Some criticism about laparo-endoscopic single site surgery (LESS) in gynecological surgery for benign and malignant diseases

29 06 2011

To the Editor:

We read with great interest the article by Fagotti et al. (1) on postoperative pain after conventional laparoscopy and laparo-endoscopic single site surgery (LESS) for benign adnexal disease.

We share the opinion of the authors on the good cosmetic results of the new “device” and on the reduced postoperative pain offered by the procedure. In our experience, we have found the same advantages with the use of LESS in patients affected by gender identity disorders and submitted to endoscopic hysterectomy with bilateral salpingovariectomy (2). The scar hidden deep in the umbilical fold may represent a great advancement in sex reassignment surgery, leading to psychological advantages. The absence of pelvic scars, which would identify the type of previous surgery, may help to complete the full integration of these female subjects into the new male role. Read the rest of this entry »

Ovarian hyperstimulation syndrome or massive intraperitoneal hemorrhage?

21 06 2011

To the Editor:

I read with interest a recent paper by Griesinger et al. (1) describing, for the first time in the English literature, a case of severe ovarian hyperstimulation syndrome (OHSS) post-GnRH agonist trigger of ovulation. However, the clinical details of the case cast serious shadow on the correct diagnosis.

The hallmark of severe OHSS is elevated hematocrit (>45%, or >30% increment over baseline values) secondary to hemoconcentration (2). However, the described patient experienced severe intraperitoneal hemorrhage leading to decreasing hematocrit (41% on day of trigger, 37% on day of oocyte retrieval). Blood transfusion was given (no details on amount) due to “drastic decrease of hemoglobin levels to 4.9 mmol/L,” with hematocrit “15,000, oliguria, elevated creatinine, liver dysfunction, anasarca) were not given. Read the rest of this entry »

Problem of assisted reproductive technology in Japan after 2011 earthquake crisis

13 06 2011

To the Editor:

The recent publication regarding problems for assisted reproduction clinics in Japan after the 2011 earthquake is very interesting (1). Ishihara and Yoshimura noted the problem of loss of embryos, and the surprising revelation that no frozen embryos in liquid nitrogen tanks were lost (1). Ishihara and Yoshimura said that “Emergency power supply is the first priority issue” (1). Read the rest of this entry »

Ovarian Hyperstimulation Syndrome in a Patient Treated with Tamoxifen for Breast Cancer

9 06 2011

To the Editor:

I read with great interest the case report by Baigent and Lashen (1) describing a case of bilateral ovarian cysts induced by tamoxifen therapy for breast cancer in a 50-year-old woman. The authors performed laparoscopic bilateral salpingo-oophorectomy to enable a histological examination as well as eliminate the source of estrogen.

We have already described ovarian cysts in 80% out of twenty premenopausal breast cancer tamoxifen-treated patients accompanied by high levels of estradiol. At the same time, these findings were found in only one (out of 12) similar patients not treated with tamoxifen (2). Read the rest of this entry »

Does complete laparoscopic excision of endometriosis in teenagers really occur?

9 06 2011

To the Editor:

We read with great interest “Complete laparoscopic excision of endometriosis in teenagers: is postoperative hormonal suppression necessary?” (1). The study evaluated 17 teens – aged 12-19 when they presented with pelvic pain – who underwent a laparoscopic procedure and were found to have biopsy-proven endometriosis. Seven of these patients (41.2%) had, in fact, been treated by ablation or fulguration previous to the “index” laparoscopy for this study, with a total of 13 of the 17 patients having at least one prior laparoscopy. The surgeons state that at this index laparoscopy “all” endometriosis was excised, and postoperatively the teens were not specifically asked to utilize suppressive hormonal therapy. However, 6 (35.1%) patients were on combination hormones and 1 was on GnRH agonist. Among the 17 patients, the study reports 47% return of pain to a level where subsequent laparoscopy was performed within an average of 23.1 months (maximum 66 months). We believe that this finding supports established data that with aggressive surgical therapy alone pain symptoms return (2). Read the rest of this entry »

Proficiency in oocyte retrieval

7 06 2011

To the Editor:

We read with great interest the article by Goldman et al. (1). We would like to make some comments regarding the methodological and statistical issues raised by this work.

First, in our opinion, the outcome measure is not accurate enough to evaluate skill acquisition in oocyte retrieval (OR). A successful OR should be defined by the ability for the trainee to perform the procedure without intervention of the tutor as well as to retrieve the expected number of oocytes. However in this study, cases where more than one provider attempted OR on one ovary were excluded from analysis. What about the cases where the trainees failed to complete OR alone? Were they not taken into account in the learning curve? Read the rest of this entry »

IVM media are designed specifically to support immature cumulus-oocyte complexes not denuded oocytes that have failed to respond to hyperstimulation

2 06 2011

To the Editor:

We wish to express concern about the design, analysis and conclusions reported in the article by Moschini et al. (1). This study compares the efficiency of an oocyte IVM medium (Medicult) to a cleavage-stage embryo culture medium (Sage IVF), for the in vitro maturation (IVM) of denuded oocytes that have failed to respond to gonadotropins in a standard IVF cycle (rescue IVM). We have a number of objections to this study: Read the rest of this entry »