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Osada M, Faller E, Lecointre L, Boisrame T, Martel C, Gabriele V, Akladios C, Host A. [Interest of multidisciplinary consultation meetings dedicated to endometriosis: From a series of 682 patients]. Gynecol Obstet Fertil Senol 2024; 52:336-342. [PMID: 38237734 DOI: 10.1016/j.gofs.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 12/20/2023] [Accepted: 01/05/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVE We decided to conduct a study based on these multidisciplinary team (MDT) in order to investigate their impact at the University Hospitals of Strasbourg and look for ways to improve this MDT. METHODS This is a retrospective study of the 682 patients presented to endometriosis MDT from its inception in March 2017 to December 2020. RESULTS The MDT decision was different from that initially proposed by the patient's referent for 406 patients (60%). Surgery was chosen for 417 patients (61%) and assisted reproduction for 261 patients (38%). A review of the MRI by a referring radiologist was carried out for 348 cases (51%), with a modification of the results for 255 patients (73%). Initial underestimation of lesions was noted in 198 cases. CONCLUSION Our study has shown the importance of MDT in endometriosis since the therapeutic proposal was modified in 60% of cases. In addition, we supported the importance of radiologists specializing in this field since they made a modification in two-thirds of the MRIs reread. These results show the importance of collegial discussions, which can modify the decisions of medical teams. This underlines the importance of setting up endometriosis networks.
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Affiliation(s)
- Marine Osada
- Hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France; Centre médico-chirurgical obstétrique, hôpitaux universitaires de Strasbourg, 19, rue Louis-Pasteur, 67300 Schiltigheim, France.
| | - Emilie Faller
- Hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France; Centre médico-chirurgical obstétrique, hôpitaux universitaires de Strasbourg, 19, rue Louis-Pasteur, 67300 Schiltigheim, France
| | - Lise Lecointre
- Hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France; Centre médico-chirurgical obstétrique, hôpitaux universitaires de Strasbourg, 19, rue Louis-Pasteur, 67300 Schiltigheim, France
| | - Thomas Boisrame
- Hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France; Centre médico-chirurgical obstétrique, hôpitaux universitaires de Strasbourg, 19, rue Louis-Pasteur, 67300 Schiltigheim, France
| | - Camille Martel
- Hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France; Centre médico-chirurgical obstétrique, hôpitaux universitaires de Strasbourg, 19, rue Louis-Pasteur, 67300 Schiltigheim, France
| | - Victor Gabriele
- Hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France; Centre médico-chirurgical obstétrique, hôpitaux universitaires de Strasbourg, 19, rue Louis-Pasteur, 67300 Schiltigheim, France
| | - Cherif Akladios
- Hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France; Centre médico-chirurgical obstétrique, hôpitaux universitaires de Strasbourg, 19, rue Louis-Pasteur, 67300 Schiltigheim, France
| | - Aline Host
- Hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France; Centre médico-chirurgical obstétrique, hôpitaux universitaires de Strasbourg, 19, rue Louis-Pasteur, 67300 Schiltigheim, France
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Lecointre L, Buttignol M, Faller E, Boisrame T, Martel C, Host A, Gabriele V, Akladios C. Urological procedures performed by gynecologists: Activity profile in a gynecological surgery department, 10-year observation cohort. Eur J Obstet Gynecol Reprod Biol 2023; 288:204-210. [PMID: 37572449 DOI: 10.1016/j.ejogrb.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 07/02/2023] [Accepted: 07/24/2023] [Indexed: 08/14/2023]
Abstract
INTRODUCTION The proximity of the urinary tract to the female genital tract explains its possible involvement in pelvic gynaecological cancer or deep endometriosis. Surgical treatment is aimed at improving overall survival and recurrence-free survival of patients, as well as restoring normal anatomy and functional integrity depending on the pathology. These operations are accompanied by significant post-operative complications. Thus, the urological procedures performed must be rigorously justified, and the different resection and reconstruction techniques adapted to the pathology and the level of infiltration. OBJECTIVE To describe the activity profile, over the last ten years, of a gynaecological surgery department in terms of urological procedures in the management of patients with deep endometriosis and pelvic carcinology. STUDY DESIGN This is a monocentric retrospective observational study, including all patients who underwent a urological procedure by a gynaecological surgeon only, as part of the management of pelvic gynaecological cancers or deep endometriosis, at the University Hospital Centre (CHU) of Strasbourg, between January 1st 2010 and April 31st 2021. The variables studied were early postoperative complications, the rate of surgical reintervention, operating time, length of hospital stay, the need for peri-operative drainage or transfusion, and post-operative functional disorders. RESULTS A total of 86 patients were included, 27 in the pelvic gynaecological cancer group and 59 in the deep endometriosis group. 61.6% of patients received uretero-vesical catheterization, 60.5% partial cystectomy, 10.5% psoic bladder ureteral reimplantation, and 3.5% trans-ileal Bricker skin ureterostomy. The mean operating time was 316 min in the pelvic gynaecological cancer group and 198.9 min in the deep endometriosis group. The average hospital stay was 11.5 days, 22.3 days for patients treated for pelvic cancer and 6.3 days for those treated for endometriosis. The rate of minor post-operative complications was 8.2% of cases, and major post-operative complications 17.4% of cases, the majority of which were in the gynecological cancer group. There were no cases of intra- or early post-operative death. Early postoperative urinary complications affected 14.0% of the total patients, mostly in the gynaecological cancer group with 33.3% of patients, but only 5.1% of patients in the deep endometriosis group. The total reoperation rate within 60 days postoperatively was 15.1%, 40.7% for patients treated for gynaecological cancer and 3.4% for those treated for deep pelvic endometriosis. The rate of reoperations for urinary complications was 11.6% of total patients, or 76.9% of total reoperations. 15 patients received labile blood products intra- or postoperatively, 11 in the pelvic gynaecological cancer group and 4 in the endometriosis group. CONCLUSION Our overall results appear comparable to those reported in the literature and are particularly satisfactory in terms of post-operative complications after partial cystectomy in the management of deep endometriosis compared to other gynaecological departments. This work encourages us to continue and improve the training of gynaecological surgeons in terms of multidisciplinary surgical procedures, including urological ones, to obtain a global vision of the pathology and to allow an optimal quality of care for the patients.
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Affiliation(s)
- Lise Lecointre
- Gynecologic Surgery, Hôpitaux universitaires de Strasbourg, 1 avenue de Molière, 67200 Strasbourg, Alsace, France; Insitute of Image-Guided Surgery, IHU-Strasbourg (Institut Hospitalo-Universitaire), 1 place de l'Hôpital, 67000 Strasbourg, France; ICube UMR 7357 - Laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie, CNRS, Université de Strasbourg, Strasbourg, France.
| | - Megane Buttignol
- Gynecologic Surgery, Hôpitaux universitaires de Strasbourg, 1 avenue de Molière, 67200 Strasbourg, Alsace, France.
| | - Emilie Faller
- Gynecologic Surgery, Hôpitaux universitaires de Strasbourg, 1 avenue de Molière, 67200 Strasbourg, Alsace, France.
| | - Thomas Boisrame
- Gynecologic Surgery, Hôpitaux universitaires de Strasbourg, 1 avenue de Molière, 67200 Strasbourg, Alsace, France.
| | - Camille Martel
- Gynecologic Surgery, Hôpitaux universitaires de Strasbourg, 1 avenue de Molière, 67200 Strasbourg, Alsace, France.
| | - Aline Host
- Gynecologic Surgery, Hôpitaux universitaires de Strasbourg, 1 avenue de Molière, 67200 Strasbourg, Alsace, France
| | - Victor Gabriele
- Gynecologic Surgery, Hôpitaux universitaires de Strasbourg, 1 avenue de Molière, 67200 Strasbourg, Alsace, France.
| | - Chérif Akladios
- Gynecologic Surgery, Hôpitaux universitaires de Strasbourg, 1 avenue de Molière, 67200 Strasbourg, Alsace, France.
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Buttignol M, Faller E, Lecointre L, Boisrame T, Akladios C. Deep infiltrating endometriosis: Laparoscopic nerve-sparing surgery and use of neutral argon plasma. J Gynecol Obstet Hum Reprod 2023; 52:102573. [PMID: 36914114 DOI: 10.1016/j.jogoh.2023.102573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 02/06/2023] [Accepted: 03/08/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVE To present a minimally approach to the management of deep pelvic endometriosis by nerve-sparing surgery and use of neutral argon plasma for extensive endometriotic lesions. DESIGN This is a clinical case video of a 29 years-old patient, affected by deep pelvic endometriosis with primary dysmenorrhea, deep dyspareunia, chronic pelvic pain and dyschezia. Pelvic MRI shows a right ovarian endometrioma measuring 5 cm, a thickening of the right uterosacral ligament and a uterine torus nodule. SETTING Laparoscopy video. INTERVENTION This laparoscopic surgery begins by an adhesiolysis of the sigmoid and a blue tube test to check the correct permeability of the tubes. A bilateral ureterolysis is performed before the excision of a torus lesion and adhesiolysis of the rectovaginal septum. A fine dissection of the uterosacral ligament by nerve-sparing surgery is realized to respect the hypogastric nerve in the Okabayashi space. Endometriosis nodules of the lumbo-ovarian ligaments and multiples endometriosis peritoneal implants, inaccessible to a complete excision, are destroyed by argon plasma vaporization. A cystectomy of the right endometrioma and an appendectomy are performed at the end. CONCLUSION The surgical management of deep infiltrating endometriosis is complex, with the recent contribution of new technical procedures such as nerve-sparing surgery to reduce postoperative urinary complications, or argon plasma for ablation of extended peritoneal implants or endometrioma to preserve ovarian function.
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Affiliation(s)
- Megane Buttignol
- Gynecology Department, Strasbourg University Hospital, Strasbourg France.
| | - Emilie Faller
- Gynecology Department, Strasbourg University Hospital, Strasbourg France
| | - Lise Lecointre
- Gynecology Department, Strasbourg University Hospital, Strasbourg France
| | - Thomas Boisrame
- Gynecology Department, Strasbourg University Hospital, Strasbourg France
| | - Cherif Akladios
- Gynecology Department, Strasbourg University Hospital, Strasbourg France
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Osada M, Lecointre L, Lodi M, Faller E, Boisrame T, Host A, Gabriele V, Garbin O, Akladios C. Nerve anatomy around lumbo-aortic lymphadenectomy by retroperitoneal approach. J Minim Invasive Gynecol 2022; 29:588. [DOI: 10.1016/j.jmig.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/25/2022] [Accepted: 02/02/2022] [Indexed: 11/28/2022]
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Jochum F, De Rozario T, Lecointre L, Faller E, Boisrame T, Dabi Y, Lavoué V, Coutant C, Touboul C, Bolze PA, Bricou A, Canlorbe G, Collinet P, Huchon C, Bendifallah S, Ouldamer L, Mezzadri M, Querleu D, Akladios C. Adherence to European ovarian cancer guidelines and impact on survival: a French multicenter study (FRANCOGYN). Int J Gynecol Cancer 2021; 31:1443-1452. [PMID: 34607855 DOI: 10.1136/ijgc-2021-002934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/14/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The primary objective of the study was to validate the European Society for Medical Oncology (ESMO)-European Society of Gynecologic Oncology (ESGO) ovarian cancer guideline as a method of assessing quality of care, and to identify patient characteristics predictive of non-adherence to European guideline care. The secondary objectives were to analyze the evolution of practices over the years and to evaluate heterogeneity between centers. METHODS This retrospective multicenter cohort study of invasive epithelial ovarian cancer reported to the FRANCOGYN database included data from 12 French centers between January 2000 and February 2017. The main outcome was adherence to ESMO-ESGO guidelines, defined by recommended surgical procedures according to the International Federation of Gynecology and Obstetrics (FIGO) stage and appropriate chemotherapy. Mixed multivariable logistic regression analysis with a random center effect was performed to estimate the probability of adherence to the guidelines. Survival analysis was carried out using the Kaplan-Meier method and a mixed Cox proportional hazards model. RESULTS 1463 patients were included in the study. Overall, 317 (30%) patients received complete guideline adherent care. Patients received appropriate surgical treatment in 69% of cases, while adequate chemotherapy was administered to 44% of patients. Both patient demographics and disease characteristics were significantly associated with the likelihood of receiving guideline adherent care, such as age, performance status, FIGO stage, and initial burden of disease. In univariate and multivariate survival analysis, adherence to the guidelines was a statistically significant and independent predictor of decreased overall survival. Patients receiving suboptimal care experienced an increased risk of death of more than 100% compared with those treated according to the guidelines (hazard ratio 2.14, 95% confidence interval 1.32 to 3.47, p<0.01). In both models, a significant random center effect was observed, confirming the heterogeneity between centers (p<0.001). CONCLUSIONS Adherence to ESMO-ESGO guidelines in ovarian cancer was associated with a higher overall survival and may be a useful method of assessing quality of care.
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Affiliation(s)
- Floriane Jochum
- Department of Gynecology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Tamara De Rozario
- Department of Gynecology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Lise Lecointre
- I-Cube UMR 7357-Laboratoire des Sciences de l'ingénieur, de l'informatique et de l'imagerie, Université de Strasbourg, Strasbourg, France.,Institut Hospitalo-Universitaire (IHU), Institute for Minimally Invasive Hybrid Image-Guided Surgery, Université de Strasbourg, Strasbourg, France
| | - Emilie Faller
- Department of Gynecology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Thomas Boisrame
- Department of Gynecology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Yohann Dabi
- Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal de Creteil, Creteil, France
| | - Vincent Lavoué
- Department of Gynecologic Surgery, Hôpital Universitaire de Rennes, Université de Rennes 1 Faculté de Médecine, Rennes, France
| | - Charles Coutant
- Department of Surgical Oncology, Georges-Francois Leclerc Centre, Dijon, France
| | - Cyril Touboul
- Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal de Creteil, Creteil, France
| | | | - Alexandre Bricou
- Department of Obstetrics and Gynecology, Hôpital Jean Verdier, Bondy, France
| | - Geoffroy Canlorbe
- Department of Gynecologic and Breast Surgery and Oncology, Hopital Universitaire Pitie Salpetriere Bibliotheque de La Pitie, Paris, France
| | - Pierre Collinet
- Department of Gynecological Surgery, Hopital Jeanne de Flandre, Lille, France
| | - Cyrille Huchon
- Department of Gynecology, Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye Site Hospitalier de Poissy, Poissy, France
| | | | - Lobna Ouldamer
- Department of Gynecology, Hôpital Universitaire de Tours, Tours, France
| | | | - Denis Querleu
- Department of Gynecology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Chérif Akladios
- Department of Gynecology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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Jochum F, Aubry G, Pellerin M, Billard C, Faller E, Boisrame T, Lecointre L, Akladios C. Relevance of Laparoscopic Surgery for Ovarian Cancer in Well-selected Patients: A Propensity-matched Comparison With Laparotomy. Anticancer Res 2021; 41:955-965. [PMID: 33517302 DOI: 10.21873/anticanres.14849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM This study aimed to evaluate the relevance of laparoscopy in comparison with laparotomy in the management of ovarian cancer in well-selected patients. PATIENTS AND METHODS Data of consecutive ovarian cancer patients treated by laparoscopy were matched 1:1 to a cohort of patients operated by laparotomy using a propensity score matching. The inclusion criteria included patients who underwent a complete staging procedure in the early stages and optimal upfront or interval debulking surgery for advanced ovarian cancer. RESULTS In total, 153 patients were included. Propensity score matching led to the analysis of 41 well-balanced pairs of patients. For a median follow-up of 34.0 [19.0-64.0] months and 38.0 [24.5-75.0] months, respectively, no difference was found between the two groups in regards to overall survival (p=0.28) and disease-free survival (p=0.89). CONCLUSION In well-selected patients, laparoscopic surgery may be a safe and effective alternative to laparotomy.
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Affiliation(s)
- Floriane Jochum
- Department of Gynecology, Strasbourg University Hospital, Strasbourg, France;
| | - Gabrielle Aubry
- Assistance Publique des Hôpitaux de Paris (AP-HP), Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière University Hospital, Paris, France
| | - Madeleine Pellerin
- Department of Gynecology, Strasbourg University Hospital, Strasbourg, France
| | - Camille Billard
- Department of Gynecology, Strasbourg University Hospital, Strasbourg, France
| | - Emilie Faller
- Department of Gynecology, Strasbourg University Hospital, Strasbourg, France
| | - Thomas Boisrame
- Department of Gynecology, Strasbourg University Hospital, Strasbourg, France
| | - Lise Lecointre
- Department of Gynecology, Strasbourg University Hospital, Strasbourg, France.,I-Cube UMR 7357 - Laboratoire des Sciences de L'ingénieur, de L'informatique et de L'imagerie. Université de Strasbourg, Strasbourg, France.,Institut Hospitalo-Universitaire (IHU), Institute for Minimally Invasive Hybrid Image-Guided Surgery, Université de Strasbourg, Strasbourg, France
| | - Cherif Akladios
- Department of Gynecology, Strasbourg University Hospital, Strasbourg, France
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Jochum F, Vermel M, Faller E, Boisrame T, Lecointre L, Akladios C. Three and Five-Year Mortality in Ovarian Cancer after Minimally Invasive Compared to Open Surgery: A Systematic Review and Meta-Analysis. J Clin Med 2020; 9:E2507. [PMID: 32759715 PMCID: PMC7463583 DOI: 10.3390/jcm9082507] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/27/2020] [Accepted: 07/30/2020] [Indexed: 12/24/2022] Open
Abstract
As regards ovarian cancer, the use of minimally invasive surgery has steadily increased over the years. Reluctance persists, however, about its oncological outcomes. The main objective of this meta-analysis was to compare the three and five-year mortality of patients operated by minimally invasive surgery (MIS) for ovarian cancer to those operated by conventional open surgery (OPS), as well as their respective perioperative outcomes. PubMed, Cochrane library and CinicalTrials.gov were systematically searched, using the terms laparoscopy, laparoscopic or minimally invasive in combination with ovarian cancer or ovarian carcinoma. We finally included 19 observational studies with a total of 7213 patients. We found no statistically significant difference for five-year (relative risk (RR) = 0.89, 95% CI 0.53-1.49, p = 0.62)) and three-year mortality (RR = 0.95, 95% CI 0.80-1.12, p = 0.52) between the patients undergoing MIS and those operated by OPS. When five and three-year recurrences were analyzed, no statistically significant differences were also observed. Analysis in early and advanced stages subgroups showed no significant difference for survival outcomes, suggesting oncological safety of MIS in all stages. Whether the surgery was primary or interval debulking surgery in advanced ovarian cancer, did not influence the comparative results on mortality or recurrence. Although the available studies are retrospective, and mostly carry a high risk for bias and confounding, an overwhelming consistency of the evidence suggests the likely effectiveness of MIS in selected cases of ovarian cancer, even in advanced stages. To validate the use of MIS, the development of future randomized interventional studies should be a priority.
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Affiliation(s)
| | | | | | | | | | - Cherif Akladios
- Department of Gynecology, Strasbourg University Hospital, 67000 Strasbourg, France; (F.J.); (M.V.); (E.F.); (T.B.); (L.L.)
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Stoll F, Lecointre L, Meyer N, Faller E, Host A, Hummel M, Boisrame T, Akladios C, Garbin O. Randomized Study Comparing a Reusable Morcellator with a Resectoscope in the Hysteroscopic Treatment of Uterine Polyps: The RESMO Study. J Minim Invasive Gynecol 2020; 28:801-810. [PMID: 32681995 DOI: 10.1016/j.jmig.2020.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 07/09/2020] [Accepted: 07/11/2020] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE To compare a reusable hysteroscopic morcellator and standard resectoscopes in the hysteroscopic management of uterine polyps. DESIGN Single-center randomized prospective single-blind trial (resectoscope-morcellator study). SETTING Centre Médico-chirurgical Obstétrique teaching hospital, Strasbourg University Hospitals, France. PATIENTS All patients presenting with a single endometrial polyp of size 1 cm or larger. INTERVENTIONS After consent, the patients were randomized into 2 groups: hysteroscopic morcellation (HM) group or standard resection (SR) group. Office-based review hysteroscopy was performed 6 weeks to 8 weeks after surgery. Primary end point: time of morcellation or resection. SECONDARY OUTCOMES total operating time (minutes), volume of fluid used (mL), fluid deficit (mL), number of morcellator or resectoscope insertions, operator comfort (visual analog scale: 0 to 10) and quality of vision (0 to 5), perioperative complications, completeness of resection, need to convert to another technique, pain assessment (visual analog scale), and length of hospitalization. At review hysteroscopy, we noted whether the resection or morcellation had been effective and if synechiae were present or absent. Statistical analyses followed Bayesian methods. MEASUREMENTS AND MAIN RESULTS Ninety patients were randomized: 45 in the HM group and 45 in the SR group. The average size of polyps at hysteroscopy was 13.3 mm. Morcellation time was lower than resection time (6.1 minutes vs 9 minutes; p [HM < SR] = .996). This also applied to total operating time (12.7 minutes vs 15.6 minutes; p [HM < SR] = .985), number of device insertions (1.50 vs 6; p [HM < SR] > .999), volume of fluid used (766.9 mL vs 1118.9 mL; p [HM < SR] = .994), and fluid deficit (60.2 mL vs 169.8 mL; p [HM < SR] = .989). Operator comfort was better in the HM group (8.4 vs 7.4; p [HM > SR] = .999) as was visualization (4 vs 3.7; p [HM > SR] = .911, highly probable). Operative complications were higher in the SR group (5 vs 0; p [HM < SR] = .989]. One patient in the SR group died after surgery owing to an anesthetic complication (anaphylactic shock complicated by pulmonary embolism). No differences were noted between the groups for pain assessment, length of hospitalization, and outcome on review hysteroscopy. CONCLUSION The reusable morcellator is quicker, uses less fluid with less deficit and fewer introductory maneuvers, and offers better comfort and visualization than the resectoscope while being as effective for the hysteroscopic treatment of uterine polyps.
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Affiliation(s)
- François Stoll
- Department of Obstetrics and Gynecology (Drs. Stoll, Lecointre, Faller, Host, Hummel, Boisrame, Akladios, and Garbin); Medical Information Department (Dr. Meyer), Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
| | - Lise Lecointre
- Department of Obstetrics and Gynecology (Drs. Stoll, Lecointre, Faller, Host, Hummel, Boisrame, Akladios, and Garbin); Medical Information Department (Dr. Meyer), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Nicolas Meyer
- Department of Obstetrics and Gynecology (Drs. Stoll, Lecointre, Faller, Host, Hummel, Boisrame, Akladios, and Garbin); Medical Information Department (Dr. Meyer), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Emilie Faller
- Department of Obstetrics and Gynecology (Drs. Stoll, Lecointre, Faller, Host, Hummel, Boisrame, Akladios, and Garbin); Medical Information Department (Dr. Meyer), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Aline Host
- Department of Obstetrics and Gynecology (Drs. Stoll, Lecointre, Faller, Host, Hummel, Boisrame, Akladios, and Garbin); Medical Information Department (Dr. Meyer), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Michel Hummel
- Department of Obstetrics and Gynecology (Drs. Stoll, Lecointre, Faller, Host, Hummel, Boisrame, Akladios, and Garbin); Medical Information Department (Dr. Meyer), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Thomas Boisrame
- Department of Obstetrics and Gynecology (Drs. Stoll, Lecointre, Faller, Host, Hummel, Boisrame, Akladios, and Garbin); Medical Information Department (Dr. Meyer), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Cherif Akladios
- Department of Obstetrics and Gynecology (Drs. Stoll, Lecointre, Faller, Host, Hummel, Boisrame, Akladios, and Garbin); Medical Information Department (Dr. Meyer), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Olivier Garbin
- Department of Obstetrics and Gynecology (Drs. Stoll, Lecointre, Faller, Host, Hummel, Boisrame, Akladios, and Garbin); Medical Information Department (Dr. Meyer), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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Saban A, Deruelle P, Boisrame T. Ondansetron Use in Pregnancy and Congenital Malformations. JAMA 2020; 323:2097. [PMID: 32453360 DOI: 10.1001/jama.2020.5064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Alicia Saban
- Association de lutte contre l'hyperémèse gravidique (French Patient Organization Against Hyperemesis Gravidarum), Vouleme, France
| | - Philippe Deruelle
- Department of Obstetrics and Gynecology, Hopitaux Universitaires de Strasbourg, Strasbourg, France
| | - Thomas Boisrame
- Department of Obstetrics and Gynecology, Hopitaux Universitaires de Strasbourg, Strasbourg, France
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Baldauf JJ, Lecointre L, Akladios CY, Faller É, Boisrame T, Fender M. [Cervical cancer screening must go on!]. Rev Prat 2020; 70:109-110. [PMID: 32877042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Jean-Jacques Baldauf
- Département de gynécologie et d'obstétrique,hôpital de Hautepierre, Hôpitaux universitaires de Strasbourg, Strasbourg, France
- EA3181, université de Franche-Comté, université Bourgogne Franche-Comté, Besançon, France
- Association EVE, Illkirch Graffenstaden, France
| | - Lise Lecointre
- Département de gynécologie et d'obstétrique,hôpital de Hautepierre, Hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - Chérif-Youssef Akladios
- Département de gynécologie et d'obstétrique,hôpital de Hautepierre, Hôpitaux universitaires de Strasbourg, Strasbourg, France
- EA3181, université de Franche-Comté, université Bourgogne Franche-Comté, Besançon, France
| | - Émilie Faller
- Département de gynécologie et d'obstétrique,hôpital de Hautepierre, Hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - Thomas Boisrame
- Département de gynécologie et d'obstétrique,hôpital de Hautepierre, Hôpitaux universitaires de Strasbourg, Strasbourg, France
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Tissot M, Petry S, Lecointre L, Faller E, Baldauf JJ, Akladios C, Boisrame T. Two Surgical Techniques for Essure Device Ablation: The Hysteroscopic Way and the Laparoscopic Way by Salpingectomy with Tubal Interstitial Resection. J Minim Invasive Gynecol 2019; 26:603. [DOI: 10.1016/j.jmig.2018.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 07/19/2018] [Accepted: 07/20/2018] [Indexed: 11/26/2022]
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12
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Bel S, Billard C, Godet J, Viviani V, Akladios C, Host A, Faller E, Boisrame T, Hummel M, Baldauf JJ, Lecointre L, Garbin O. Risk of malignancy on suspicion of polyps in menopausal women. Eur J Obstet Gynecol Reprod Biol 2017; 216:138-142. [DOI: 10.1016/j.ejogrb.2017.07.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 06/27/2017] [Accepted: 07/08/2017] [Indexed: 12/13/2022]
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