Segmental Rectum Resection for Deep Endometriosis and Excision Similarly Improve Sexual Function and Pain.

Segmental rectum resections for indications other than endometriosis were reported to result in up to 40% sexual dysfunctions. We, therefore, evaluated sexual function after low bowel resection ( = 33) for deep endometriosis in comparison with conservative excision ( = 23). Sexual function was evaluated with the FSFI-19 (Female Sexuality Functioning Index) and EHP 30 (Endometriosis Health Profile).

Genetic Predisposition of Postoperative Adhesions Varies in Substrains of BALB/c Mice.

Postoperative adhesions are a major clinical problem because of the associated infertility, chronic pain, bowel obstruction, and the associated costs. Variability in adhesion formation was suggested by clinical observations that apparently similar interventions can cause little to severe adhesions. This is supported by the presence of polymorphisms and genetic predisposition to develop adhesions in animal models and humans.

Pneumoperitoneum induced mesothelial cell changes in a laparoscopic mouse model.

Background: CO pneumoperitoneum (PP) during laparoscopic surgery, can cause hypoxia and desiccation in the peritoneal mesothelial cell, resulting in a time-dependent retraction and bulging of these cells, an acute inflammatory reaction and enhanced adhesion formation. Since hypoxia is prevented by adding 4% of oxygen (O) to the CO PP, the aim of this study was to evaluate the effect of adding 4% O to the CO PP on mesothelial cell morphology.

Methods: In a standardized laparoscopic mouse model (n=8 mice per group), a control group with a 30- or 60-min PP with humidified CO + 4% of O (groups I and II) was compared to a hypoxic group with 30- or 60-min humidified pure CO (groups III and IV) and a desiccation group with 60-min of dry CO PP (group V).

Which Knots Are Recommended in Laparoscopic Surgery and How to Avoid Insecure Knots.

Study Objective: To investigate why security of identical knot sequences is variable and how to avoid occasionally insecure knots.

Design: A factorial design was used to assess factors affecting the security of half knot (H) and half-hitch (S) knot combinations. The effect of tying forces and the risk factors to transform H knots into S knots were investigated.

What is the Best Surgeon's Knot? Evaluation of the Security of the Different Laparoscopic Knot Combinations.

Study Objective: To investigate the security of various knot combinations in laparoscopic surgery.

Design: Prospective nonrandomized trial (Canadian Task Force classification II).

Setting: Storz Training Centre, Sao Paulo, Brazil.

Predicting formation of adhesions after gynaecological surgery: development of a risk score.

Purpose: Risk factors for post-surgical adhesions following gynaecological surgery have been identified, but their relative importance has not been precisely determined. No practical tool exists to help gynaecological surgeons evaluate the risk of adhesions in their patients. The purpose of the study was to develop an Adhesion Risk Score to provide a simple tool that will enable gynaecological surgeons to routinely quantify the risk of post-surgical adhesions in individual patients.

A European survey on awareness of post-surgical adhesions among gynaecological surgeons.

The present survey was conducted among gynaecological surgeons from several European countries to assess the actual knowledge and practice related to post-surgical adhesions and measures for reduction. From September 1, 2012 to February 6, 2013, gynaecological surgeons were invited to answer an 18-item online questionnaire accessible through the ESGE website. This questionnaire contained eight questions on care settings and surgical practice and ten questions on adhesion formation and adhesion reduction.

Conditioning of the abdominal cavity reduces tumor implantation in a laparoscopic mouse model.

Purpose: The addition of 4 % O2 and 10 % N2O to the CO2 pneumoperitoneum (PP), together with slight cooling and humidification (conditioning), contributes to reducing adhesions by preventing mesothelial damage. We investigated the effect of peritoneal damage during laparoscopy on tumor implantation.

Methods: In Experiment 1, different tumor cell concentrations were injected into control mice without PP and into mice with 60-min dry CO2PP (mesothelial damage).

"Adhesions after abdominal, pelvic and intra-uterine surgery and their prevention".

We here present the full text of a patient leaflet we have designed, and routinely use, to provide preoperative education about adhesions to patients undergoing open or laparoscopic gynaecological surgery. The leaflet presents appropriate, patient-orientated information on the nature of adhesions, their causes and the health risks they may involve as well as on adhesiolysis and modern methods of adhesion prevention. As adhesion formation is not specific to gynaecological surgery, the leaflet can also be adapted for the purposes of general abdominal surgery.

Prevention of adhesions in gynaecological surgery: the 2012 European field guideline.

Postoperative adhesions have become the most common complication of open or laparoscopic abdominal surgery and a source of major concern because of their potentially dramatic consequences. The proposed guideline is the beginning of a major campaign to enhance the awareness of adhesions and to provide surgeons with a reference guide to adhesion prevention adapted to the conditions of their daily practice. The risk of postoperative adhesions should be systematically discussed with any patient scheduled for open or laparoscopic abdominal surgery prior to obtaining her informed consent.

Laparoscopic ureteral repair in gynaecological surgery.

Purpose Of Review: To review laparoscopic surgery in the treatment options for ureteral lesions in gynaecological surgery.

Recent Findings: Laparoscopic treatment of ureteral injuries has been increasingly reported over the past years. Treatment has progressively shifted from ureteroneocystostomy performed by laparotomy to less invasive treatment options such as ureteral stenting or dilatation in case of stricture, stenting under laparoscopic guidance and laparoscopic stitching of lacerations, laparoscopic ureteral reanastomosis or laparoscopic ureteroneocystostomy for transections.

Postoperative inflammation in the abdominal cavity increases adhesion formation in a laparoscopic mouse model.

Objective: To investigate acute inflammation in the peritoneal cavity in adhesion formation.

Design: Prospective randomized, controlled trial.

Setting: University laboratory research center.

Effect of upper abdomen tissue manipulation on adhesion formation between injured areas in a laparoscopic mouse model.

Study Objective: These experiments were designed to examine the effect of manipulation during surgery as a cofactor in adhesion formation at trauma sites.

Design: Randomized, controlled trial. Canadian Task Force Classification-class 1.

Intercoat gel (oxiplex): efficacy, safety, and tissue response in a laparoscopic mouse model.

Study Objective: To study the efficacy and safety of Intercoat gel in a laparoscopic mouse model with pneumoperitoneum-enhanced adhesion formation.

Design: Randomized controlled trial. Evidence obtained from a properly designed, randomized, controlled trial (Canadian Task Force classification I).

Laparoscopic management of ureteral lesions in gynecology.

Objective: To investigate the outcome of laparoscopic repair of ureteral injury in laparoscopic gynecologic surgery.

Design: Prospective trial.

Setting: University hospital.

Effect of Reteplase and PAI-1 antibodies on postoperative adhesion formation in a laparoscopic mouse model.

Background: Postoperative adhesions remain an important clinical problem, accounting for infertility, chronic pain and bowel obstruction. Its prevention is still inadequate and overall poorly understood. The aim of this study was to investigate the effect of Reteplase (a recombinant plasminogen activator, r-PA) and of PAI-1 antibodies upon adhesion formation in a laparoscopic model.

Efficacy of barriers and hypoxia-inducible factor inhibitors to prevent CO(2) pneumoperitoneum-enhanced adhesions in a laparoscopic mouse model.

Study Objective: To investigate the effects of hypoxia-inducible factor (HIF) inhibitors, flotation agents, barriers, and a surfactant on pneumoperitoneum-enhanced adhesions in a laparoscopic mouse model.

Design: Prospective randomized trial (Canadian Task Force classification I).

Setting: Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Catholic University of Leuven.

Iatrogenic ureteral lesions and repair: a review for gynecologists.

Ureter injuries are a well-known complication of gynecologic surgery and a frequent cause of medicolegal problems. Because there are no randomized, controlled trials and the available studies are small series and case reports, the evidence on which to base treatment is weak. We therefore reviewed the complete English-language literature of ureter repair since 1990.

Outcome after rectum or sigmoid resection: a review for gynecologists.

It remains unclear when to perform a discoid or segmental bowel resection for large endometriotic nodules with intestinal invasion. Moreover, endometriosis series are rather small to fully evaluate functional consequences of bowel resection. We therefore reviewed the incidence of leakage and functional problems after anterior and sigmoid resection as reported in the surgical literature albeit for other indications.

Effect of desiccation and temperature during laparoscopy on adhesion formation in mice.

Objective: To investigate the effects of desiccation (without cooling) and of oversaturation of the pneumoperitoneum on adhesion formation.

Design: Prospective randomized trial.

Setting: Academic research center.

Adhesion formation and interanimal variability in a laparoscopic mouse model varies with strains.

Adhesion formation after laparoscopic surgery was evaluated in mice of different strains. More adhesions were observed in Swiss, NMRI, and BALB/c mice, with less interanimal variability in BALB/c mice. These data point to genetics effects on adhesion formation, which open new insights in its pathogenesis and indicate the importance of a careful strain selection for animal studies.

Effect of adding more than 3% oxygen to carbon dioxide pneumoperitoneum on adhesion formation in a laparoscopic mouse model.

Objective: To investigate the effect of the addition of 3% or higher oxygen concentrations to the carbon dioxide (CO2) pneumoperitoneum.

Design: Prospective, randomized trial.

Setting: Academic research center.

Role of vascular endothelial growth factor receptor 1 in basal adhesion formation and in carbon dioxide pneumoperitoneum-enhanced adhesion formation after laparoscopic surgery in mice.

Objective: To evaluate the role of vascular endothelial growth factor receptor-1 (VEGFR-1) in adhesion formation after laparoscopic surgery.

Design: Prospective, randomized study.

Setting: Academic research center.

Role of CO(2) pneumoperitoneum-induced acidosis in CO(2) pneumoperitoneum-enhanced adhesion formation in mice.

The effect of assisted ventilation and CO(2) pneumoperitoneum during laparoscopic surgery upon blood gases and adhesion formation were evaluated in mice. We confirmed that the CO(2) pneumoperitoneum induces acidosis and enhances adhesion formation, and an association between both effects was demonstrated, together with its modulation by the assisted ventilation.

The rabbit nephrectomy model for training in laparoscopic surgery.

Background: Laparoscopic surgical training is generally done with the teacher-student model using complex exercises. This study was performed to evaluate a new training model that emphasizes the repetition of simple procedures.

Methods: Laparoscopic surgery was performed in rabbits (n=200) using conventional instruments.