Publications

[Cysts of the adnexa. The role of endoscopy].

[Laparoscopic myomectomy. 102 cases].

Myomectomy was performed by laparoscopy in 102 patients, according to a precise technique using the monopolar hook for the uterine incision and intraperitoneal sutures. Myomes were mostly removed through the suprapubic puncture site after fragmentation or by colpotomy. A laparotomy during the laparoscopic procedures was necessary in 2 cases. No complications were observed. A second-look laparoscopy or a cesarean section was performed in 24 cases. Post-operative adhesions were noted in 3 cases. In our experience, operative laparoscopy has several advantages over laparotomy and the risks of complications is low in selected cases.

Complications of gynecologic laparoscopic surgery--a French multicenter collaborative study.

444. N Engl J Med. 1993 May 6;328(18):1355. doi: 10.1056/NEJM199305063281817. Complications of gynecologic laparoscopic surgery--a French multicenter collaborative study. Querleu D, Chapron C, Chevallier L, Bruhat MA.

Laparoscopic management of tubal ectopic pregnancy.

As with laparotomy, laparoscopic treatment of ectopic pregnancy (EP) can be either conservative or radical. After conservative laparoscopic treatment by salpingotomy the risk of failure (between 4 and 6%) is comparable with that observed after similar treatment by laparotomy. The fertility results after laparoscopic treatment of EP are comparable if not better than those observed after similar treatment by laparotomy. These two reasons, together with the considerable advantages of endoscopy over laparotomy, mean that today laparoscopic treatment is without question the best surgical treatment for EP. The prognosis for post-EP fertility is unrelated to the characteristics of the EP (size, rupture, location). The post-EP fertility depends mainly on the patient's previous history. We have established the Therapeutic Scoring System for EP by assessing the different factors affecting future fertility and multivariable analysis. This score allowed us to choose the most suitable treatment to preserve fertility and reduce the risk of recurrence between conservative laparoscopic treatment, laparoscopic salpingectomy with or without contralateral tubal sterilization.

[The benefits and risks of laparoscopic surgery].

The advantages of laparoscopic surgery in comparison to those of conventional surgery are mainly due to the very low rates of postoperative infections and adhesions and due to the aesthetic nature of this type of surgery. Endoscopy enables a thorough search of lesions which can then be treated in a more conservative manner. The short hospital stay and rapid postoperative recovery are two key advantages of endoscopic surgery. Complications at endoscopic surgery mainly occur if the safety measures are not strictly followed, due to improper choice and use of instruments (eg. old instruments), an antecedent laparotomy and also depend upon the type of surgery performed. It should be noted that the introduction of the trocar is not a simple affair, that non-recognition of complications is not infrequent and that the incidence of complications is directly proportional to the experience of the operator.

[Place of celiosurgery in cancer of the cervix uteri].

Laparoscopic hysterectomy. A preliminary study.

Thirty-three patients were selected for laparoscopic hysterectomy and operated on in the Department of Obstetrics, Gynecology and Reproductive Medicine of Clermont-Ferrand University Hospital. Surgical techniques included blunt dissection with scissors and bipolar coagulation to achieve hemostasis. A case was considered successful when all the uterine vessels were treated by laparoscopy. Twenty-four cases were completed laparoscopically (72.7%). None of these patients had postoperative bleeding; 22 had an uneventful postoperative recovery. Nine procedures were converted to laparotomy (27.3%), five because of a difficult or unsatisfactory hemostasis. We conclude that in selected cases, a total hysterectomy can be performed safely by experienced laparoscopists. Further technological progress is necessary to make this procedure more acceptable. Its value as compared to the others will have to be demonstrated.

Treatment of recurrent ectopic pregnancy.

451. Fertil Steril. 1992 Oct;58(4):859-60. doi: 10.1016/s0015-0282(16)55347-3. Treatment of recurrent ectopic pregnancy. Chapron C, Pouly JL, Manhès H, Mage G, Canis M, Wattiez A, Bruhat MA.

Second-look laparoscopy after laparoscopic cystectomy of large ovarian endometriomas.

Forty-two patients who underwent a second-look laparoscopy after a unilateral or bilateral intraperitoneal cystectomy for treatment of an ovarian endometrioma of greater than 3 cm were included. At second-look laparoscopy, 92.4% of the adnexae treated for a large endometrioma had no deep ovarian endometriosis. Adhesion de novo formation occurred in 21% of the treated adnexae and in 17% of the contralateral adnexae. Complete or partial recurrence of dense adhesions occurred in 82% of the cases. Laparoscopic cystectomy is effective in treating large endometriomas. However, operative difficulties may be encountered, explaining persistent endometriomas and postoperative adhesions.

Results of conservative laparoscopic treatment of isthmic ectopic pregnancies: a 26 case study.

Twenty-six ectopic pregnancies located strictly within the isthmus were treated surgically using conservative laparoscopic techniques. In each and every case, the Triton monopolar electrode was used to perform salpingostomy which was followed by aspiration of the trophoblast. This therapeutic approach is very reliable since only one failure was observed (3.9%), requiring a further operation during which salpingectomy was carried out by laparoscopy. It was possible to evaluate subsequent fertility for 11 patients, seven of whom (63.6%) obtained an intrauterine pregnancy and only one patient (9.1%) had a recurrence. This highly satisfactory prognosis is perfectly comparable with that obtained with treatment via laparotomy with segmental resection of the isthmic portion of the tube and immediate or delayed anastomosis. These very encouraging results mean that conservative laparoscopic treatment presents an advantageous alternative to classic surgical treatment for isthmic ectopic pregnancies, in that the patients are spared a laparotomy.