To analyze short-term effectiveness and symptom resolution after surgical removal of Essure (Bayer AG, Leverkusen, Germany) sterilization devices. Design: A single-center retrospective cohort study (Canadian Task Force classification III). Setting: A large secondary care teaching hospital in the Netherlands. Patients: All patients who underwent surgical removal of Essure devices between January 2009 and December 2015. Interventions: Surgical removal of Essure devices was predominantly performed by laparoscopic surgery. In the majority of patients, Essure devices were removed by performing bilateral salpingectomy (66.6%). Measurements and Main Results: Data regarding patient characteristics, symptoms, the insertion procedure, the removal procedure, results of the pathological assessment, and follow-up were extracted from patient files. A total of 93 patients had Essure devices removed in the selected period. The onset of symptoms after Essure sterilization was variable. The most frequently reported symptom was abdominal pain (69.9%) followed by lower back pain and fatigue. Most patients reported multiple symptoms; 39.8% of women reported complete relief of symptoms after removal surgery, whereas 15.1% did not notice any relief in symptoms. Conclusion: Six weeks after removal surgery, 39.8% of patients reported complete resolution of symptoms. Further research to reported symptoms after Essure sterilization and symptom resolution after removal surgery is necessary to inform both patients and gynecologists in order to make a well-considered decision about taking the risks of (major) surgery and the expected benefits of removal.

Fetuses with CHD showed a modest but significant linear decrease in HC growth, whereas AC and FL growth trajectories remained stable.

Background and Objectives: Robot-assisted laparoscopic hysterectomy is a safe and feasible approach in patients with higher body mass index (BMI). Slightly longer operating time in patients with high BMI did not result in higher complication or conversion rates. The purpose of this study was to evaluate whether robot-assisted total laparoscopic hysterectomy is a feasible and safe surgical approach in different classes of obesity. Methods: A single center retrospective cohort study was performed in a large secondary teaching hospital in the Netherlands. All patients who underwent robot-assisted total laparoscopic hysterectomy between January 1, 2011 and January 31, 2019 were included. Results: Data regarding patient characteristics, complication rate, conversion rate, skin-to-skin time, robot console time, and operating room time were collected. Surgery specific data were compared in patients with several classes of obesity. In total 356 cases were included. Median BMI was 29 kg/m 2 (range 18 – 59). Complication rate and conversion to laparotomy did not differ significantly in different classes of obesity. Robot console time and skin-to-skin time was significantly longer in women with a BMI ≥ 40 kg/m 2 (n = 34) compared to patients with normal BMI. Conclusion: Robot-assisted laparoscopic hysterectomy is a safe and feasible approach in women in different classes of obesity. The significantly prolonged operating time does not result in higher complication or conversion rates.

Pubic osteomyelitis is a rare and often late-onset complication of radiation therapy and surgery for vulvar and vaginal carcinoma. It typically presents with vulvar pain, fever, vaginal discharge and/or gait disorders. Pubic osteomyelitis is often accompanied by fistulas or wound dehiscence in the pelvic area. Its accurate diagnosis and treatment are challenging and require a multidisciplinary team effort. In our patients, multiple combined surgical procedures, long-term antibiotic treatment and days to weeks of hospital admission were necessary to treat pubic osteomyelitis. We emphasise the importance of timely and adequate diagnosis and multidisciplinary approach resulting in a course of treatment that is as effective as possible, limiting the impact on quality of life, which is generally high in this group of patients.