Benign Uterine Pathology Research Articles

Hystérectomie Supracervicale par Laparoscopie : Déjà Vu?

Objectives: describe a technique of laparoscopic supracervical hysterectomy, and to compare its morbidity to that of total abdominal hysterectomy.Methods: records of patients selected for laparoscopie supracervical hysterectomy were studied retrospectively to compare their morbidity with that of randomly chosen patients fulfilling the same eligibility criteria where total abdominal hysterectomy was performed.Results: the group with laparoscopic supracervical hysterectomy was associated with a shorter hospital stay and less morbidity than the group with total abdominal hysterectomy. However, the laparoscopie technique required a much longer operating time. No difference was noted in the haemoglobin levels between the two groups.Conclusion: laparoscopic supracervical hysterectomy seems to be a safe and efficient alternative for most benign uterine pathologies and deserves to be further evaluated by prospective randmnized trials. However, compliance for gynaecological cancer screening is a prerequisite.

Total laparoscopic hysterectomy for benign uterine pathologies with reusable instruments: a safe, reproducible and cost‐effective procedure

With the technique of total laparoscopic hysterectomy described in this paper all the instruments are re‐usable and haemostasis is secured with bipolar coagulation. It is a safe technique whose cost is comparable to that of vaginal or abdominal hysterectomies. The routine use of disposable equipment and automatic disposable staplers for laparoscopic hysterectomies is very debatable as the considerable increase in cost is not accompanied by any benefit for patients or society.

Transvaginal ultrasound in the diagnosis of diffuse adenomyosis.

The purpose of this study is to evaluate the diagnostic capability of transvaginal ultrasound in detecting diffuse adenomyosis. One hundred and seventy-five women, mean age 45.8 years (range 37-62), were studied by TV ultrasound before hysterectomy for benign uterine pathology. The sonographer diagnosed adenomyosis in 19 patients, whereas the pathologist diagnosed adenomyosis in 15 women making ex novo diagnoses in 2 cases. The sensitivity of TV ultrasound was 86.6%, the specificity 96.2%, the positive predictive value 68.4%, and the negative predictive value 98%. In conclusion, this study showed that TV ultrasound is an important and advanced tool in the diagnosis of diffuse adenomyosis.

Endometrial ablation for refractory postmenopausal bleeding with continuous hormone replacement therapy

To determine the role of endometrial ablation and benign uterine pathology in menopausal women with refractory bleeding who were treated with continuous hormone replacement therapy (HRT). Prospective. Health maintenance organization. One hundred seventy-one menopausal women with an average age of 55 were enrolled in an algorithm of continuous HRT, endometrial biopsy for bleeding with initial therapy, doubling of the progestin dose, hysteroscopy, and endometrial resection-ablation for continued refractory bleeding. Endometrial biopsy, hormone manipulation, office hysteroscopy, and hysteroscopic resection-ablation. Refractory menopausal bleeding and benign uterine pathology. One hundred sixty-two women completed the study. One hundred six (65.4%) remained free of bleeding at the end of the initial 3 months of hormone therapy. Fifty-six (34.6%) had one or more bleeding episodes and required office biopsy and an increase in dosage of progestin. Bleeding ceased in an additional 35 (87%) while 21 (13%) continued to bleed. Those patients underwent endometrial resection-ablation. Surgical specimen demonstrated endometrial polyps, submucous leiomyomas, and adenomyosis in 85.7% of the cases. All patients are now free of bleeding. Many women became amenorrheic on the initial dose of continuous HRT; however, if bleeding continues, most stop when the dosage of progestin is doubled. Benign uterine pathology may cause refractory bleeding in a small group of patients but may be eliminated with endometrial resection-ablation.

Intrauterine Devices in Clinical Practice

traceptive for all women; its use is absolutely contraindicated in patients who have: cancer of the cervix or of the body of the uterus; congenital heart disease; a history of rheumatic heart disease and/or endocarditis (since patients with valvular heart disease are especially susceptible to subacute bacterial endocarditis, and all possible sources of septic foci should be eliminated where these patients are concerned). Insertion should be postponed if any of the above are suspected, as well as in the presence of pregnancy (or suspected pregnancy), acute pelvic inflammatory disease (PID), acute cervicitis with obvious purulent discharge, dysfunctional uterine bleeding, polyp or other benign uterine or cervical pathology. Insertion is more likely to produce