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Choi S, Roviglione G, Chou D, D'Ancona G, Ceccaroni M. Nerve-sparing surgery in deep endometriosis: Has its time come? Best Pract Res Clin Obstet Gynaecol 2024:102506. [PMID: 38981835 DOI: 10.1016/j.bpobgyn.2024.102506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 05/05/2024] [Accepted: 05/19/2024] [Indexed: 07/11/2024]
Abstract
Nerve-sparing (NS) surgery was first introduced for the treatment of deep endometriosis (DE) 20 years ago, drawing on established neuroanatomy and success from oncological applications. It aims to identify and preserve autonomic nerve fibres, reduce iatrogenic nerve injury, and minimize postoperative visceral dysfunction, without compromising the therapeutic effectiveness against endometriosis. The evolution of NS surgical techniques over the past two decades has been supported by an expanding body of literature on anatomical details, dissection techniques, and functional outcomes. Recent evidence suggests that NS surgery results in reduced postoperative voiding dysfunction (POVD). Transient POVD may be influenced by preoperative dysfunction, with parametrial infiltration being a strong predictive factor for POVD. While the benefits in bowel and sexual functions are less pronounced and consistent, NS surgery potentially prevents de novo dysfunctions in these areas. Furthermore, perioperative complication rates, effectiveness in pain relief, and fertility outcomes are reportedly on par with conventional surgery.
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Affiliation(s)
- Sarah Choi
- Sydney Women's Endosurgery Centre, Women's & Children's Health, St. George Hospital, South Eastern Sydney Local Health District, New South Wales, 2217, Australia.
| | - Giovanni Roviglione
- Department of Obstetrics and Gynaecology, Gynaecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS Sacro-Cuore - Don Calabria Hospital, Via Don A. Sempreboni 5, Negrar, Verona, Italy.
| | - Danny Chou
- Sydney Women's Endosurgery Centre, Women's & Children's Health, St. George Hospital, South Eastern Sydney Local Health District, New South Wales, 2217, Australia; Division of Obstetrics and Gynaecology, School of Clinical Medicine, Health and Medicine, University of New South Wales, Sydney, New South Wales, 2052, Australia.
| | - Gianmarco D'Ancona
- Department of Obstetrics and Gynaecology, Gynaecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS Sacro-Cuore - Don Calabria Hospital, Via Don A. Sempreboni 5, Negrar, Verona, Italy.
| | - Marcello Ceccaroni
- Department of Obstetrics and Gynaecology, Gynaecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS Sacro-Cuore - Don Calabria Hospital, Via Don A. Sempreboni 5, Negrar, Verona, Italy.
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Park Y, Song A, Jee J, Bae N, Oh S, Shin JH, Kim YJ. Changes in anti-Müllerian hormone values for ovarian reserve after minimally invasive benign ovarian cystectomy: comparison of the Da Vinci robotic systems (Xi and SP) and the laparoscopic system. Sci Rep 2024; 14:9099. [PMID: 38643310 PMCID: PMC11032402 DOI: 10.1038/s41598-024-59935-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 04/16/2024] [Indexed: 04/22/2024] Open
Abstract
To investigate the impact on the ovarian reserve after minimally invasive ovarian cystectomy using two platforms, the Da Vinci robotic system (Xi and SP) and the laparoscopic system. Patients underwent laparoscopic or Da Vinci robotic (Xi or SP) ovarian cystectomy for benign ovarian cysts between January 1, 2018, and December 31, 2022 at Guro Hospital, Korea University Medical center. We measured the change of AMH values (%) = [(postAMH - preAMH)] × 100/preAMH. No significant differences in preoperative age, cyst size, estimated blood loss during surgery, hemoglobin drop, length of hospital stay, adhesion detachment rate and cyst rupture rate were observed. However, the operative time was significantly shorter in the laparoscopic group than that in the robotic group (67.78 ± 30.58 min vs. 105.17 ± 38.87 min, p < 0.001) The mean preAMH and postAMH were significantly higher with the Da Vinci robotic group than with the laparoscopic group (preAMH: 5.89 ± 4.81 ng/mL vs. 4.01 ± 3.59 ng/mL, p = 0.02, postAMH: 4.36 ± 3.31 ng/mL vs. 3.08 ± 2.60 ng/mL, p = 0.02). However, the mean ΔAMH was not significantly different between two groups. ΔAMH also did not demonstrate significant differences among the three groups; laparoscopic, Xi and SP robotic. Even in the patient groups with preAMH < 2 and diagnosed with endometriosis, the ΔAMH did not show significant differences between the laparoscopic and robotic groups. The Da Vinci robotic system is no inferior to conventional laparoscopic systems in preserving ovarian function.
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Affiliation(s)
- Yunjeong Park
- Department of Obstetrics and Gynecology, Korea University College of Medicine, 148 Gurodong-ro, Guro-Gu, Seoul, 08308, South Korea
| | - Ayoung Song
- Department of Obstetrics and Gynecology, Korea University College of Medicine, 148 Gurodong-ro, Guro-Gu, Seoul, 08308, South Korea
| | - Junghyun Jee
- Department of Obstetrics and Gynecology, Korea University College of Medicine, 148 Gurodong-ro, Guro-Gu, Seoul, 08308, South Korea
| | - Nayoung Bae
- Department of Obstetrics and Gynecology, Korea University College of Medicine, 148 Gurodong-ro, Guro-Gu, Seoul, 08308, South Korea
| | - Sumin Oh
- Department of Obstetrics and Gynecology, Korea University College of Medicine, 148 Gurodong-ro, Guro-Gu, Seoul, 08308, South Korea
| | - Jung-Ho Shin
- Department of Obstetrics and Gynecology, Korea University College of Medicine, 148 Gurodong-ro, Guro-Gu, Seoul, 08308, South Korea
| | - Yong Jin Kim
- Department of Obstetrics and Gynecology, Korea University College of Medicine, 148 Gurodong-ro, Guro-Gu, Seoul, 08308, South Korea.
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3
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Piozzi GN, Burea V, Duhoky R, Stefan S, So C, Wilby D, Tsepov D, Khan JS. Robotic surgery for bowel endometriosis: a multidisciplinary management of a complex entity. Tech Coloproctol 2024; 28:31. [PMID: 38329622 PMCID: PMC10853297 DOI: 10.1007/s10151-023-02904-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/13/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND Bowel endometriosis impacts quality of life. Treatment requires complex surgical procedures with associated morbidity. Precision approach with robotic surgery leads to organ preservation. Bowel endometriosis requires a multidisciplinary management to improve patient outcomes. This study evaluates perioperative outcomes of bowel endometriosis undergoing multidisciplinary planning and robotic surgery. METHODS Consecutive cases of multidisciplinary robotic bowel endometriosis procedures (January 2021-December 2022) were evaluated from a prospectively maintained database in a national endometriosis accredited centre. Patients were managed through a multidisciplinary setting including gynaecologists, colorectal robotic surgeons, and other specialists. Dyschezia (menstrual and non-cyclical) and quality of life were assessed pre- and postoperatively (6 months) through validated questionnaires. RESULTS Sixty-eight consecutive cases of robotic bowel endometriosis were included. Median age was 35.0 (30.2-42.0) years. Median body mass index was 24.0 (21.0-26.7) kg/m2. Procedures performed were 48 (70.6%) shavings, 11 (16.2%) deep shavings, 3 (4.4%) disc excisions, and 6 (8.8%) segmental resections. One (1.5%) patient required temporary stoma. Median operating time was 150 (120-180) min. There were no conversions/return to theatre postoperatively. Median endometriotic nodule size was 25.0 (15.5-40.0) mm. Two (2.9%) patients developed postoperative complications. Median length of postoperative stay was 2 (2-4) days. Median follow-up was 12 (7-17) months. One (1.5%) patient recurred. Median menstrual dyschezia score improved from 5.0 (2.0-8.0) to 1.0 (0.0-5.7). Median non-cyclical dyschezia significantly improved (p < 0.001) from 1.0 (0.0-5.7) to 0.0 (0.0-2.0). Median quality of life score improved from 52.5 (35.0-70.0) to 74.5 (60.0-80.0). CONCLUSIONS Robotic multidisciplinary approach to bowel endometriosis provides good perioperative outcomes with improvement of dyschezia and quality of life.
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Affiliation(s)
- G N Piozzi
- Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Queen Alexandra Hospital, Southwick Hill Road, Cosham, Portsmouth, PO6 3LY, UK
| | - V Burea
- The Princess Grace Hospital Robotic Endometriosis Centre, The Harley Street Clinic, HCA Healthcare UK, London, UK
| | - R Duhoky
- Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Queen Alexandra Hospital, Southwick Hill Road, Cosham, Portsmouth, PO6 3LY, UK
| | - S Stefan
- Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Queen Alexandra Hospital, Southwick Hill Road, Cosham, Portsmouth, PO6 3LY, UK
| | - C So
- The Princess Grace Hospital Robotic Endometriosis Centre, The Harley Street Clinic, HCA Healthcare UK, London, UK
| | - D Wilby
- The Princess Grace Hospital Robotic Endometriosis Centre, The Harley Street Clinic, HCA Healthcare UK, London, UK
- Department of Urology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - D Tsepov
- The Princess Grace Hospital Robotic Endometriosis Centre, The Harley Street Clinic, HCA Healthcare UK, London, UK
| | - J S Khan
- Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Queen Alexandra Hospital, Southwick Hill Road, Cosham, Portsmouth, PO6 3LY, UK.
- The Princess Grace Hospital Robotic Endometriosis Centre, The Harley Street Clinic, HCA Healthcare UK, London, UK.
- University of Portsmouth, Portsmouth, UK.
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Hebert T. Robotic assisted laparoscopy for deep infiltrating endometriosis. Best Pract Res Clin Obstet Gynaecol 2024; 92:102422. [PMID: 38007964 DOI: 10.1016/j.bpobgyn.2023.102422] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 10/09/2023] [Accepted: 10/22/2023] [Indexed: 11/28/2023]
Abstract
Deep infiltrative endometriosis is a condition affecting up to 15 % of women of childbearing age, defined by extra uterine location of endometrial like tissues. The symptoms of endometriosis range from severe dysmenorrhea to infertility, chronic pelvic pain, bowel dysfunction and urinary tract involvement to name the most common. Endometriosis has an impact on the quality of life of patients, with personal and social consequences. Although medical treatment is indicated in the first instance, surgery may be necessary. Standard laparoscopy has become the gold standard for this surgery. However, surgery for deep infiltrative endometriosis is known to be highly complex, and the significant development of robotic assistance in recent years has had an impact on the evolution of surgical practice. This comprehensive review of the literature provides an overview of the contributions of robotic surgery in the field of endometriosis and gives an insight into the next steps in its development.
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Affiliation(s)
- T Hebert
- Centre Olympe de Gouges, Gynecologic Surgery Department, University Hospital, Tours, France.
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5
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Pavone M, Seeliger B, Alesi MV, Goglia M, Marescaux J, Scambia G, Ianieri MM. Initial experience of robotically assisted endometriosis surgery with a novel robotic system: first case series in a tertiary care center. Updates Surg 2024; 76:271-277. [PMID: 38133880 DOI: 10.1007/s13304-023-01724-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023]
Abstract
Endometriosis is a benign disease requiring surgery if medical treatment can not achieve symptom control. Laparoscopy remains the gold standard and robotic assistance can be beneficial in complex cases. Robot-assisted radical endometriosis excision using the Hugo™ RAS system is a novel approach. The aim of this study is to describe its setting and outcomes in a series of patients in a robotic surgery center. Endometriosis patients who consecutively underwent robot-assisted surgery with the Hugo™ RAS system (Medtronic, USA) were retrospectively enrolled. Disease-specific symptoms before and after surgery, endometriosis stage, as well as perioperative and intraoperative variables including system setup were collected. Early post-operative complications (< 30 days) and follow-up (up to 3 months) were reported. All procedures were completed robotically. Port placement followed the "bridge" configuration with a "compact" docking. The median operative time was 186.5 min (IQR 174-220), the median estimated blood loss 50 ml (IQR 0-100). An intraoperative complication occurred in one patient (6.6%), a bladder laceration with postoperative antibiotic treatment. The median lenght of hospital stay (LOS) was 3 days (IQR 3-4). Surgery achieved a statistically significant decrease in symptoms: mean dysmenorrhea (9.50 ± 0.83 versus 1.7 ± 2.26; p = 0.001), dyschezia (4.27 ± 3.61 versus 2.40 ± 2.92; p = 0.026), dysuria (2.73 ± 3.39 versus 1.87 ± 2.41; p = 0.358), dyspareunia (6.53 ± 3.15 versus 2.93 ± 2.89; p = 0.002) and chronic pelvic pain (8.8 ± 1.20 versus 3.20 ± 2.39; p = 0.001). The integration of this platform in the described configuration was safe with regular perioperative outcomes and significant improvement in symptoms. Prospective comparative studies with a larger cohort and longer follow-up are needed to assess potential advantages over the current gold standard.
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Affiliation(s)
- Matteo Pavone
- Dipartimento di Scienze per la Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Largo Agostino Gemelli 8, 00168, Rome, Italy.
- IHU Strasbourg , Institute of Image-Guided Surgery, Strasbourg, France.
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France.
| | - Barbara Seeliger
- IHU Strasbourg , Institute of Image-Guided Surgery, Strasbourg, France
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
- Department of Visceral and Digestive Surgery, University Hospitals of Strasbourg, Strasbourg, France
- ICube, UMR 7357 CNRS, University of Strasbourg, Strasbourg, France
| | - Maria Vittoria Alesi
- Dipartimento di Scienze per la Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Marta Goglia
- IHU Strasbourg , Institute of Image-Guided Surgery, Strasbourg, France
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
- Department of Translational Medicine and Oncology, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Jacques Marescaux
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
| | - Giovanni Scambia
- Dipartimento di Scienze per la Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Manuel Maria Ianieri
- Dipartimento di Scienze per la Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Largo Agostino Gemelli 8, 00168, Rome, Italy
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
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6
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Song Z, Li S, Luo M, Li H, Zhong H, Wei S. Assessing the role of robotic surgery versus laparoscopic surgery in patients with a diagnosis of endometriosis: A meta-analysis. Medicine (Baltimore) 2023; 102:e33104. [PMID: 38115379 PMCID: PMC10727685 DOI: 10.1097/md.0000000000033104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Surgical management of endometriosis can be carried out with the traditional standard laparoscopic technique or the robotic surgery technique; however, it is not clear if there is a significant difference between techniques. This meta-analysis aims to evaluate and compare the impact of robotic and standard laparoscopic techniques in endometriosis regarding the clinical outcome. METHODS Studies comparing robotic surgery to laparoscopic surgery for endometriosis were among the studies from various languages that met the inclusion criteria. Using dichotomous and continuous random-effect models, the results of these investigations (surgery time, hospitalization time, blood loss, complications, and conversion rate) were examined, and the mean difference with 95% confidence intervals was computed. RESULTS Eight studies from 2013 to 2022 were selected for the current analysis including 1741 patients with endometriosis. The studied data revealed a statistically significant (P = .01) lower operation time related to laparoscopic surgery compared with the robotic technique. In addition, the hospitalization time of laparoscopic surgery is significantly (P = .03) lower than that of robotic surgery. On the other hand, blood loss, rehospitalization, postoperative and intraoperative complications, and conversion rates were not significantly different between both techniques. Heterogeneity values were variable according to the analysis factor, from 0% to 91%. CONCLUSION Both robotic and standard laparoscopic techniques have similar outcomes regarding blood loss, rehospitalization, conversion rate, and rate of complication. However, the substantial difference between techniques was in favor of standard laparoscopic surgery regarding operation and hospitalization time.
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Affiliation(s)
- Zhihua Song
- Department of Gynecology, Hospital of Chengdu University of Traditional Chinese Medicine, Sichuan, China
| | - Songtao Li
- Department of Oncology, Hospital of Chengdu University of Traditional Chinese Medicine, Sichuan, China
| | - Mei Luo
- Department of Gynecology, Chongqing Institute of Traditional Chinese Medicine, Chongqing, China
| | - Hongjun Li
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Sichuan, China
| | - Hanzhi Zhong
- Department of Gynecology, Hospital of Chengdu University of Traditional Chinese Medicine, Sichuan, China
| | - Shaobin Wei
- Department of Gynecology, Hospital of Chengdu University of Traditional Chinese Medicine, Sichuan, China
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Pavone M, Goglia M, Campolo F, Scambia G, Ianieri MM. En-block butterfly excision of posterior compartment deep endometriosis: The first experience with the new surgical robot Hugo™ RAS. Facts Views Vis Obgyn 2023; 15:359-362. [PMID: 38128095 PMCID: PMC10832646 DOI: 10.52054/fvvo.14.5.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Background Minimally invasive surgery is the gold standard treatment for deep endometriosis when medical management fails. In selected cases, such as when bowel or urinary tract are involved, robotic assisted surgery can be useful due to its characteristics of high dexterity and manoeuvrability. This is the first case of robotic en-bloc excision of posterior compartment deep endometriosis performed with the new HugoTM RAS system. Objective The purpose of this video article is to show for the first time the feasibility of bowel surgery for deep endometriosis with this new robotic device. Materials and Methods A 24-years-old woman affected by severe dysmenorrhea, chronic pelvic pain, dyschezia and dyspareunia underwent to deep endometriosis excision using the new robotic platform HugoTM RAS system at the Unit of Gynaecological Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. Main outcome measures Intraoperative data, docking set up, post-operative outcomes up to three months follow up were evaluated. Results The surgical procedure was carried out without intra-operative or post-operative complications, operative time (OT) was 200 minutes, while docking time was 8 minutes. No system errors or faults in the robotic arms were registered. Post-operative complete disease-related symptoms relief was reported. Conclusion According to our results, the introduction of this new robotic platform in the surgical management of deep endometriosis seems to be feasible, especially in advanced cases. However, further studies are needed to demonstrate the benefits of this surgical system and the advantages of robotic surgery compared to laparoscopy in this subset of patients.
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LONGO M, GAIA G, AFONINA M, ALBONI C, LA MARCA A. Robotic-assisted laparoscopy in reproductive surgery: what is new? GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2023. [DOI: 10.23736/s0393-3660.22.04959-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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Andres MP, Souza C, Villaescusa M, Vieira M, Abrao MS. The current role of robotic surgery in endometriosis management. Expert Rev Endocrinol Metab 2022; 17:63-73. [PMID: 35073819 DOI: 10.1080/17446651.2022.2031976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 01/17/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Endometriosis is a chronic inflammatory disease that affects approximately 10%-15% of women of childbearing age. Laparoscopic surgery is the preferred surgical approach. Recently, robotic surgery has been used for benign gynecologic surgery, but its role in the treatment of endometriosis is still unknown. AREAS COVERED We included studies that evaluated the outcomes of robotic surgery for endometriosis. Using the keywords 'endometriosis' and 'robotics', a comprehensive literature search on PubMed, Embase, and the Cochrane Library was performed in July 2021. EXPERT OPINION Robotic surgery for endometriosis has similar outcomes as conventional laparoscopy, with no evidence of increased complication rates. Despite the non-inferiority of the surgical route, the associated costs of robotic surgery limit its availability. Rapid development of robot-assisted surgery necessitates long-term prospective randomized controlled trials. However, the limitations of robotic surgery should not be overlooked. If robotic surgery can facilitate the spread of minimally invasive surgery, it will be necessary to evaluate the cost, availability, complexity of the lesions, and most importantly, the results of patient satisfaction and values of value-based medicine.
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Affiliation(s)
- Marina Paula Andres
- Departamento de Obstetricia E Ginecologia, Hospital Das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- Division of Gynecologic, BP - A Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | - Carolina Souza
- Division of Gynecologic, BP - A Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | - Marina Villaescusa
- Division of Gynecologic, BP - A Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | - Marcelo Vieira
- Gynecologic Oncology, Barretos Cancer Hospital/Pio XII Foundation, Barretos, São Paulo, Brazil
| | - Mauricio S Abrao
- Departamento de Obstetricia E Ginecologia, Hospital Das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- Division of Gynecologic, BP - A Beneficência Portuguesa de São Paulo, São Paulo, Brazil
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10
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Endometriosis: Epidemiology, Classification, Pathogenesis, Treatment and Genetics (Review of Literature). Int J Mol Sci 2021; 22:ijms221910554. [PMID: 34638893 PMCID: PMC8508982 DOI: 10.3390/ijms221910554] [Citation(s) in RCA: 111] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/22/2021] [Accepted: 09/26/2021] [Indexed: 12/11/2022] Open
Abstract
Endometriosis is a “mysterious” disease and its exact cause has not yet been established. Among the etiological factors, congenital, environmental, epigenetic, autoimmune and allergic factors are listed. It is believed that the primary mechanism of the formation of endometriosis foci is retrograde menstruation, i.e., the passage of menstrual blood through the fallopian tubes into the peritoneal cavity and implantation of exfoliated endometrial cells. However, since this mechanism is also observed in healthy women, other factors must also be involved in the formation of endometriosis foci. Endometriosis is in many women the cause of infertility, chronic pain and the deterioration of the quality of life. It also represents a significant financial burden on health systems. The article presents a review of the literature on endometriosis—a disease affecting women throughout the world.
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11
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Hiltunen J, Eloranta ML, Lindgren A, Keski-Nisula L, Anttila M, Sallinen H. Robotic-assisted laparoscopy is a feasible method for resection of deep infiltrating endometriosis, especially in the rectosigmoid area. J Int Med Res 2021; 49:3000605211032788. [PMID: 34407685 PMCID: PMC8381426 DOI: 10.1177/03000605211032788] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE This study aimed to compare outcomes of mini-invasive surgical treatment of endometriosis, especially conventional laparoscopy with robotic-assisted laparoscopy, and to evaluate the quality of life. METHODS One hundred three consecutive patients with endometriosis who had surgery from 2014 to 2017 owing to an indication of pain were enrolled in this retrospective study. The majority (n = 77, 75%) of patients underwent conventional laparoscopy and 18 (17%) had robotic-assisted laparoscopy. The quality of life was postoperatively assessed with a questionnaire. RESULTS The rates of parametrectomy (76% vs. 45%,) and rectovaginal resection (28% vs. 4%) were significantly higher in robotic-assisted laparoscopy than in laparoscopy. Additionally, the rate of bowel operations (50% vs. 17%), especially the shaving technique, was higher in robotic-assisted laparoscopy surgery than in laparoscopy (39% vs. 8%). There was no difference in the rate of postoperative complications between laparoscopy and robotic-assisted laparoscopy. Most (91%) of the patients who answered the questionnaire felt that surgical treatment had relieved their pain. In the laparoscopic and robotic-assisted groups, 88% of respondents felt that their quality of life had improved after surgery. CONCLUSIONS This study suggests that robotic-assisted laparoscopy is a feasible method to resect deep infiltrating endometriosis, especially in the rectosigmoid area.
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Affiliation(s)
- Janika Hiltunen
- Department of Gynecology and Obstetrics, 60650Kuopio University Hospital, Kuopio University Hospital, Kuopio, Finland.,Department of Health Sciences, Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Marja-Liisa Eloranta
- Department of Gynecology and Obstetrics, 60650Kuopio University Hospital, Kuopio University Hospital, Kuopio, Finland
| | - Auni Lindgren
- Department of Gynecology and Obstetrics, 60650Kuopio University Hospital, Kuopio University Hospital, Kuopio, Finland
| | - Leea Keski-Nisula
- Department of Gynecology and Obstetrics, 60650Kuopio University Hospital, Kuopio University Hospital, Kuopio, Finland.,Department of Health Sciences, Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Maarit Anttila
- Department of Gynecology and Obstetrics, 60650Kuopio University Hospital, Kuopio University Hospital, Kuopio, Finland
| | - Hanna Sallinen
- Department of Gynecology and Obstetrics, 60650Kuopio University Hospital, Kuopio University Hospital, Kuopio, Finland
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Raimondo D, Alboni C, Orsini B, Aru AC, Farulla A, Maletta M, Arena A, Del Forno S, Sampogna V, Mastronardi M, Petrillo M, Seracchioli R. Comparison of perioperative outcomes between standard laparoscopic and robot-assisted approach in patients with rectosigmoid endometriosis. Acta Obstet Gynecol Scand 2021; 100:1740-1746. [PMID: 33999408 PMCID: PMC8453718 DOI: 10.1111/aogs.14170] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/15/2021] [Accepted: 05/04/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Robot-assisted laparoscopic surgery (RALS) has gained widespread application in several surgical specialties. Previous studies on the feasibility and safety of RALS vs standard laparoscopy (S-LPS) for rectosigmoid endometriosis are limited and reported conflicting data. This study aims to compare S-LPS and RALS in patients with rectosigmoid endometriosis in terms of perioperative surgical and clinical data. MATERIAL AND METHODS This is a multicentric, observational, prospective cohort study including 44 patients affected by rectosigmoid endometriosis referred to two tertiary referral centers for endometriosis from September 2018 to September 2019. Patients were divided into two groups: 22 patients underwent S-LPS, and 22 underwent RALS. Our primary outcome was to compare operative time (from skin incision to suture) between the two groups. Secondary outcomes included: operative room time (patient entry into operative room and patient out), estimated blood loss, laparotomic conversion rate, length of hospital stay, perioperative complications, and evaluation of endometriosis-related symptoms at 12-month follow up. RESULTS The two groups were comparable regarding preoperative and surgical data, except for higher rates of hysterectomies and bilateral uterosacral ligament removal procedures in the RALS group. Also after adjusting for these discrepancies, operative time was similar between S-LPS and RALS. Operative room time was statistically longer in the RALS group compared with that of S-LPS. No statistically significant difference was found concerning other study outcomes. Pain and bowel symptoms improved in both groups at 12-month follow up. CONCLUSIONS If performed by expert teams, RALS provides similar perioperative outcomes compared with S-LPS in rectosigmoid endometriosis surgical treatment, except for longer operative room time.
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Affiliation(s)
- Diego Raimondo
- Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Carlo Alboni
- Department of Obstetrics and Gynecology, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Benedetta Orsini
- Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Anna Chiara Aru
- Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Antonino Farulla
- Department of Obstetrics and Gynecology, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Manuela Maletta
- Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Alessandro Arena
- Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Simona Del Forno
- Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Veronica Sampogna
- Department of Obstetrics and Gynecology, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Manuela Mastronardi
- Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Marco Petrillo
- Department of Medical, Surgical and Experimental Science, Gynecologic and Obstetric Clinic, University of Sassari, Sassari, Italy
| | - Renato Seracchioli
- Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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Crispi CP, Crispi CP, de Oliveira BRS, de Nadai Filho N, Peixoto-Filho FM, Fonseca MDF. Six-month follow-up of minimally invasive nerve-sparing complete excision of endometriosis: What about dyspareunia? PLoS One 2021; 16:e0250046. [PMID: 33891600 PMCID: PMC8064592 DOI: 10.1371/journal.pone.0250046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/30/2021] [Indexed: 12/17/2022] Open
Abstract
STUDY OBJECTIVE To assess individual changes of deep dyspareunia (DDyspareunia) six months after laparoscopic nerve-sparing complete excision of endometriosis, with or without robotic assistance. METHODS This preplanned interdisciplinary observational study with a retrospective analysis of intervention enrolled 126 consecutive women who underwent surgery between January 2018 and September 2019 at a private specialized center. Demographics, medical history and surgery details were recorded systematically. DDyspareunia (primary outcome), dysmenorrhea and acyclic pelvic pain were assessed on self-reported 11-point numeric rating scales both preoperatively and at six-month follow-up. Cases with poor prognosis in relation to dyspareunia were described individually in greater detail. RESULTS Preoperative DDyspareunia showed weak correlation with dysmenorrhea (rho = .240; P = .014) and pelvic pain (rho = .260; P = .004). Although DDyspareunia improved significantly (P < .001) by 3 points or more in 75.8% (95%CI: 64.7-86.2) and disappeared totally in 59.7% of cases (95%CI:47.8-71.6), individual analysis identified different patterns of response. The probability of a preoperative moderate/severe DDyspareunia worsening more than 2 points was 4.8% (95%CI: 0.0-10.7) and the probability of a woman with no DDyspareunia developing "de novo" moderate or severe DDyspareunia was 7.7% (95%CI: 1.8-15.8) and 5.8% (95%CI: 0.0-13.0), respectively. In a qualitative analysis, several conditions were hypothesized to impact the post-operative DDyspareunia response; these included adenomyosis, mental health disorders, lack of hormone therapy after surgery, colporrhaphy, nodule excision in ENZIAN B compartment (uterosacral ligament/parametrium), the rectovaginal septum or the retrocervical region. CONCLUSION Endometriosis surgery provides significant improvement in DDyspareunia. However, patients should be alerted about the possibility of unsatisfactory results.
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Affiliation(s)
| | | | | | - Nilton de Nadai Filho
- Crispi Institute of Minimally Invasive Surgery, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fernando Maia Peixoto-Filho
- Department of Women’s Health—Fernandes Figueira National Institute for Women, Children and Youth Health—Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Marlon de Freitas Fonseca
- Crispi Institute of Minimally Invasive Surgery, Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Women’s Health—Fernandes Figueira National Institute for Women, Children and Youth Health—Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
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Chamié LP, Ribeiro DMFR, Ribeiro GMPAR, Serafini PC. Postoperative imaging findings after laparoscopic surgery for deeply infiltrating endometriosis. Abdom Radiol (NY) 2020; 45:1847-1865. [PMID: 32030450 DOI: 10.1007/s00261-020-02434-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Deeply infiltrative endometriosis (DIE) is a common gynecologic disease affecting women of reproductive age and often causing chronic pelvic pain and infertility. Clinical treatment options and preventive actions are ineffective due to the lack of knowledge about the etiology of DIE. Surgical treatment is currently the only alternative to eradicate the disease. Diagnostic imaging plays a crucial role for surgical planning and postoperative evaluation. Transvaginal sonography (TVS) with a dedicated protocol and magnetic resonance imaging (MRI) can be used to evaluate recurrent disease. Extensive pelvic surgery may cause anatomical changes and a variable spectrum of postoperative findings. Residual disease and complications can be also evaluated and are of great importance to estimate pain relief and fertility prognosis. The most common imaging findings following radical surgery for DIE are fibrotic scars in the retrocervical space and bowel anastomosis, absence of the posterior vaginal fornix and loculated fluid in the pararectal spaces. Ovaries are the most frequent site of early recurrence. Complications include infection, hemorrhage, urinary/evacuatory voiding dysfunctions as well as bowel and ureteral stenosis. The purpose of this article is to review the surgical techniques currently used to treat endometriosis in the retrocervical space, vagina, bladder, bowel, ureters, and ovaries and to describe the most common imaging findings including normal aspects, residual disease, complications, and recurrence.
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Affiliation(s)
- Luciana P Chamié
- Department of Diagnostic Imaging, Chamié Imagem da Mulher, Rua Casa do Ator, 1117, cj 72, São Paulo, São Paulo, 04546-004, Brazil.
- Department of Diagnostic Imaging, Fleury Medicina e Saúde, São Paulo, São Paulo, Brazil.
| | - Duarte M F R Ribeiro
- Department of Female Reconstructive Surgery, Clínica Doutor Duarte Miguel Ferreira Ribeiro, São Paulo, São Paulo, Brazil
| | - Gladis M P A R Ribeiro
- Department of Female Reconstructive Surgery, Clínica Doutor Duarte Miguel Ferreira Ribeiro, São Paulo, São Paulo, Brazil
| | - Paulo C Serafini
- Clínica Huntington de Medicina Reprodutiva, São Paulo, São Paulo, Brazil
- Department of Gynecology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Restaino S, Mereu L, Finelli A, Spina MR, Marini G, Catena U, Turco LC, Moroni R, Milani M, Cela V, Scambia G, Fanfani F. Robotic surgery vs laparoscopic surgery in patients with diagnosis of endometriosis: a systematic review and meta-analysis. J Robot Surg 2020; 14:687-694. [DOI: 10.1007/s11701-020-01061-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 02/29/2020] [Indexed: 12/21/2022]
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Bendifallah S, Vesale E, Daraï E, Thomassin-Naggara I, Bazot M, Tuech JJ, Abo C, Roman H. Recurrence after Surgery for Colorectal Endometriosis: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2020; 27:441-451.e2. [DOI: 10.1016/j.jmig.2019.09.791] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/17/2019] [Accepted: 09/23/2019] [Indexed: 01/27/2023]
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Uccella S, Gisone B, Serati M, Biasoli S, Marconi N, Angeretti G, Gallotta V, Cardinale S, Rausei S, Dionigi G, Scambia G, Ghezzi F. Functional outcomes of nerve-sparing laparoscopic eradication of deep infiltrating endometriosis: a prospective analysis using validated questionnaires. Arch Gynecol Obstet 2018; 298:639-647. [PMID: 30062386 DOI: 10.1007/s00404-018-4852-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 07/25/2018] [Indexed: 12/17/2022]
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Vercellini P, Facchin F, Buggio L, Barbara G, Berlanda N, Frattaruolo MP, Somigliana E. Management of Endometriosis: Toward Value-Based, Cost-Effective, Affordable Care. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:726-749.e10. [DOI: 10.1016/j.jogc.2017.07.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 07/12/2017] [Indexed: 12/13/2022]
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Grouin A, Florian A, Sans Mischel AC, Toullalan O. [Detrusor sphincter disorders associated with deep endometriosis: Systematic review of the literature]. Prog Urol 2017; 28:2-11. [PMID: 29170015 DOI: 10.1016/j.purol.2017.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 09/13/2017] [Accepted: 10/20/2017] [Indexed: 11/18/2022]
Abstract
CONTEXT Detrusor sphincter disorders impact quality of life in case of deep endometriosis. Surgery, which is one of the main treatments, is responsible of detrusor sphincter disorders. Since then, it is essential to look for those disorders and find the right medical care. OBJECTIVE To specify the detrusor sphincter disorders, its links with anatomical localisation of deep endometriosis and its prognosis after surgery. METHODS A literature review was carried out via PubMed® with the followings keywords: "deep endometriosis", "urinary disorders", "voiding dysfunction" and "urinary dysfunction". Prospective and retrospective studies as well as previous reviews were analyzed. RESULTS Concerning bladder deep endometriosis, detrusor sphincter disorders are observed in more than 50%. Resection of the lesions allows a clear improvement or even a disappearance of the disorders. Concerning the deep endometriosis of the posterior part of the pelvis, disorders are highlighted even if women do not complain of urinary trouble. Detrusor sphincter disorders are observed in 2 to 50% and women with colorectal localisation have the highest rate. Resection of the lesions improves the symptoms described preoperatively but also provides de novo disorders of up to 47.5%. In terms of prevention, the nerve sparing surgery respects the pelvic nerve plexus, and reduces post-operative morbidity to less than 1%. CONCLUSIONS Detrusor sphincter disorders associated with deep endometriosis have a prognosis if their management is adapted. Well-conducted interviews and standardized questionnaires is necessary to diagnosis them. Urodynamic test may be discussed in case of bladder endometriosis, including for urinary asymptomatic patients. The management of the detrusor sphincter disorders requires a complete resection of the nodules of deep endometriosis. In the case of posterior endometriosis, a dissection must be performed respecting the retroperitoneal vegetative nerves.
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Affiliation(s)
- A Grouin
- Service de gynécologie obstétrique, centre hospitalier de Cannes, 15, avenue des Broussailles, 06400 Cannes, France.
| | - A Florian
- Service de gynécologie obstétrique, centre hospitalier Gabriel-Martin, 38, rue Labourdonnais, 97460 Saint-Paul, Réunion
| | - A C Sans Mischel
- Service de gynécologie obstétrique, centre hospitalier de Cannes, 15, avenue des Broussailles, 06400 Cannes, France
| | - O Toullalan
- Service de gynécologie obstétrique, centre hospitalier de Cannes, 15, avenue des Broussailles, 06400 Cannes, France
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