Practice of laparoscopic prolapse surgery in Europe - ESGE Survey.

peer reviewedSacrocolpopexy is considered as the "gold standard" for management of women with apical prolapse. Numerous technical variants are being practiced. The first aim of this survey was to determine the habits of practice of laparoscopic sacrocolpopexy (LSCP) in Europe. The second aim was to determine whether surgeons who perform laparoscopic pelvic organ prolapse (POP) repair are familiar with the practice of alternative techniques and with mesh-less laparoscopic treatment of prolapse. The questionnaire was designed by the Urogynaecology Special Interest Group of the European Society for Gynaecological Endoscopy (ESGE). All ESGE-members were invited by email to respond to this survey consisting of 54 questions divided in different categories. Following review of ESGE member's responses, we have highlighted the great heterogeneity concerning the practice of LSCP and important variability in performance of concomitant surgeries. Alternative techniques are rarely used in practice. Furthermore, the lack of standardisation of the many surgical steps of a laparoscopic sacrocolpopexy is mainly due to the lack of evidence. There is a need for training and teaching in both standard and newer innovative techniques as well as the reporting of medium and long-term outcomes of both standard laparoscopic sacrocolpopexy and any of its alternatives

Solving the problems of gas leakage at laparoscopy

International audienc

Chemical state estimation for the middle atmosphere by four-dimensional variational data assimilation: System configuration

A novel stratospheric chemical data assimilation system has been developed and applied to Environmental Satellite Michelson Interferometer for Passive Atmospheric Sounding (ENVISAT/MIPAS) data, aiming to combine the sophistication of the four-dimensional variational (4D-var) technique with flow-dependent covariance modeling and also to improve numerical performance. The system is tailored for operational stratospheric chemistry state monitoring. The atmospheric model of the assimilation system includes a state-of-the-art stratospheric chemistry transport module along with its adjoint and the German weather service's global meteorological forecast model, providing meteorological parameters. Both models share the same grid and same advection time step, to ensure dynamic consistency without spatial and temporal interpolation errors. A notable numerical efficiency gain is obtained through an icosahedral grid. As a novel feature in stratospheric variational data assimilation a special focus was placed on an optimal spatial exploitation of satellite data by dynamic formulation of the forecast error covariance matrix, providing potential vorticity controlled anisotropic and inhomogeneous influence radii. In this first part of the study the design and numerical features of the data assimilation system is presented, along with analyses of two case studies and a posteriori validation. Assimilated data include retrievals of O-3, CH4, N2O, NO2, HNO3, and water vapor. The analyses are compared with independent observations provided by Stratospheric Aerosol and Gas Experiment II (SAGE II) and Halogen Occultation Experiment (HALOE) retrievals. It was found that there are marked improvements for both analyses and assimilation based forecasts when compared with control model runs without any data ingestion

Trauma and endometriosis. A review. May we explain surgical phenotypes and natural history of the disease?

International audienc

Laparoscopic-assisted Retropubic Midurethral Sling Placement: A Technique to Avoid Major Complications

Study Objective To describe a technique for the safe placement of retropubic midurethral slings in patients undergoing concomitant laparoscopic surgery in order to avoid major complications associated with this procedure such as bladder perforation and retropubic hematomas. Design Step-by-step video demonstration of the technique. Setting A university tertiary care hospital. Patients Patients with an indication for retropubic midurethral sling placement because of recurrent stress urinary incontinence, intrinsic sphincter deficiency, or severe pelvic organ prolapse in whom a concomitant laparoscopic surgery has to be performed for other medical conditions. Intervention Laparoscopic opening and dissection of the Retzius space and insertion of the sling under a laparoscopic view of this space. Measurements and Main Results This technique has been mainly used in patients undergoing laparoscopic pelvic organ prolapse repair. No complications have been identified so far, even in high-risk patients such as those with previous Burch colposuspension. Conclusion This is a simple and reproducible technique for preventing major complications associated with retropubic sling placement in patients undergoing laparoscopic surgery for other reasons. It also permits the immediate detection and even resolution of complications in case any arise. Even high-risk patients may be safely approached

Equipment failures in laparoscopic surgery: Causes and consequences

International audienc