Publications

[Laparoscopy and bladder endometriosis].

Partial cystectomy is in the great majority of the cases the treatment of choice for patients with bladder endometriosis. The aim is to assess the methods, indications and results of operative laparoscopy for patients presenting with bladder endometriosis. We perform a descriptive retrospective study of 13 cases. All patients presenting with bladder endometriosis infiltrating the bladder muscularis between January 1, 1993 and June 30, 1998 were included in this series. It was possible to treat bladder endometriosis in all the patients by performing a laparoscopic partial cystectomy. With an average follow-up of 29.3 +/- 24.6 months (range 4-77) the results are satisfactory. Neither peri- nor postoperative complications were observed. The patients experienced an improvement in their condition, with complete disappearance of the urinary symptoms in every case. No recurrence of the functional urological symptoms occurred. Provided the surgeons are skilled and the lesions require no ureteral reimplantation, operative laparoscopy is a valid alternative to laparotomy for partial cystectomy.

Ureteral injuries after laparoscopic hysterectomy.

354. Hum Reprod. 2000 Mar;15(3):733-4. doi: 10.1093/humrep/15.3.733. Ureteral injuries after laparoscopic hysterectomy. Chapron C, Dubuisson JB.

[Initial access for laparoscopic gynecologic surgery. French Society of Endoscopic Gynecology, International Society of Pelvic Surgery and the National College of French Gynecologists-Obstetricians].

Reproductive outcome after laparoscopic myomectomy in infertile women.

OBJECTIVE: To assess reproductive outcome after laparoscopic myomectomies for interstitial and/or subserosal myomas in infertile women with or without associated infertility factors. STUDY DESIGN: In this observational study, 91 women with infertility for one year and at least one interstitial and/or subserosal myoma > 20 mm were treated with laparoscopic myomectomy. All patients were mailed questions about fertility and pregnancy outcome. Cumulative pregnancy rates were calculated by the Kaplan-Meier method. The log rank test and Cox's model were used for comparing the spontaneous pregnancy rate in patients with and without associated infertility factors. RESULTS: The mean age of the patients was 35 +/- 4 years. The mean duration of infertility was 44 +/- 33 months. Twenty-five patients (27.5%) had no associated infertility factors, and 66 (72.5%) had one or more. The mean size of the largest myomas was 45 +/- 19 mm. The mean number of myomas removed was 2.0 +/- 1.4. Eighty-six patients had laparoscopic myomectomy (94.5%), and five had laparoscopically assisted myomectomy (5.5%). There were no conversions to laparotomy. Ten patients were lost to follow-up (11.0%). Among the 91 patients treated surgically, 81 (89.0%) of them were evaluated. Forty-three (53.1%) conceived, resulting in a total of 51 pregnancies. The two-year overall cumulative conception rate was 51.2% (95% confidence interval [CI], 39.2-63.2%). The two-year spontaneous pregnancy rate was 43.9% (95% CI, 32.1-55.7%). This rate was 69.9% (95% CI, 50.3-89.5%) for patients with no associated factors and 31.5% (95% CI, 18.4-44.6%) for patients with associated factors (P < .001). This result was not affected by adjusting for age or duration of infertility. CONCLUSION: Laparoscopic myomectomy seems to be a good procedure for patients with myomas and no other infertility factors. In cases with associated infertility factors, the need for myomectomy has to be studied.

[Indications and modalities of conservative surgical treatment of interstitial and sub-serous myomas].

Laparoscopic management of bladder endometriosis.

BACKGROUND: To assess the methods, indications and results of operative laparoscopy for patients presenting with bladder endometriosis. METHODS: Descriptive retrospective study. All the patients presenting with bladder endometriosis infiltrating the bladder muscularis between January 1, 1993 and June 30, 1998 were included in this series. RESULTS: It was possible to treat bladder endometriosis in all the patients by performing a laparoscopic partial cystectomy. With an average follow-up of 31.6 months (range 6-61) the results are satisfactory. Neither per- nor postoperative complications were observed. The patients experienced an improvement in their condition, with complete disappearance of the urinary symptoms in every case. No recurrence of the functional urological symptoms occurred. CONCLUSIONS: Provided the surgeons are skilled and the lesions require no ureteral reimplantation, operative laparoscopy is a valid alternative to laparotomy for partial cystectomy.

[Ovarian puncture: supposed functional cysts].

Hysterectomy techniques used for benign pathologies: results of a French multicentre study.

The objective of this study was to assess the techniques by which hysterectomies are carried out and to determine the rate of total laparoscopic hysterectomy (TLH). A transversal multicentre study was conducted in 23 gynaecology and obstetrics departments of French University Hospital Centres. The study population comprised only those patients for whom hysterectomy was indicated for benign disease without genital prolapse or urinary stress incontinence. Whereas the rates of performance of hysterectomy by laparotomy and by the vaginal route are comparable [respectively 40.0% (94 patients) and 46.8% (110 patients)], the rate of performance of TLH is only 13.2% (31 patients). All 23 centres (100%) carried out hysterectomy by laparotomy and 21 centres (91.3%) carried out vaginal hysterectomy; however, only nine centres (39.1%) carried out TLH. Only seven centres (30.4%) performed all three types of operation. Of the eight centres whose rate of vaginal hysterectomy was >60%, six (75%) did not carry out TLH. The study suggests that the usage of the TLH technique appears to be limited. The extent of surgical training is a major factor in the choice of technique for hysterectomy.

[Endothelin receptors in benign human tumours of uterine muscle].

The endothelins (ET1, ET2, ET3) are a family of peptides that exert vasoactive and mitogenic effects. ETs bind to at least two subtypes of receptors: the ETA subtype is ET1 selective whereas the ETB subtype binds ET1, ET2 and ET3. By RT-PCR, we detected ETA receptor mRNA and ETB receptor mRNA in leiomyoma and in homologous myometrium distal from the tumor. Despite the presence of four spliced variants of ETA receptors, we identified a single class of ETA-binding sites. The level of ETB receptor mRNA was found to be higher in myometrium versus leiomyomas. Using complementary pharmacologic approach, we demonstrated the predominance of ETA receptors in normal myometrium (75% of total receptors). Both ETA and ETB transcripts coexist in leiomyomas, but we have reported only ETA binding sites. Because of growth properties of ET1, we suggest a role for this peptide in the tumoral development of human uterine smooth muscle.

[Profound endometriosis and infertility. Fertility results after laparoscopic treatment of profound endometriosis infiltrating the uterosacral ligaments].