The impact of laparoscopic gynecological surgery training on the technicity index of a developing country center

ABSTRACT Purpose: To compare laparoscopic gynecological surgery training between a developed country’s reference center (host center) and a public reference service in a developing country (home center), and use the technicity index (TI) to compare outcomes and to determine the impact of laparoscopic gynecological surgery fellowship training on the home center’s TI. Methods: The impact of training on the home center was assessed by comparing surgical performance before and after training. TI was assessed in 2017 in the host center, and before and after training in the home center. Epidemiological and clinical data, and information on reason for surgery, preoperative images, estimated intraoperative bleeding, operative time, surgical specimen weight, hospital stay length, complication and reintervention rates were collected from both institutions. Home center pre-training data were retrospectively collected between 2010 and 2013, while post-training data were prospectively collected between 2015 and 2017. A two-tail Z-score was used for TI comparison. Results: The analysis included 366 hysterectomies performed at the host center in 2017, and 663 hysterectomies performed at the home center between 2015 and 2017. TI in the host center was 82.5%, while in the home center it was 6% before training and 22% after training. There were no statistical differences in length of hospital stay, preoperative uterine volume, surgical specimen weight and complication rate between centers. However, significantly shorter mean operative time and lower blood loss during surgery were observed in the host center. Conclusions: High-quality laparoscopic training in a world-renowned specialized center allowed standardizing laparoscopic hysterectomy procedures and helped to significantly improve TI in the recipient’s center with comparable surgical outcomes

The burden of endometriosis: costs and quality of life of women with endometriosis and treated in referral centres

BACKGROUND This study aimed to calculate costs and health-related quality of life of women with endometriosis-associated symptoms treated in referral centres. METHODS A prospective, multi-centre, questionnaire-based survey measured costs and quality of life in ambulatory care and in 12 tertiary care centres in 10 countries. The study enrolled women with a diagnosis of endometriosis and with at least one centre-specific contact related to endometriosis-associated symptoms in 2008. The main outcome measures were health care costs, costs of productivity loss, total costs and quality-adjusted life years. Predictors of costs were identified using regression analysis. RESULTS Data analysis of 909 women demonstrated that the average annual total cost per woman was €9579 (95% confidence interval €8559-€10 599). Costs of productivity loss of €6298 per woman were double the health care costs of €3113 per woman. Health care costs were mainly due to surgery (29%), monitoring tests (19%) and hospitalization (18%) and physician visits (16%). Endometriosis-associated symptoms generated 0.809 quality-adjusted life years per woman. Decreased quality of life was the most important predictor of direct health care and total costs. Costs were greater with increasing severity of endometriosis, presence of pelvic pain, presence of infertility and a higher number of years since diagnosis. CONCLUSIONS Our study invited women to report resource use based on endometriosis-associated symptoms only, rather than drawing on a control population of women without endometriosis. Our study showed that the economic burden associated with endometriosis treated in referral centres is high and is similar to other chronic diseases (diabetes, Crohn's disease, rheumatoid arthritis). It arises predominantly from productivity loss, and is predicted by decreased quality of lif

La chirurgie robotique. Peut-on (doit-on) nager à contre-courant ?

International audienc

Place de l'échographie et de la coelioscopie dans la prise en charge des tumeurs ovariennes (à propos de 844 cas)

CLERMONT FD-BCIU-Santé (631132104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Restadification dans les tumeurs frontières de l'ovaire (étude multicentrique, expérience clermontoise)

Les objectifs sont d'évaluer la faisabilité et l'impact de la restadification coelioscopique er d'identifier des indications ciblées de restadification. Il s'agit d'une étude rétrospective multicentrique portant sur 142 patientes présentant une tumeur frontière de l'ovaire. Comparaison des paramètres épidémiologiques, chirurgicaux et histologiques entre les patientes stadifiées (n=55), restadifiées (n=45) et non restadifiées (n=42). Evaluation de la survie globale et sans récidive. Une restadification coelioscopique a été réalisée chez 43 patientes. La restadification diminuait significativement le taux de rechutes (p<10-7) sans modifier la survie globale. L'âge le plus précoce (p=0,003), la micropapillarité (p=0,0004) et la cytologie intrapéritonéale positive (p<10-7) étaient significativement liés à l'upstadification. Les récidives survenaient significativement plus souvent dans les formes séreuses (p=0,08) ou non diploïdes (p=0,004). La restadification coelioscopique est faisable et sûre. Les restadifications systématiques demeurent controversées. Les patientes jeunes, traitées de façon conservatrice, présentant une forme séreuse, et/ou micropapillaire et/ou non diploïde, des implants, et/ou une cytologie intrapéritonéale positive pourraient constituer des indications ciblées de restadification.The objectives are to evaluate the faisability and impact of laparoscopic restaging and identify restaging indications. Methods : Retrospective multicenter study, about 142 women with boderline ovarian tumour. Comparison of epidemiological, surgical and histological parameters between women who underwent staging (n=55), restaging (n=45) and those who did not (n=42). Overall and disease free survival were examined. A laparoscopic restaging operation was performed in 43 women. Nine (20%) of the 45 women restaged had their tumors upstaged. The recurrence rate was significantly decreased after restaging operation (p<10-7). The young age (p=0,0032), micropapillarity (p=0,0004) and positive intraperitoneal cytology (p<10-7) were significantly linked to upstaging. Recurrence tented to be more common with serous borderline tumors or non diploid tumours (p=0,04). Laparoscopic restaging is feasible and safe.The indications of systematic restaging remain controversial. The youngest patients who underwent conservative treatment, who had serous or micropapillar borderline tumors, implants, a positive cytology or a non diploid tumor, could be selected for restaging surgery.CLERMONT FD-BCIU-Santé (631132104) / SudocSudocFranceF

Effects of U0126 and MK2206 on cell growth and re-growth of endometriotic stromal cells grown on substrates of varying stiffness

International audienceEndometriosis is a common gynecological disorder responsible for infertility and pelvic pain. A complete cure for patients with endometriosis awaits new targets and strategies. Here we show that U0126 (a MEK inhibitor) and MK2206 (an AKT inhibitor) synergistically inhibit cell growth of deep endometriotic stromal cells (DES) grown on polyacrylamide gel substrates (PGS) of varying stiffness (2 or 30 kilopascal [kPa]) or plastic in vitro. No significant differences in cell proliferation were observed among DES, endometrial stromal cells of patients with endometriosis (EES) from the proliferative phase (P), EES-S (secretory phase) and EES-M (menstrual phase) compared to cells grown on a substrate of the same stiffness at both higher (U0126 [30 μM] and MK2206 [9 μM]) and lower (U0126 [15 μM] and MK2206 [4.5 μM]) combined doses. However, cell re-growth of DES after drug discontinuation was higherthan that of EES-P and EES-S when cells were grown on rigid substrates at both combined doses. Combination U0126 and MK2206 treatment is more effective than each drug alone in cell growth inhibition of DES. However, further studies are required to investigate the mechanisms underlying high cell survival and proliferation after drug discontinuation for developing target therapies that prevent recurrence