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Biomedical subjects

F Lécuru

Publications and source records attributed to F Lécuru.

At least 19 recordsLinked to original sources
PubMed1999

Morbidity in laparoscopic gynecological surgery: results of a prospective single-center study.

BACKGROUND: We set out to investigate prospectively the morbidity rate for gynecological laparoscopy patients at a tertiary care center. METHODS: We prospectively recorded data on 743 laparoscopic procedures performed between January 1, 1992 and December 31, 1996. The procedures included 36 diagnostic laparoscopies (4.8%), 115 laparoscopies carried out for minor surgical acts (15.4%), 523 for major surgical acts (70.4%), and 69 for advanced surgical acts (9. 4%). A total of 127 patients had a history of prior laparotomy (17%). All those procedures were performed by young senior surgeons. We defined a complication as an event that had modified the usual course of the procedure or of the postoperative period. For statistical analysis, we used the chi-squared test or Fisher's exact test. RESULTS: Complications occurred in 22 cases; the overall complication rate was 2.9% when all events were considered. One complication (injury of the left primitive iliac artery) was related to insertion of the Veress needle (0.13%). A total of 2,578 trocars were inserted, giving rise to 10 complications (1.3%). Three unintended laparotomies were required for bowel or bladder injuries (0.4%). Finally, the introduction of the laparoscope was responsible for 11 complications (1.4%); this figure represents 50% of all the complications of this series. Eight intraoperative complications (1%) occurred during the laparoscopic surgery (seven severe bleedings and one ureter injury, but no intestinal lesions); laparotomy was required in six of these cases. Three complications occurred during the postoperative stage: one granulomatous peritonitis after intraabdominal rupture of a dermoid cyst, one incisional hernia, and a fast-resolving cardiac arrhythmia. CONCLUSIONS: In our experience, operative gynecological laparoscopy is associated with an acceptable morbidity rate. Moreover, about half of the complications occur during the installation of the laparoscopic procedure, underscoring the usefulness of safety rules.

Chi-Square Distribution↗
PubMed1999

Effect of methotrexate on tubal epithelium. A report of three cases.

BACKGROUND: Tubal effects of methotrexate injections have been poorly reported. CASES: Three fallopian tubes were examined with light microscopy 9-13 months after tubal methotrexate injection (one case) and intramuscular methotrexate injection (two cases) given for the treatment of unruptured ectopic pregnancies. No evidence of tubal damage was found. CONCLUSION: These three cases confirm previous experimental and clinical data showing the absence of a direct adverse effect of methotrexate on the fallopian tubes in the treatment of ectopic pregnancy.

Abortifacient Agents, Nonsteroidal↗
PubMed1998

Transperitoneal laparoscopic pelvic lymphadenectomy for gynecologic malignancies (I). Technique and results.

BACKGROUND: We reviewed the published experimental and clinical data, available in MEDLINE, and compared them to our experience in a university-affiliated tertiary medical center of obstetrics and gynecology in order to describe the accepted techniques and results of laparoscopic pelvic lymphadenectomy. METHODS: The procedure requires a four-port access laparoscopy. Dissection boundaries are similar to those for open surgery. RESULTS: Experimental and clinical comparative series have shown that the number of harvested lymph nodes is not significantly different for laparoscopy than for laparotomy. Several authors reported a learning curve, reflecting the surgeon's increasing accuracy with growing operative experience. Obesity and prior history of laparotomy are both factors that impact adversely on the number of nodes harvested and the complication rate. Otherwise, the number of residual nodes is similar for the two approaches. In both cases, it is low, resulting in a high sensitivity (95-100%). The complication rate is directly linked to the surgeon's experience and thus appears low for skilled laparoscopic operators. It is similar to that reported for open surgery. Anesthesiological complications have not been well assessed in the literature on laparoscopic lymphadenectomy. Operating time was longer than for laparotomy in all the series. Conversely, mean blood loss, duration of hospitalization, and recovery time were significantly decreased. Although intraoperative cost of the laparoscopic procedure is high in comparison with laparotomy, since the time of recovery appears shorter, total costs may be similar or even lower. CONCLUSION: We conclude that laparoscopic pelvic lymphadenectomy is a reliable and safe procedure for the evaluation and treatment of gynecologic cancers.

Female↗
PubMed1998

Transperitoneal laparoscopic pelvic lymphadenectomy for gynecologic malignancies (II). Indications.

BACKGROUND: We reviewed the published experimental and clinical data, available in MEDLINE, and compared them with our own experience, in a university-affiliated tertiary medical center of obstetrics and gynecology in order to report on the accepted indications for laparoscopic pelvic lymphadenectomy. METHODS: Surgical staging of cervical carcinoma can be performed via the laparoscopic approach. Intraperitoneal biopsies, washings, and pelvic lymphadenectomy can also be carried out with high accuracy and limited morbidity. Node-negative women are better treated by a radical hysterectomy performed either simultaneously (using frozen sections) or secondarily after routine pathologic examination of the pelvic nodes. Node-positive patients have a poor prognosis, no matter what the treatment is, and are generally considered for radiotherapy and/or chemotherapy. The use of laparoscopic pelvic lymphadenectomy in advanced cervical cancers is limited. RESULTS: Laparoscopy has a direct therapeutic application in endometrial carcinoma. Total hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy can all be performed via laparoscopy. Thus, stage I and some stage II endometrial cancers can be treated exclusively laparoscopically. This approach seems as effective as laparotomy, but it dramatically reduces the costs and morbidity associated with conventional treatment. CONCLUSIONS: Currently, the use of laparoscopy in ovarian and tubal cancers is confined to referral centers. Laparoscopy appears to be as effective as laparotomy for second-look surgery. Treatment of stage II and more advanced ovarian cancers has been reported, but it cannot be recommended in a routine situation.

Endometrial Neoplasms↗
PubMed1998

Use of hysterosalpingosonography for early diagnosis of ectopic pregnancy.

Diagnosis of unruptured ectopic pregnancy was performed using hysterosonography in a patient with no adnexial mass visible on transvaginal sonography and low hCG level (440 UI l(-1)). This avoided a laparoscopy and allowed treatment by single injection of methotrexate. Hysterosonography may be useful for the diagnosis of small ectopic pregnancies.

Adult↗
PubMed1998

[Microinvasive carcinoma uterine cervix. Which approach in 1998?].

Numerous definitions of microinvasive carcinoma (MIC) have been proposed. The SGO takes into account the depth of stromal invasion and presence of capillary like space involvement (LVI). The Figo uses the lesion width and describes different substages according to the depth of stromal invasion. Two major prognostic factors can be identified in the literature: the depth of invasion and the presence of LVI. The lesion volume is probably more accurate than the depth of stromal invasion but cannot be measured in routine. Taking into account that a classification must be a guide for the evaluation of prognosis and treatment, the SGO definition seems more reliable. Pelvic lymph node metastasis rate and recurrence increase with these two factors. MIC with stromal invasion under 3 mm and without LVI have a little risk of parametrial and nodal involvement: with a high rate of survival. Conversely, MIC with invasion over 3.1 mm depth or LVI have a greater risk of spread beyond the cervix (1% versus 7.7%) and many authors now consider them as true invasive cancers. For lesion invading the stroma within 3 mm, the treatment can be limited to a standard hysterectomy with good results. Some authors have proposed more conservative therapy as conization. This procedure is interesting for young women willing to preserve their anatomy, fertility and sexual function. In selected cases, short term results are similar to those of hysterectomy but there is a lack of controlled studies with long term follow-up. Lesions over 3.1 mm with LVI should be treated as true invasive cancers. Intermediate cases should have a conservative therapy associated with a laparoscopic lymphadenectomy.

Female↗
PubMed1997

Laparoscopic pelvic lymphadenectomy in an anatomical model: results of an experimental comparative trial.

OBJECTIVES: The aim of this paper was to compare the accuracy of laparoscopic versus open pelvic lymphadenectomy in an experimental trial. STUDY DESIGN: We performed unilateral laparoscopy pelvic lymphadenectomy (LPL) in 33 non-embalmed cadavers between the external iliac vein, the obliterated umbilical artery and the obturator nerve. Then a laparotomy was performed to inspect the LPL limits, look for laparoscopic complications and finally realize a controlateral lymphadenectomy. The LPL side was randomly decided. A pathologist counted the number of lymph nodes collected with both techniques. We compared the number of retrieved lymph nodes, the completeness of the dissection and the complication rate with those two procedures. Student's t-test, chi 2-test and non-parametric tests were used when appropriate. RESULTS: No dissection had to be aborted. One hundred and twelve nodes were removed laparoscopically (mean, 3.73; S.E., 2.9) and 84 at laparotomy (mean, 2.77; S.E., 2.06). There was no significant difference in the number of nodes retrieved with both procedures. Effectiveness of laparoscopy was not significantly different in the first ten procedures, in the second ten or in the last ten LPL. Residual tissue was observed after LPL in 13.3% of the procedures whereas all open lymphadenectomies were complete. LPL sensitivity reached at least 86% in this paper. Failures were more frequent at the beginning of the study (50% among the first ten dissections), in obese subjects or in subjects with prior history of laparotomy (but the difference was not significant). Two venous injuries occurred during LPL (6.7%). Complication rates for the two techniques were not significantly different. However, the LPL complication rate was higher at the beginning of the study and increased significantly in subjects with prior history of laparotomy (P < 0.05). CONCLUSIONS: This randomized study shows that LPL and laparotomy have similar effectiveness. Incomplete dissections and complications are more frequent in obese subjects or in case of prior history of laparotomy. Fifteen procedures seems necessary to learn the technique and provide constant and safe results in routine practice.

Aged↗
PubMed1997

Saline contrast sonohysterography as first-line investigation for women with uterine bleeding.

The objective of this study was to assess the effectiveness of saline contrast sonohysterography (SCSH) as a first-line investigation for perimenopausal women with uterine bleeding. A total of 162 women were enrolled in a prospective study. They underwent SCSH indicated for abnormal uterine bleeding. Patients with normal or atrophic endometrium were scheduled for diagnostic hysteroscopy or hormone therapy. Patients with uterine cavity abnormalities were scheduled for surgery (operative hysteroscopy or hysterectomy). A clinical follow-up was obtained for all the patients after SCSH. Sonohysterographic findings were compared with pathological results. SCSH was carried out in 159 patients. In all but one case, the procedure was well tolerated by the patients. There were no complications either during or after the examination. Surgical and pathological results were available in 109 cases. SCSH was highly sensitive and specific in the differentiation between women with intrauterine lesions and those with normal or atrophic endometrium (98.9% and 76.4%, respectively). SCSH was also accurate in the diagnosis of polyps and submucosal myomas (sensitivity 87.8 and 89.6%, specifically 90.7 and 95%). SCSH and surgery displayed the same reliability in the measurement and the localization of the lesions. SCSH recognized endometrial cancer in only 40% of cases. However, all these patients had abnormalities at sonohysterography which indicated a surgical exploration, leading to a zero false-negative rate. Saline contrast sonohysterography appears to be a reliable tool for the investigation of abnormal uterine bleeding in perimenopausal women. It can distinguish women who only require medical therapy from those who require surgery. The method is easy to learn, and is well tolerated by the patients.

Adult↗
PubMed1997

[Lymphatic drainage of the uterus. Preliminary results of an experimental study].

We carried out an experimental study on the lymphatic drainage of the uterus in 11 female cadavers. We performed 5 injections of a colored fluid in the corpus uterinum and 6 in the cervix. We observed 2 main routes along the external iliac vessels. The first was anterior and drains the lower limb. The second is medial and posterior to the external iliac vessels and drained the uterus (2.4 lymph nodes/side). The number and location of the lymph nodes varied between subjects but also in the same subject (45.5% of cases). The cervix was essentially drained to lymph nodes located on the posterior aspect of the external iliac vein, especially near the hypogastric artery origin. We did not observe any direct connexion between the cervix and the para-aortic area. The corpus uterinum was drained to the lymph nodes located in the lateral part of the parametrium and or under the external iliac vein. One other main route ran along the infudibulo-pelvic ligament. These findings confirm that the first lymph nodes metastases of the cervical carcinoma are under the external iliac vein. and particularly near the hypogastric artery. On the other hand, endometrial carcinomas spread along two lymphatic connections: one extending to the external iliac area and another to the para-aortic area. These results have to be considered in order to define lymphadenectomy margins for these cancers.

Aged↗
PubMed1997

Microinvasive carcinoma of the cervix. Rationale for conservative treatment in early squamous cell carcinoma.

Numerous definitions of microinvasive carcinoma (MIC) have been proposed. Taking into account that a classification must be a guide for the evaluation of prognosis and treatment, the authors reviewed the risk of spread in MIC. Two major prognostic factors can be identified in the literature: the volume of the lesion and the presence of capillary-like space involvement (LVI). The former item is generally assessed by the depth of invasion. Two kinds of MIC can be distinguished. Those with stromal invasion under 3 mm and without LVI, and those with invasion over 3.1 mm depth or LVI. The former have little risk of parametrial and nodal involvement and a high rate of survival. The latter have a greater risk of spread beyond the cervix and many authors now consider them as true invasive cancers. The Society of Gynaecologic Oncologists (SGO) definition seems more reliable. For lesions invading the stroma within 3 mm, treatment can be limited to a standard hysterectomy with good results. Some authors have proposed more conservative therapy such as conization. This procedure could be desirable for young women who want to preserve their anatomical integrity, fertility and sexual function. In selected cases, short term results are similar to those of hysterectomy but there is a lack of controlled studies with long term follow-up.

Carcinoma, Squamous Cell↗
PubMed1997

[Microinvasive cervical cancer].

While the rate of invasive carcinoma of the cervix is relatively constant among women under 40 years of age, the rate of microinvasive carcinoma (MIC) appears to increase steadily in this young age group. The definition of MIC is not universally established and if the probability of dissemination of the disease is low, it is not unconceivable and calls for an adequate surgical treatment that should respect the anatomic and functional integrity of these young women. The diagnosis of MIC relies primarily on conisation that is indicated in severe dysplasia and cervical neoplasia with no evidence of invasion on colposcopic directed biopsies. Conisation is the standard approach that requires a rigorous surgical technique and a thorough histological evaluation of the surgical sample by a skilled pathologist. This pathologic examination should be particularly attentive to the depth of stromal invasion, the width and volume of the lesion and the magnitude of LVI. While the dissemination within the parametrium cannot be well assessed, it appears that the likelihood of pelvic lymph node involvement approximates the depth of stromal invasion of the MIC with a threshold limit of 3 mm. LVI also carries the risk of poor prognosis, particularly in the early stages of the disease, and has been taken into consideration by the Society of Gynecologic Oncologists (SGO). The standard treatment of MIC is also conisation under the condition that the surgical limits are not diseased. If the depth of stromal invasion exceeds 3 mm or if LVI is reported by the pathologist, the lesion should then be treated like an invasive carcinoma of the cervix (i.e.: colpohysterectomy and pelvic lymphadenectomy). In some instances however (e.g.: early invasion with LVI), a laparoscopy directed pelvic lymphadenectomy could be suggested as a first line investigation associated with conisation. Since early invasive carcinoma of the cervix can now be defined and carries a reduced spreading potential we can propose an adequate treatment allowing functional integrity in these patients in a particularly young age group.

Biopsy↗