Patrick Petignat

University of Geneva, Genève, Geneva, Switzerland

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Publications (136)429.95 Total impact

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    ABSTRACT: To present a standardized and minimally invasive procedure to occlude uterine artery via a posterior approach. Step-by-step explanations of the technique using videos. The preventive occlusion of uterine arteries during uterine surgery reduces perioperative bleeding by temporarily devascularizing the uterus. This technique, usually performed by conventional or robotically-assisted laparoscopy, can be combined with surgical procedures that have a potential risk of major bleeding such as myomectomy or hysterectomy, particularly in cases of a large uterus. Here, we describe a minimally invasive technique using a laparoscopic posterior approach of the retroperitoneal space, which allows more direct access to the uterine pedicles. Institutional review board approval was obtained through our local ethics committee in Geneva University Hospitals. The main occlusion technique described in the literature involves a superior approach at the level of the lateral pelvic triangle. We propose to access the uterine artery via a posterior approach, at the posterior and inferior level of the broad ligament. The peritoneum is opened after previous identification of the uterine artery and the ureter by transparency. After a limited dissection, the occlusion of the uterine artery is performed under direct visual control through the atraumatic placement of a 10 mm endoscopic vascular clip. The posterior peritoneal approach should be favored if, during a laparoscopic procedure, a uterine artery occlusion is chosen to reduce blood loss. This technique offers an easier and a more limited dissection to access the uterine pedicles, thus minimizing the risk of accidental injuries. Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.
    Journal of Minimally Invasive Gynecology 08/2015; DOI:10.1016/j.jmig.2015.08.885 · 1.83 Impact Factor
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    ABSTRACT: Our aim was to evaluate the feasibility and performance of smartphone digital images for the detection of cervical intraepithelial neoplasia of grade 2 or worse (CIN2+) as an adjunct to a conventional visual inspection approach with acetic acid (VIA) and Lugol's iodine (VILI), in comparison with detection by histopathologic examination. Three hundred women were primarily screened for human papillomavirus (HPV) using self-collected vaginal specimens. Human papillomavirus-positive women were then invited for VIA and VILI, which were interpreted as (i) nonpathological, (ii) pathological or, (iii) inconclusive. Cervical smearing, endocervical brushing, and cervical biopsies were performed. Digital images of the cervix were taken with a smartphone and evaluated offsite by experienced health care providers. Sensitivity and specificity for CIN2+ were compared between on-site and off-site observers, using histopathological diagnosis as the criterion standard. Eighty-eight HPV-positive women were screened for cervical cancer. Overall, 7 cases of CIN2+ (8.0%) were diagnosed using biopsy specimens. The on-site physician obtained a sensitivity of 28.6% (95% confidence interval [95% CI], 3.7-71) and a specificity of 87.2% (95% CI, 77.7- 93.7). The off-site physicians obtained a sensitivity ranging between 42.9% (95% CI, 9.9-81.6; p = 1) and 85.7% (95% CI, 42.1-99.6; p = .13) and a specificity between 48.1% (95% CI, 36.5- 59.7; p < .001) and 79.2% (95% CI, 68.5-87.6; p = .10). Comparison between observers did not reach significance. Observers assessed 95.6% of all images as very good or acceptable for interpretation purpose. Smartphone images may be a useful adjunct to conventional VIA and VILI for the detection of CIN2+ and improve cervical cancer screening in low-resource settings.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.
    Journal of Lower Genital Tract Disease 08/2015; DOI:10.1097/LGT.0000000000000136 · 1.99 Impact Factor
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    ABSTRACT: Visual inspection of the cervix after application of 5% acetic acid (VIA) is a screening technique for cervical cancer used widely in low and middle-income countries (LMIC). To improve VIA screening performance, digital images after acid acetic application (D-VIA) are taken. The aim of this study was to evaluate the use of a smartphone for on- and off-site D-VIA diagnosis. Women aged 30-65 years, living in the city of Ambanja, Madagascar, were recruited through a cervical cancer screening campaign. Each performed a human papillomavirus (HPV) self-sample as a primary screen. Women testing positive for HPV were referred for VIA followed by D-VIA, cervical biopsy and endocervical curettage according to routine protocol. In addition, the same day, the D-VIA was emailed to a tertiary care center for immediate assessment. Results were scored as either D-VIA normal or D-VIA abnormal, requiring immediate therapy or referral to a tertiary center. Each of the three off-site physicians were blinded to the result reported by the one on-site physician and each gave their individual assessment followed by a consensus diagnosis. Statistical analyses were conducted using STATA software. Of the 332 women recruited, 137 (41.2%) were HPV-positive and recalled for VIA triage; compliance with this invitation was 69.3% (n = 95). Cervical intraepithelial neoplasia was detected in 17.7% and 21.7% of digital images by on-site and off-site physicians, respectively. The on-site physician had a sensitivity of 66.7% (95%CI: 30.0-90.3) and a specificity of 85.7% (95%CI: 76.7-91.6); the off-site physician consensus sensitivity was 66.7% (95%CI: 30.0-90.3) with a specificity of 82.3% (95%CI: 72.4-89.1). This pilot study supports the use of telemedicine for off-site diagnosis of cervical intraepithelial neoplasia, with diagnostic performance similar to those achieved on-site. Further studies need to determine if smartphones can improve cervical cancer screening efficiency in LMIC.
    PLoS ONE 07/2015; 10(7):e0134309. DOI:10.1371/journal.pone.0134309 · 3.23 Impact Factor
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    ABSTRACT: Objective To assess and compare the accuracy of visual inspection with acetic acid (VIA), visual inspection with Lugol's iodine (VILI), and human papillomavirus (HPV) testing as alternative standalone methods for primary cervical cancer screening in sub-Saharan Africa. Design Systematic review and meta-analysis of diagnostic test accuracy studies. Data sources Systematic searches of multiple databases including Medline, Embase, and Scopus for studies published between January 1994 and June 2014. Review methods Inclusion criteria for studies were: alternative methods to cytology used as a standalone test for primary screening; study population not at particular risk of cervical cancer (excluding studies focusing on HIV positive women or women with gynaecological symptoms); women screened by nurses; reference test (colposcopy and directed biopsies) performed at least in women with positive screening results. Two reviewers independently screened studies for eligibility and extracted data for inclusion, and evaluated study quality using the quality assessment of diagnostic accuracy studies 2 (QUADAS-2) checklist. Primary outcomes were absolute accuracy measures (sensitivity and specificity) of screening tests to detect cervical intraepithelial neoplasia grade 2 or worse (CIN2+).
    BMJ (online) 07/2015; 351:h3084. DOI:10.1136/bmj.h3084 · 17.45 Impact Factor
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    ABSTRACT: The gynaecological environment can become contaminated by human papillomavirus (HPV) from healthcare workers' hands and gloves. This study aimed to assess the presence of HPV on frequently used equipment in gynaecological practice. In this cross-sectional study, 179 samples were taken from fomites (glove box, lamp of a gynaecological chair, gel tubes for ultrasound, colposcope and speculum) in two university hospitals and in four gynaecological private practices. Samples were collected with phosphate-buffered saline-humidified polyester swabs according to a standardised pattern, and conducted twice per day for 2 days. The samples were analysed by a semiquantitative real-time PCR. Statistical analysis was performed using Pearson's χ(2) test and multivariate regression analysis. Thirty-two (18%) HPV-positive samples were found. When centres were compared, there was a higher risk of HPV contamination in gynaecological private practices compared with hospitals (OR 2.69, 95% CI 1.06 to 6.86). Overall, there was no difference in the risk of contamination with respect to the time of day (OR 1.79, 95% CI 0.68 to 4.69). When objects were compared, the colposcope had the highest risk of contamination (OR 3.02, 95% CI 0.86 to 10.57). Gynaecological equipment and surfaces are contaminated by HPV despite routine cleaning. While there is no evidence that contaminated surfaces carry infectious viruses, our results demonstrate the need for strategies to prevent HPV contamination. These strategies, based on health providers' education, should lead to well-established cleaning protocols, adapted to gynaecological rooms, aimed at eliminating HPV material. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to
    Sexually transmitted infections 06/2015; DOI:10.1136/sextrans-2014-051977 · 3.40 Impact Factor
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    ABSTRACT: Prostate apoptosis response-4 (PAR-4) is considered as a tumour suppressor due to its ability to selectively induce cell apoptosis in most cancer cells. However little is known about the role of PAR-4 in ovarian cancer. In this study, we investigated for the first time the role of PAR-4 in ovarian carcinogenesis. We showed that PAR-4 mRNA level is not significantly different between healthy and cancer ovarian cells. Immunohistochemistry on ovarian tissue showed that ovarian cancer cells are positive for PAR-4 nuclear and cytoplasmic staining whereas ovarian healthy cells are negative for PAR-4 nuclear staining. We then studied the role of PAR-4 in cell apoptosis. We determined that PAR-4 induces cell apoptosis in response to stimuli, in vitro, but is also involved in the relocation of GRP78 from endoplasmic reticulum to the cell surface of ovarian cancer cell line (SKOV-3 cells). In ovo, PAR-4 decreases ovarian tumour development and increases the response to taxol treatment. These observations suggest that PAR-4 is a very interesting therapeutic target against ovarian carcinogenesis.
    Oncotarget 05/2015; 6(26). DOI:10.18632/oncotarget.4010 · 6.36 Impact Factor
  • Emilien Jeannot · Patrick Petignat · Philippe Sudre
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    ABSTRACT: We describe a human papillomavirus (HPV) vaccination program implemented since 2007 in Geneva Canton, Switzerland, that used school services, a public hospital, and private physicians as vaccination providers. We assessed program performance with the evolution of immunization coverage during the first four years of program implementation. We measured vaccination coverage of the target population using individual records of vaccination status collected by service providers and transmitted to the Geneva Canton Medical Office. The target population was 20,541 adolescent girls aged 11-19 years as of September 1, 2008, who resided in the canton when the program began. As of June 30, 2012, HPV vaccination coverage was 72.6% and 74.8% in targeted cohorts for three and two doses, respectively. The global coverage for three doses increased by 27 percentage points from December 2009 to June 2012. Coverage for girls aged 16-18 years at the beginning of the program reached 80% or more four years into the program. High coverage by this HPV vaccination program in Geneva was likely related to free vaccination and easy access to the vaccine using a combination of delivery services, including school health services, a public hospital, and private physicians, covering most eligible adolescent girls.
    Public Health Reports 05/2015; 130(3):202-6. · 1.55 Impact Factor
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    ABSTRACT: We determined the human papillomavirus (HPV) types present in invasive cervical cancer (ICC) of women in Cameroon in order to estimate the potential efficacies of HPV prophylactic vaccines. This is a retrospective study using 181 formalin-fixed paraffin-embedded cervical tissue samples of ICC collected from the Institute of Pathology, Gyneco-Obstetric and Pediatric Hospital, Yaoundé, Cameroon. HPV was detected by PCR using modified GP5+/GP6+ (MGP) primers. Genotyping was performed by reverse-blot hybridisation, which allowed the detection of 9 of the 14 high-risk HPV types. Of the 181 samples, 91.7% were squamous cell carcinomas and 6.6% were adenocarcinomas. Counting all the single and multiple infections, the three most common high-risk types in descending order were HPV16 (88%), HPV45 (32%) and HPV18 (14.8%). 54.9% of cases were infected with a single HPV type and 45.1% had two or more HPV infections. The frequencies of HPV16, HPV45 and multiple infections are all higher than previously reported. These observations have significant implications on the consideration of vaccination strategies because each vaccine has different duration and efficacies in cross-protection of different HPV types. The method used proved to be sensitive and cost-efficient for retrospective studies where fresh materials are not available. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to
    Sexually Transmitted Infections 03/2015; 91(6). DOI:10.1136/sextrans-2014-051642 · 3.40 Impact Factor
  • Nicola Pluchino · Jean-Marie Wenger · Patrick Petignat
    Obstetrics and Gynecology 03/2015; 125(3):739. DOI:10.1097/AOG.0000000000000709 · 5.18 Impact Factor
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    ABSTRACT: In a previous letter published in Swiss Medical Weekly, we emphasised the need for Switzerland to change from cytology-based to human papillomavirus (HPV) screening for cervical cancer in women aged 30 years and older [1]. According to a recent study published in The Lancet [2], which included individual level data from four random-ised controlled trials (RCTs) conducted in Sweden (Swe-descreen [3]), the Netherlands (POBASCAM [4, 5]), Eng-land (ARTISTIC [6]) and Italy (NTCC [7]), Ronco and colleagues demonstrated that HPV screening is more effective than cytology in preventing cervical cancer. This study had a median follow-up time of 6.5 years and involved more than 175,000 women. As such, it provides a significant milestone for cervical cancer detection based on HPV testing. The authors demonstrated that HPV screening offers 60–70% greater protection against cervical cancer compared with cytology and showed that HPV testing performed at 5-year intervals is safer than a 3-year interval for cytology. The implications of these findings for cervical cancer prevention are immediate and global, and suggest that international and national experts should now consider how to implement the change from cytology-based to HPV-based screening, as well as an extension of the screening interval. In response to overwhelming evidence from several good-quality RCTs, which demonstrated that HPV testing might be a more clinically effective option [8, 9], some Western countries have already adopted it as a stand-alone cer-vical cancer screening method. Countries with organised population-based screening programmes where decisions can be executed in a relatively short time period, such as England, the Scandinavian countries and the Nether-lands, tend to embrace the change more easily than countries not having a well-controlled screening system. Indeed, the Netherlands have already entered the annals of public health history as a pioneer in the implementation of an HPV-based cervical cancer screening protocol [10]. Reluctance to accept the change may come from physicians who consider Pap smears to be part of every woman's annual visit; if intervals for screening are lengthened, they fear that women will not come for an annual checkup and may be less inclined to undergo screening. Price is another important concern, and efforts should be made to ensure that HPV testing is fully refunded by health insurance, as is the case for Pap smears. Concerns about the introduction of HPV testing have to be balanced by societal and epidemiological perspectives, because the best strategy for preventing cervical cancer is to use the most accurate test (maximising the benefits of screening) at the longest possible interval (minimising the potential harm of screening). However, Western countries, with liberal health systems and opportunistic screening depending on the initiative of individual women and physicians, have demonstrated in the history of cervical cancer prevention that, despite the presence of a general agreement in favour of new recommendations , the speed and scope of clinical adoption might greatly vary. This is particularly true because each interest group has its own directives and limitations. The United States of America was the first country with opportunistic screening to recommend HPV testing. Since 2012, the American College of Obstetricians and Gyneco-logists and the American Cancer Society have recommended that women aged 30–65 years should undergo " co-testing " with both cytology screening and HPV testing every 5 years if both tests are negative [11]. In fact, HPV testing alone is not recommended. However, this recommendation might be about to change, because the US Food and Drug Administration has approved (on April 24 2014) HPV testing as a first-line screening method for cervical cancer screening [12]. In the case of Switzerland, it is now time to incorporate HPV testing in the national cervical cancer screening recommendation and to update the current guidelines. Evidence suggests that longer screening intervals would be appropriate for HPV testing owing to its high negative pre-dictive value. Furthermore, the extension of the screening interval controls overscreening and reduces the detection of transient HPV infections and insignificant lesions, thus minimising the risk of undergoing unnecessary procedures. Besides the evidence provided by Ronco et al. [2], Elfstrom et al. [13] analysed data from a RCT on HPV testing in Sweden (13 years of follow-up) and found the longitudinal Swiss Medical Weekly · PDF of the online version ·
    Swiss medical weekly: official journal of the Swiss Society of Infectious Diseases, the Swiss Society of Internal Medicine, the Swiss Society of Pneumology 02/2015; 145. DOI:10.4414/smw.2015.14112 · 2.09 Impact Factor
  • Jean Dubuisson · Aurore Fehlmann · Patrick Petignat
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    ABSTRACT: We present a minimally invasive surgical technique for the treatment of presumed benign giant cysts using the Alexis® Laparoscopic System (Applied Medical, Rancho Santa Margarita, California, USA) that includes a wound protector/retractor and a laparoscopic "cap". Step-by-step explanation of the procedure using videos. The incidence of presumed benign giant ovarian cysts is rare. The standard surgical treatment traditionally requires gaining access by a midline laparotomy to facilitate the retrieval of the resected specimen and minimize the risk of cyst spillage. Various minimally invasive techniques (ultrasound-guided or laparoscopically-guided intra-cystic aspiration methods) have been described in the last few decades to reduce morbidity associated with open surgery. Nonetheless, these techniques are poorly standardized and have not seen widespread use. They have been shown to be fairly technically complex to perform, and they are sometimes unreliable in case of unexpected malignancy. We propose a standardization of the minimally invasive surgical treatment of presumed benign giant ovarian cysts using the Alexis® Laparoscopic System. We were driven by the advantages provided by the Alexis wound protector/retractor used in other surgical disciplines. This device allows for better surgical exposure and oncologic safety. The pre-operative criteria for selection are very strict in order to minimize the risk of unexpected malignancy. The use of the Alexis® Laparoscopic System for the surgical management of presumed benign giant ovarian cysts offers excellent exposure and control, representing a safe alternative to the other minimally-invasive surgical procedures. Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.
    Journal of Minimally Invasive Gynecology 02/2015; 22(4). DOI:10.1016/j.jmig.2015.01.027 · 1.83 Impact Factor
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    ABSTRACT: Information about women's acceptance of new screening methods in Sub-Saharan Africa is limited. The aim of this study was to report on women's acceptance of human papillomavirus (HPV) self-sampling following an educational intervention on cervical cancer and HPV. Women were recruited from the city of Tiko and a low-income neighborhood of Yaoundé, both in Cameroon. Written and oral instructions about how to perform an unsupervised HPV self-sample were given to participants, who performed the test in a private room. Acceptability of HPV self-sampling was evaluated by questionnaire. Participants previously screened for cervical cancer by a physician were asked additional questions to assess their personal preferences about HPV self-sampling. A sample of 540 women were prospectively enrolled in the study; median age was 43 years old (range 30-65 years). Participants expressed a high level of acceptance of HPV self-sampling as a screening method following information sessions about cervical cancer and HPV. Most expressed no embarrassment, pain, anxiety, or discomfort (95.6%, 87.8%, 91.3%, and 85.0%, respectively) during the information sessions. Acceptance of the method had no correlation with education, knowledge, age, or socio-professional class. Eighty-six women (16%) had a history of previous screening; they also reported high acceptance of HPV self-sampling. Educational interventions on cancer and HPV were associated with high acceptability of HPV self-testing by Cameroonian women. Further evaluation of the intervention in a larger sample and using a control group is recommended.
    International Journal of Women's Health 02/2015; 7:149-54. DOI:10.2147/IJWH.S56307
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    ABSTRACT: Estetrol (E4), a naturally occurring estrogen produced exclusively by human fetal liver, is currently being evaluated for potential use in contraception and menopausal care in humans. The present study was designed to profile E4 effects on the central nervous system, to assess the in vivo effects of E4 administration on Beta-Endorphin (β-END) release in specific brain structures and to evaluate whether E4 has synergic or antagonistic effects on estradiol-mediated β-END synthesis. Intact female adult rats received different doses of E4 and ovariectomized (OVX) rats received different doses of E4 or E2V or combinations of both drugs. The concentrations of β-END were assessed in the frontal and parietal cortex, hippocampus, hypothalamus, neurointermediate lobe, anterior pituitary and plasma. E4 at the dose of 1mg/kg/day did not alter β-END content in most brain areas, as well as, plasma levels of intact animals E4 administered at a dose of 5mg/kg/day decreased β-END content in the hippocampus, hypothalamus, and in the neurointermediate lobe, as well as, plasma levels, compared to intact animals receiving vehicle. E4 increased β-END values in the frontal cortex, but not in the plasma, following the administration of 1mg/kg/day in OVX rats, whereas treatment with 5mg/kg/day in OVX rats induced a significant increase in β-END levels in most brain areas and in the plasma. However, in the presence of estradiol, E4 showed an estrogen-antagonistic effect in selected brain structures at the dose of 5mg/kg/day and in plasma levels of β-END at the dose of 1mg/kg/day and 5mg/kg/day. In OVX rats, E4 increases CNS and peripheral levels of β-END, behaving as a weak estrogen-agonist. The antagonistic effect observed after combined estradiol and E4 administration further profiles E4 as a natural SERM. Copyright © 2015 Elsevier Inc. All rights reserved.
    Steroids 01/2015; 95. DOI:10.1016/j.steroids.2015.01.003 · 2.64 Impact Factor
  • Asia-Pacific Journal of Clinical Oncology 12/2014; 10:52-52. · 1.54 Impact Factor
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    Jasmine Abdulcadir · Maria I Rodriguez · Patrick Petignat · Lale Say
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    ABSTRACT: Introduction. Clitoral reconstruction following female genital mutilation/cutting (FGM/C) is a new surgical tech-nique reported to be a feasible and effective strategy to reduce clitoral pain, improve sexual pleasure, and restore a vulvar appearance similar to uncircumcised women. However, data on safety, care offered, and evaluation of sexual and pain outcomes are still limited. Aims. This study aims to present the care offered and clinical outcomes of two women who received multidisci-plinary care, including psychosexual treatment, with clitoral reconstruction. We report their long-term outcomes, and the histology of the removed periclitoral fibrosis. Methods. We report the cases of two women with FGM/C types II and III who requested clitoral reconstruction for different reasons. One woman hoped to improve her chronic vulvar pain, as well as improve her sexual response. The other woman requested surgery due to a desire to reverse a procedure that was performed without her consent, and a wish to have a genital appearance similar to non infibulated women. They both underwent psychosexual evaluation and therapy and surgery. The histology of the periclitoral fibrosis removed during surgery was analyzed. Results. At 1-year postoperatively, the first woman reported complete disappearance of vulvar pain and improved sexual pleasure, including orgasm. Our second patient also described improved sexuality at 1-year follow-up (increased sexual desire, lubrication, vulvar pleasure, and sensitiveness), which she attributed to a better self body image and confidence. Both women reported feeling satisfied, happy, and more beautiful. Conclusion. We show a positive outcome in pain reduction and improved sexual function, self body image, and gender after psychosexual therapy and clitoral reconstruction. More evidence is needed about clitoral reconstruction to develop guidelines on best practices. Until research is conducted that rigorously evaluates clitoral reconstruction for its impact on pain and sexuality, we advise always offering a multidisciplinary care, including sexual therapy before and after the surgery. Abdulcadir J, Rodriguez MI, Petignat P, and Say L. Clitoral reconstruction after female genital mutilation/cutting: Case studies.
    Journal of Sexual Medicine 11/2014; 12(1). DOI:10.1111/jsm.12737 · 3.15 Impact Factor
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    ABSTRACT: Developing countries are interested in using human papillomavirus (HPV) testing as a primary screening test for cervical cancer prevention programs. The low specificity of the HPV assay requires triage testing of HPV-positive women. To compare visual inspection with acetic acid (VIA) and cytology as triage testing methods in HPV-positive women to detect cervical intraepithelial neoplasia or grade 2 or higher (CIN2+). The study was conducted in two Cameroonian towns (Yaoundé and Edea) and included 846 eligible women aged 25 to 65 years. All participants performed self-HPV testing. HPV-positive women (n=259) were randomly assigned to be tested either by VIA (VIA group) or cytology (cytology group). HPV-positive women had both cervical biopsy and endocervical curettage to detect biopsy-confirmed CIN2+. All statistical tests were two-sided. The prevalence of HPV was 38.5%, and the mean age of HPV-positive women was 41.5±10.1 years. One hundred ninety-eight women (97 in the VIA group and 99 in the cytology) were randomly assigned to one of the two testing arms. The sensitivity of VIA was 25.0% (95% CI, 7.1%-59.1%), and the sensitivity of cytology was 90.0% (59.6%-98.2%). The specificity was 74.2% (95% CI, 64.2%-82.1%) for VIA and 85.2% (76.3%-91.2%) for cytology. ROC area for cytology was 0.910 against the 0.496 area for VIA. In this trial, VIA was inferior to cytology as a triage test among HPV-positive women. Further investigations are needed to determine the optimal triage method for HPV-positive women. This article is protected by copyright. All rights reserved.
    International Journal of Cancer 11/2014; 137(1). DOI:10.1002/ijc.29353 · 5.09 Impact Factor
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    ABSTRACT: Objective: Human papillomavirus (HPV) self-sampling (Self-HPV) may be used as a primary cervical cancer screening method in a low resource setting. Our aim was to evaluate whether an educational intervention would improve women's knowledge and confidence in the Self-HPV method. Method: Women aged between 25 and 65 years old, eligible for cervical cancer screening, were randomly chosen to receive standard information (control group) or standard information followed by educational intervention (interventional group). Standard information included explanations about what the test detects (HPV), the link between HPV and cervical cancer and how to perform HPV self-sampling. The educational intervention consisted of a culturally tailored video about HPV, cervical cancer, Self-HPV and its relevancy as a screening test. All participants completed a questionnaire that assessed sociodemographic data, women's knowledge about cervical cancer and acceptability of Self-HPV. Results: A total of 302 women were enrolled in 4 health care centers in Yaounde and the surrounding countryside. 301 women (149 in the "control group'' and 152 in the "intervention group'') completed the full process and were included into the analysis. Participants who received the educational intervention had a significantly higher knowledge about HPV and cervical cancer than the control group (p < 0.05), but no significant difference on Self-HPV acceptability and confidence in the method was noticed between the two groups. Conclusion: Educational intervention promotes an increase in knowledge about HPV and cervical cancer. Further investigation should be conducted to determine if this intervention can be sustained beyond the short term and influences screening behavior. Trials Registration: International Standard Randomised Controlled Trial Number (ISRCTN) Register ISRCTN78123709
    PLoS ONE 10/2014; 9(10):e109788. DOI:10.1371/journal.pone.0109788 · 3.23 Impact Factor
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    ABSTRACT: Our objective was (i) to assess if a self-collected test for human papillomavirus (HPV) may serve as a primary cervical cancer screening method in a low-resource setting, (ii) to evaluate its implication in a screen and treat approach, and (iii) to identify the most eligible age group in a screening program. Women were recruited through a cervical cancer screening campaign conducted in Cameroon. Written and oral instructions were given to participants by a health-care professional to carry out an unsupervised self-collected HPV-test (SelfHPV), followed by a physician-collected cervical sample for HPV testing (Physician-HPV) and cytology. Differences in performance between Self-HPV versus Physician-HPV and their ability to detect abnormal cytology results (ASC-US+) were evaluated. Descriptive analyses were used to examine the correlation between HPV positivity and cervical abnormalities by age. A sample of 789 women was prospectively enrolled. HPV prevalence was 14.6% and 12.7% for Self-HPV and Physician-HPV, respectively (Cohen's kappa = 0.74). HPV positivity by cytological diagnosis for ASC-US+ was similar with the two tests. PPV of the Self-HPV for ASC-US+ was 20.4; OR and NNT were 6.5 (3.2-13.4) and 6 (4.2-10.9), respectively. We observed a trend of increasing cytological abnormalities in 30-49 year-old women and a concomitant trend of decreasing HPV prevalence supporting that this age group might be the most eligible group for screening. In conclusion, Self-HPV can be used as a primary screening test but needs to be followed by a triaging test that would identify the subset of women affected by clinically significant precancer or cancer. © 2014 Wiley Periodicals, Inc.
    International Journal of Cancer 10/2014; 135(8). DOI:10.1002/ijc.28834 · 5.09 Impact Factor
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    ABSTRACT: The World Health Organization recently advocated a two-stage strategy with HPV testing followed by Visual inspection of the cervix with Acetic acid (VIA) as a suitable option for cervical cancer screening. However, its accuracy has never been directly assessed in the context of primary screening. To evaluate effectiveness of HPV testing on self-obtained specimens (self-HPV) followed by VIA (sequential testing) in a low income setting, we recruited 540 women aged between 30 and 65 years in two Cameroonian peri-urban areas. Eligible women were counseled about cervical cancer and how to perform self-sampling. HPV positive and a random sample of HPV negative women were called back for VIA and biopsy. Disease was defined by interpretation of cervical intraepithelial neoplasia grade 2 or worse (CIN2+). Performances of VIA, self-HPV and sequential testing were determined after adjustment for verification bias. HPV prevalence was 27.0%. VIA positivity was 12.9% and disease prevalence was 5%. Sensitivity and specificity of VIA for CIN2+ were 36.4% (95% CI: 15.2%-64.6%) and 90.4% (95% CI: 85.4%-93.7%), respectively. Sensitivity of self-HPV (100.0% (95% CI: 79.6%-100.0%)) was 66% higher than that of sequential testing (33.3% (95% CI: 15.2%-58.3%)). Meanwhile, specificity of self-HPV (74.5% (95% CI: 70.6%-78.1%)) was 22% lower than that of sequential testing (96.7% (95% CI: 94.8%-97.9%)). A two-stage screening strategy with self-HPV followed by VIA improves specificity of cervical cancer screening, but at the cost of an important loss of sensitivity. Ways to improve VIA performance or other tools are needed to increase positive predictive value of HPV testing. © 2014 Wiley Periodicals, Inc.
    International Journal of Cancer 10/2014; 136(6). DOI:10.1002/ijc.29250 · 5.09 Impact Factor
  • Patrick Dällenbach · Patrick Petignat
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    ABSTRACT: This study evaluated the feasibility and safety of 3-port robotically assisted laparoscopic hysterectomy (RALH), using a consecutive series of women who underwent 3-port RALH in a university hospital. From November 2010 until June 2013 we operated on 53 women, whose mean age was 48.4 ± 7.7 years (range 35–68 years), and mean body mass index was 27.1 ± 5.1 kg/m2 (range 19.5–42.9 kg/ m2). The indications for hysterectomy were myoma in 31 (58.5 %), adenomyosis in 10 (18.9 %), cervical dysplasia in 4 (7.5 %), neoplasia in 4 (7.5 %), and recurrent polyps or postmenopausal bleeding in the remaining 4 women (7.5 %). We performed total RALH in 50 cases (94.3 %) and subtotal in the others. The median duration of total intervention was 169 min (interquartile range 147.5–206.5 min). The mean weight of the uterus was 209.8 ± 166.6 g (range 36–790 g) and mean estimated blood loss was 72.3 ± 75.9 ml (range 0–300 ml). There were no perioperative complications, in particular no blood transfusions nor conversions to laparotomy. The median hospital stay was 4 days (interquartile range 3–4 days). One patient was reoperated 1 month later for vaginal vault hematoma and another was readmitted 3 weeks post-operatively due to vaginal vault dehiscence after premature intercourse, but did not require reoperation. Three-port RALH is feasible and safe for simple hysterectomy. We believe this experience using minimum ports to be useful to prepare for robotically assisted single-port hysterectomy.
    Journal of Robotic Surgery 09/2014; 8(3):221-226. DOI:10.1007/s11701-014-0454-3

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1k Citations
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  • 2002–2015
    • University of Geneva
      • Department of Obstetrics and Gynaecology
      Genève, Geneva, Switzerland
  • 2008–2013
    • Hôpitaux Universitaires de Genève
      • • Département de gynécologie et d'obstétrique
      • • Unité d’oncogynécologie chirurgicale
      Genève, Geneva, Switzerland
  • 2010
    • McGill University
      Montréal, Quebec, Canada
    • University of Antwerp
      • Laboratory of Cell Biology & Histology
      Antwerpen, Flanders, Belgium
  • 2007
    • University of Liège
      Luik, Walloon, Belgium
    • Hôpital Notre-Dame
      Montréal, Quebec, Canada
  • 2006–2007
    • Centre hospitalier de l'Université de Montréal (CHUM)
      Montréal, Quebec, Canada
  • 2005–2006
    • Université de Montréal
      • • Department of Pathology and Microbiology
      • • Department of Obstetrics and Gynecology
      Montréal, Quebec, Canada
  • 1998–2004
    • University Hospital of Lausanne
      • Institute of Microbiology (IMUL)
      Lausanne, Vaud, Switzerland