or with an inadequate endoscopic technique. Several studies have suggested that the stripping technique is a tissue-sparing procedure.
The laparoscopic puncture of malignant ovarian tumours confined to the ovaries is uncommon, and should be avoided whenever possible. The teaching of endoscopy is essential to promote adequate procedures performed according to the principles of microsurgery and to preserve postoperative ovarian physiology.
Current Opinion in Obstetrics and Gynecology 09/2002; 14(4):423-8. · 2.38 Impact Factor
