Publications by authors named "Dion L"

Introduction: Uterine transplantation is currently intended for women with absolute uterine infertility. Since proof of the concept in 2014, many countries have started research programs and clinical activities. However, access to uterine transplantation remains limited given that only a few hundred transplants have been described worldwide compared with the 1.

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  • Uterus transplantation is currently the only solution for women with absolute uterine infertility, such as those with Rokitansky syndrome, allowing them to experience pregnancy and childbirth.
  • There are significant challenges with uterus transplantation, including the risks of ischemia-reperfusion injury and a notable thrombotic complication rate of up to 20%, which can lead to graft rejection.
  • This protocol aims to outline the surgical steps for obtaining porcine uteruses and implementing dynamic preservation through machine perfusion, which may reduce hypoxic injury compared to traditional static cold storage methods.
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Background: Uterus transplantation from deceased donors offers a promising solution to the organ shortage, but optimal preservation methods are crucial for successful outcomes. Our primary objective is to conduct an initial assessment of the contribution of oxygenated hypothermic perfusion in uterine transplantation.

Methods: We performed a preclinical study on a porcine model of controlled donation after circulatory death (60 min warm ischemia).

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Introduction: The aims of this study were to describe survival outcomes in patients with ovarian cancer aged ≥80 years and to explore predictors of poor prognosis.

Methods: We collected clinical, demographic, histologic, surgical and follow-up data for patients with ovarian cancer aged ≥80 years from a multicenter French cohort (FRANCOGYN) who underwent surgery from 1999 to 2019. Primary endpoints were overall survival (OS) and disease-free survival (DFS).

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  • MRKH syndrome is a serious condition that affects women's reproductive systems and can have other health issues, like kidney problems or heart defects.
  • Most women with MRKH have not been thoroughly checked for other related health problems, which is important for their treatment options.
  • Some women with MRKH may be able to get a uterine transplant, but many do not meet the criteria to be eligible for this procedure.
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Introduction: Metroplasty is a procedure used by some teams to correct certain uterine anomalies to improve fertility outcomes. Our goal was to evaluate hysteroscopic metroplasty in the management of nulliparous and infertile patients with a uterine anomalies.

Material And Methods: We conducted a single-center, retrospective, observational study of women who underwent hysteroscopic metroplasty for infertility between January 1, 2015 and December 31, 2019.

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Unlabelled: Extracellular cytochrome filaments are proposed to serve as conduits for long-range extracellular electron transfer. The primary functional physiological evidence has been the reported inhibition of Fe(III) oxide reduction when the gene for the filament-forming cytochrome OmcS is deleted. Here we report that the OmcS-deficient strain from that original report reduces Fe(III) oxide as well as the wild-type, as does a triple mutant in which the genes for the other known filament-forming cytochromes were also deleted.

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  • Uterine innervation is crucial to female reproductive health and has significant implications for conditions like endometriosis; recent histological advances have revealed its complex structure and role in these disorders.
  • This review summarizes current research on uterine innervation, focusing on its effects on endometriosis and associated pain, using a systematic approach to analyze relevant studies.
  • The review identified 45 studies that highlighted a trend towards increased nerve fiber density in ectopic endometrial tissue, suggesting a link between this heightened innervation and the chronic pain seen in endometriosis patients.
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  • Pelvic gynecological surgeries often lead to complications due to damage to the autonomic nervous system, and recognizing the deep uterine vein (DUV) can help prevent this.
  • A systematic literature review and anatomical studies were conducted to better understand the DUV's structure and role in surgical settings, utilizing cadaver dissections and advanced imaging techniques.
  • The research confirmed the DUV's importance in dividing uterine regions and assisting surgeons in navigating the subperitoneal anatomy to reduce the risk of nerve and ureter injuries during procedures.
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Uncertainty is a fundamental aspect of medical practice, necessitating incorporation into undergraduate medical training. The integrative model of uncertainty tolerance (UT) developed by Hillen and Han serves as a comprehensive framework for exploring clinical uncertainty. While studies have extensively examined UT dimensions, including sources, responses, and moderators, the factors influencing the perception of uncertainty stimuli remain underexplored.

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  • The updated clinical practice guidelines aim to improve the first-line management of infertility in couples by revisiting existing recommendations based on recent research.
  • A systematic review was conducted by expert working groups on five major themes, resulting in 28 PICO-formulated questions addressing both male and female infertility assessments, environmental factors, ovulation induction, and reproductive surgery techniques.
  • Key recommendations include tailored fertility evaluations based on the woman's age, specific tests for both partners, and the dismissal of certain outdated procedures, with an emphasis on evidence-based approaches to optimize infertility treatment.
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Introduction: Uterine infertility (UI) is defined as the complete absence of a uterus (absolute uterine infertility or AUI) or the presence of a non functional uterus (non-absolute uterine infertility or NAUI). The exact prevalence of uterine infertility is currently unknown. Our aim was to assess the number of French women concerned by Uterine Infertility according to a recent literature review.

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Objective: To better understand patients' conditions and expectations before starting a uterus transplantation (UTx) program for women suffering from Mayer-Rokitansky-Küster-Hauser syndrome (MRKH syndrome).

Method: A web-based survey was conducted among MRKH patients via the French national association network from March to August 2020. The questionnaire comprised twenty-eight questions about their desire for parenthood, their condition's characteristics and previous reconstructive procedures, opinions and knowledge about UTx.

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  • - The study aims to evaluate how well surgeons and oncologists follow the European Society of Gynaecological Oncology (ESGO) guidelines for managing morbidly obese patients (BMI >40) with endometrial cancer, focusing on surgical practices, lymph node staging, and adjuvant therapies.
  • - Over 2,300 patients were analyzed, revealing that only 30% of morbidly obese patients received guideline-conforming surgical management, compared to 44% of obese and 48% of normal/overweight patients; however, morbidly obese patients were more likely to receive the recommended adjuvant therapy.
  • - Surprisingly, while weight status didn't affect overall survival rates, those in the morbidly obese group
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Objective: Pelvic examination including vaginal digital examination and speculum inspection are crucial medical skills that are challenging to teach for both professors and students, because of its intimate nature. Consequently, education has shifted from a traditional approach to a simulation-enhanced education. This literature review summarizes the level of evidence for these not-so-new training modalities.

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Objective: To describe the feasibility of hypothermic machine perfusion (HMP) in uterus transplantation (UT) to potentially improve the preservation of the uterus and enhance graft preservation in the donation after brainstem death (DBD) context. Uterus transplantation is a new surgical approach to treating absolute uterine infertility; it can be performed after living donation or after DBD. In the DBD context, the uterus is typically the last organ removed after other vital organs, with the exception of the Baylor team, which removes the uterus first.

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  • Hemostasis Hysterectomy (HH) is a rare but critical emergency procedure for post-partum hemorrhage, and all obstetrician-gynecologists should be prepared to perform it, despite limited training opportunities during residency.
  • A survey of French obstetrics and gynecology fellows revealed that only half had performed an HH during residency, with a majority having limited experience in scheduled hysterectomies.
  • The study concluded that lack of sufficient surgical exposure in residency hampers the development of competence in HH, highlighting a gap in training that needs to be addressed.
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  • The study focused on managing and understanding the survival rates of endometrial cancer patients aged 80 and older to identify indicators of poor prognosis.
  • Data was collected from a French cohort, revealing that 184 out of 1647 patients treated for endometrial cancer were senior citizens, with a median overall survival of 16.4 months.
  • Findings indicate that not using chemotherapy when indicated significantly correlated with worse survival outcomes, emphasizing the need for elderly patients to follow standard care guidelines for treatment.
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Uterine factor infertility (UFI) is defined as a condition resulting from either a complete lack of a uterus or a non-functioning uterus due to many causes. The exact prevalence of UFI is currently unknown, while treatments to achieve pregnancy are very limited. To evaluate the prevalence of this condition within its different causes, we carried out a worldwide systematic review on UFI.

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Objective: To assess the surgical management and survival of severely obese patients with high-risk endometrial cancer.

Materials And Methods: Data from 269 patients with high-risk endometrial cancer who were treated between 2001 and 2018 were collected from a multicenter database (11 centers). We classified the patients according to their BMI and compared outcomes in two groups: a normal weight group of women with a BMI < 25 kg/m, and a severe obesity group of women with a BMI ≥ 35 kg/m.

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  • Endometriosis is a chronic condition that negatively affects women's fertility, and the study aims to explore the relationship between preoperative Enzian scores and postoperative fertility outcomes after deep pelvic endometriosis surgery.
  • A retrospective study conducted at Rennes University Hospital analyzed data from women who underwent surgery for deep endometriosis, utilizing the ENDOREN database to assess the correlation between MRI-based Enzian scores and live birth rates.
  • Results showed a live birth rate of 35%, identifying the Enzian B score as a positive predictor for live births, while factors like uterine adenomyosis and previous endometriosis surgeries were found to negatively impact fertility outcomes.
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  • This study aimed to map the anatomy and function of nerve innervation in the human uterus to enhance understanding of pelvic pain conditions like endometriosis.* -
  • Researchers dissected female fetal pelvises to create a 3D reconstruction model, identifying nerve types and their distribution throughout different layers of the uterus.* -
  • The findings revealed diverse nerve fiber types and densities, highlighting rich innervation in certain areas, which could inform future therapeutic strategies for uterine pain disorders.*
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Objective: To determine how results on the EXAmen Cognitif abrégé en Traumatologie (EXACT), a new test specifically designed to briefly assess global cognitive functioning during the acute phase of traumatic brain injury (TBI), can predict long-term functional outcome compared with length of posttraumatic amnesia (PTA), a well-established predictor.

Design: Inception cohort.

Settings: Level 1 trauma center.

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Uterine transplantation is on the rise worldwide. In contrast to its arterial anatomy, venous drainage of the uterus is poorly defined in the literature. Our aim was to provide a standardized description of uterine veins through a multimodal approach to establish anatomical landmarks for the uterine transplantation surgeon.

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