Toward adhesion-free endoscopy?

3 03 2014

To the Editor:

Although the influence of CO2 insufflation on adhesion formation remains controversial, its non-physiological effects include tissue acidosis combined with metabolic hypoxemia and other respiratory and cardiovascular alterations. Therefore, the suggested hypothesis in a recent article by Corona et al. (1) that CO2-pneumoperitoneum should be supplemented by N2O seems to be promising. Read the rest of this entry »

Comment on “Surgical treatment of ovarian endometriomas: state of the art?”

13 11 2012

To the Editor:

We read with interest the recent review conducted by Jadoul et al. (1) on the surgical treatment of ovarian endometriomas. The authors stress, as we do, that laparoscopic cystectomy for ovarian endometriomas may be difficult, and that a meticulous surgical technique should be used. The stripping technique, similar to that used for other benign cysts, cannot be used for this situation as it may induce severe bleeding and damage to the ovary (2, 3, 4). As we published before, the authors suggest that whenever the plane is adequately exposed, the surgeon may identify “arrows” on the surface of the cyst wall. These “arrows” help the surgeon to identify the correct cleavage plane. Indeed, a precise cut on the top of the arrow will present a safe and bloodless plane close to the cyst wall and away from the normal ovarian tissue, which should be preserved as much as possible. Read the rest of this entry »

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 »

Specificity of peritoneal blue staining

10 03 2011

To the Editor:

We read with interest and pleasure the technique proposed by Rauh-Hain and Laufer (1) to increase the diagnostic accuracy of laparoscopy in endometriosis. The diagnostis of superficial implants may be difficult, particularly the identification of the limits of the disease. Therefore a staining technique would be useful to identify abnormal peritoneal areas, helping the surgeons to decide the limits of the surgical treatment. We would like to propose three comments to this approach. Read the rest of this entry »

Robotic-assisted laparoscopic management of a case with juvenile cystic adenomyoma

2 06 2010

To the Editor:

We read with great interest the article by Takeuchi et al. (1), which reports the largest series, 9 patients, who all underwent laparoscopic excision of the juvenile cystic adenomyoma (JCA) with 2- to 3-layer closure of the myometrium.

JCA is a condition characterized by the focal presence of ectopic endometrial glands and stroma within the uterine myometrium. Takeuchi et al. defined additional diagnostic criteria including an age range of menarche to age 30 with mean presenting age of 25.2 years. They also pointed out that the diagnosis should be confirmed by imaging modality of TVUS or MRI, excluding other diagnoses of obstructive uterine anomaly, adenomyosis with internal bleeding and acquired cystic lesions (1).

We want to add a new JCA case to the existing literature that was operated laparoscopically with robotic-assistance. Read the rest of this entry »

Arguments for a left lateral predisposition of endometrioma.

11 12 2009

To the Editor:

Matalliotakis and colleagues, in the April 2009 issue of Fertility and Sterility, present an argument for the left lateral predisposition of ovarian endometriomas based on a retrospective series of 251 women who underwent surgical intervention for the disease (1). They also suggest a new ‘female varicocele theory’ for the development of ovarian endometriomas based on the left lateral predilection of ovarian vein dilation (2). Read the rest of this entry »

Patient’s fertility desire should be taken into consideration in the surgical treatment algorithm of infiltrating endometriosis

30 10 2009

To the Editor:

We read with great interest the manuscript by Fanfani et al., which reports their experience with laparoscopic treatment of bowel-infiltrating endometriosis (1). The authors analyzed their patients in regards to operative long-term complications, pain relief and recurrence rate, and suggest a surgical management algorithm. However, women with bowel endometriosis, besides having gastrointestinal symptoms and pain, frequently suffer from infertility. Read the rest of this entry »