Publications

Fertility after laparoscopic myomectomy of large intramural myomas: preliminary results.

Fertility outcome following laparoscopic myomectomy was evaluated. A prospective clinical study was carried out between October 1990 and October 1993 in 21 infertile patients who underwent laparoscopic myomectomy for a myoma measuring > or = 5 cm in diameter. The overall rate of intrauterine pregnancy was 33.3% (seven patients). Out of 12 patients with infertility factors associated with uterine myomas, three (25.0%) became pregnant, whereas four (44.4%) out of nine patients with no other associated infertility factor became pregnant. No uterine rupture was observed. Out of the seven pregnancies, four were spontaneous and began within 1 year of the operation. The other three were achieved after in-vitro fertilization in patients with associated infertility factors. In the four patients who gave birth by Caesarean section, no adhesions were found on the myomectomy scar. From these preliminary results, laparoscopic surgery for myomas seems to offer comparable results with those obtained by laparotomy.

Uterine fibroids: place and modalities of laparoscopic treatment.

Only fibroids which give rise to symptoms resistant to properly conducted medical treatment and/or complicated myomas require surgical treatment. The possibility offered by the new surgical approaches enables myomectomies to be now carried out via laparoscopy. We report our technique of laparoscopic myomectomy performed since 1989. Monopolar coagulation is used for the uterine incision, after myomectomy, myometrium and serosa are sutured. Myomas are removed through the suprapubic puncture site after fragmentation of large myomas, through a colpotomy or using the morcellator. Our results enable us to say that, although it is a difficult technique, laparoscopic myomectomy is a safe and reliable technique even for large intramural myomas.

[Radical laparoscopic surgery of ectopic pregnancy: results from a continuous series of 383 interventions].

From January 1983 to December 1993, 375 patients underwent laparoscopic salpingectomy. Six complications (1.5 %) were observed. Among 145 patients with a patent contralateral tube who desired pregnancy, 73 had an intrauterine pregnancy (50.3 %) and 22 had ectopic pregnancy (15.2 %). These results are discussed according to the contralateral tube status and gynecologic past history.

[Genital bilharziasis and female infertility. Review of the literature and three case reports].

Genital schistosomiasis is an uncommon disease. Its responsibility in female infertility is controversial. We reported 3 cases of pelvic schistosomiasis and we debate about the pathogenic contribution of the bilharziosis in sterility.

[Uterine fibroma. Diagnosis, development, treatment].

[Complete hysterectomy for benign pathology and laparoscopy: respective indications of laparoscopic preparation and an exclusively laparoscopic approach].

According to whether uterine artery treatment takes place vaginally or laparoscopically, laparoscopy for hysterectomy can be considered according to two modalities: laparoscopically assisted vaginal hysterectomy (LAVH) and total laparoscopic hysterectomy (TLH). The indications for laparoscopy are defined by the limits and/or contraindications of the vaginal route. LAVH is indicated in the following situations: pelvic pain syndrome where diagnosis and treatment can be made at the same time as hysterectomy; minimal endometriosis; past surgical history favouring adhesions formation; necessity to perform an oophorectomy; existence of an ovarian pathology. The elective indications for TLH are the severe pelvic adhesions, deep endometriosis and especially a limited vaginal accessibility associating with a narrow vagina and a fixed or non prolapsed uterus. Laparoscopy thus allows to reduce the number of laparotomies. When on overage three quarters of the hysterectomies (excluding cases of uterogenital prolapse) were up till now performed abdominally, laparoscopy could reduce this rate to approximately 10%.

[Laparoscopic tubal sterilization reversal: a technic using a single stitch].

We report our laparoscopic technique of tubal sterilization reversal. We perform a simple and atraumatic technique with a single point. After preparation and approximation of the two tubal segments, the anastomosis consists of one single suture placed at the -'12 o'clock-' site of the antimesenteric border. The feasibility, the advantages and the preliminary results are presented.

Laparoscopic myomectomy and myolysis.

The indications for operative laparoscopy have increased greatly over the past decades as its many advantages over laparotomy have become recognized. Laparoscopic myomectomy as a technique is now clearly described. A monopolar hook is used for the uterine incision. After atraumatic enucleation of the myoma, myometrium and serosa are usually sutured particularly if the incision is deep or more than 2 cm long. Myomas can be removed by posterior colpotomy. However, the development of an electrical cutting device permits an easier and quicker removal of the myoma through the suprapubic puncture site. Only complicated myomas and/or those which give rise to persistent symptoms despite properly prescribed medical treatment, together with those which grow rapidly, require surgery. In our experience of ablation of myomas measuring 5 cm and over the results were satisfactory in all 71 patients with more than one year of follow-up. In two cases (2.7%) we were obliged to convert to laparotomy. We were confronted with no serious per-operative or post-operative complications. These satisfactory results must not mask the fact that the technique is lengthy and difficult and should be carried out by experienced surgeons thoroughly familiar with endoscopic sutures. Under these conditions, laparoscopic myomectomy is possible, for large myomas (5 cm and over) even if they are located completely intramurally. However, there are limits and it is preferable to use laparotomy for myomas measuring over 10 cm and for multiple myomectomy (over 3). Finally, the risk of causing adhesions and the quality of the uterine suture need to be assessed in the near future.

[Hydrosalpinx and sterility: indications for salpingectomy].

[Total hysterectomy for benign pathologies: why is laparoscopy of value?].

The majority of the hysterectomies are performed by laparotomy. With laparoscopic surgery it will be possible to perform only 10 to 20 per cent of the hysterectomies by the abdominal route. Even if laparoscopic hysterectomy is a feasible technique, all the hysterectomies should not be performed by the endoscopic route. Laparoscopic surgery is in no case an alternative to vaginal surgery. Laparoscopic surgery is not indicated for hysterectomy if the operation is feasible quickly and under good conditions via the vaginal route. Laparoscopic surgery is only indicated when vaginal surgery is difficult and/or contra-indicated. In these situations, laparoscopic surgery can be performed according two different modalities: laparoscopically assisted vaginal hysterectomy and total hysterectomy completely performed by laparoscopy.