Neodymium: YAG laser hysteroscopy in large submucous fibroids.

The preoperative use of a potent, subcutaneously injected gonadotropin-releasing hormone agonist (GnRH-a) was evaluated in a series of 60 women with large submucosal fibroids. Myomectomy by hysteroscopy and Nd:YAG laser was easily performed. In 12 cases, the largest portion of the myoma was not inside the uterine cavity and myomectomy was carried by a two-step hysteroscopy. In women who wished to become pregnant, a pregnancy rate of 66% was achieved. Advantages of preoperative use of a GnRH-a are (1) the significant decrease of the fibroid size, (2) a lower fluid absorption, and (3) the restoration of a normal hemoglobin concentration

Treatment of endometriosis. Evaluation of preoperative therapy with danazol, gestrinone and buserelin (nasal spray and implant)

In order to adequately assess the effectiveness of danazol, gestrinone, buserelin-nasal spray (IN) and buserelin-implant (SC), a prospective non randomized study was initiated in 178 patients with laparoscopically confirmed ovarian endometriosis. After hormonal therapy, laparotomy with microsurgical resection of endometriotic cysts or laparoscopy laser was carried out. Regression (greater than 25%) of ovarian endometriosis was noted in 30, 34, 73 and 91% of cases after danazol, gestrinone and buserelin IN and buserelin SC respectively. Histological study proves that hormonal treatment leads to an incomplete suppression of ovarian endometriotic implants and this suggests the necessity to remove surgically invasive ovarian endometriosis. The pregnancy rate in moderate endometriosis (55%) differed significantly from the rate obtained in severe endometriosis (44%). The highest percentages were found after buserelin therapy. In conclusion, preoperative use of a potent GnRH agonist, administered subcutaneously, seems to be the best therapeutic approach when associated to surgery (CO2 laser or microsurgery)

Innovations en Gynécologie. Que retenir de 2015?

La gynécologie-andrologie vous présente quelques innovations marquantes développées en 2015. Les nouveautés de la spécialité concernent tant la progression thérapeutique avec l'application de la technique du ganglion sentinelle en chirurgie oncologique pelvienne, que l'aspect qualité de vie des patients durant les soins, en particulier au travers de l'utilisation de l'hypnose lors des traitements des pathologies mammaires bénignes et malignes ou en procréation médicalement assistée.[Innovations] The gynecology-andrology department presents several major innovations developed in 2015. Advances have been achieved in the fields of both treatment strategies, as illustrated by the implementation of the sentinel node technique for pelvic cancers, and of quality of life during patient care, especially via using hypnosis while treating benign and malignant breast diseases or in reproductive medicine