Results of clinical applications of NOTES in the IMTN Study showed the feasibility of different methods of this new minimally invasive alternative for laparoscopic and open surgery.

Background: To review women with symptomatic and clinically progressive endometriosis after menopause in the absence of estrogen intake or excessive systemic endogenous production.Design: Seven case reports and a systematic review of the literature from 1995 till February 2018. Results: Only 7 case reports from the authors and 29 cases from the literature described women with either cystic ovarian or deep endometriosis. Severity, symptoms, and localization are highly variable. No case report describes symptomatic superficial typical lesions. In 22 of 36 women (61%), symptoms started more than 10 years after menopause. Conclusions: Symptomatic and clinically progressive endometriosis after menopause in the absence of increased systemic estrogen concentrations or exogenous estrogen intake starts more than 10 years after menopause in the majority of women. This observation suggests that a genetic and/or epigenetic incident caused estrogen-independent progression, increased sensitivity to estrogens or increased local production of estrogens. This observation is important for understanding the pathophysiology of endometriosis, for the management of postmenopausal endometriosis, and for individualization of medical therapy of endometriosis since estrogen-independent endometriosis growth probably also occurs before menopause.

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Background Laparoscopic cystectomy is currently considered the gold standard for the treatment of ovarian endometrioma, resulting in an improvement in symptoms, a lower recurrence rate, and a higher pregnancy rate among infertile patients. However, this treatment is not free from risk, since it is associated with a reduction in ovarian reserve. There is still controversy in the literature regarding whether the cause of the reduction in ovarian reserve is due to damage caused by the coagulation energy during hemostasis or whether the procedure itself is the cause of the damage irrespective of the hemostatic method used. The aim of this study is to compare the effects of different hemostatic methods on the ovarian function of women subjected to laparoscopic surgery for ovarian endometrioma. Methods An open-label randomized clinical trial to be conducted at the Lauro Wanderley University Hospital between December 2017 and August 2020. Eighty-four patients will be randomly allocated to three groups according to the hemostatic technique used during laparoscopic surgery for ovarian endometrioma: bipolar coagulation; laparoscopic suture; and hemostatic matrix. Ovarian function will be assessed by serum anti-Müllerian hormone measurement and by performing an antral follicle count using ultrasound before surgery and one, three, and six months after surgery. The internal review board of the Medical Sciences Center, Federal University of Paraíba approved the study protocol under reference CAAE 71621717.9.0000.8069. Discussion Bearing in mind the need for more randomized clinical trials to clarify this issue, we hope to contribute with data that will determine whether there is any difference between hemostatic methods despite the rational use of bipolar energy or whether the procedure itself explains the ovarian damage irrespective of the hemostatic technique used. Trial registration ClinicalTrials.gov, NTC03430609 . Registered on XX.10/31/2017. ISRCTN Registry, ISRCTN11469394 . Registered on XX.17/12/2017. Unique Protocol ID: U1111–1203-2508.

the DCBE presents high sensitivity and high positive predictive value, in the diagnosis of the rectum and sigmoid endometriosis. Radiologic images speculum and stenosis-type present high sensitivity and positive predictive value for the intestinal infiltration by endometriosis.

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Elective surgery should be delayed for a period of 2 weeks or performed after repeated testing for COVID-19 is negative. Personal protective equipment for the surgeon during (laparoscopic) surgery must include eye protection, a waterproof gown, and a surgical mask that conforms to at least the type IIR standards. There is no reason to perform a laparotomy when laparoscopy is normally the procedure of first choice. There is no moratorium on vaginal or hysteroscopic surgeries, which can be performed using normal protective methods. To decrease the contamination risk for HCPs during laparoscopy, we advise low-pressure operating rooms during intubation and extubation, if possible; balloon trocars that minimize gas leakage; active evacuation of surgical smoke and carbon dioxide in a closed circuit; removal of tissue after desufflating the abdomen; and allowing the operating room air to be sufficiently refreshed before attending new surgery [3]. With the availability of national guidelines and support from international societies, we sincerely hope that we can find the means to perform safe surgery and protect patients and HCPs. On behalf of the Dutch Society of Gynaecological Surgery.

RESUMOObjetivos: caracterizar histologicamente pólipos endometriais em mulheres após a menopausa e avaliar o risco de lesões hiperplásicas e neoplásicas neles contidos. Métodos: análise retrospectiva de 82 casos de mulheres portadoras de histopatologia confirmatória de pólipo endometrial, submetidas à polipectomia histeroscópica devido ao diagnóstico de espessamento endometrial à ultra-sonografia transvaginal. Todos os prontuários pertinentes foram revisados para obtenção da história clínica, antecedentes, dados referentes ao exame histeroscópico e resultado final da histopatologia. Resultados: das 82 mulheres avaliadas, 10,9% faziam uso de algum tipo de terapia hormonal e 28 (34,1%) queixavam-se de sangramento por via vaginal. Pólipo solitário foi encontrado em 56 mulheres (68,3%), em 19 casos (23,2%) foram encontrados dois pólipos e em 7 casos (3,6%), três ou mais pólipos. A avaliação histológica definitiva evidenciou pólipo benigno em 63 mulheres (76,8%), pólipos com hiperplasia em 17 casos (20,8%), sendo dez com hiperplasia simples sem atipias (12,2%) e sete com hiperplasia complexa sem atipias (8,6%). Em dois pólipos foi encontrada neoplasia associada (2,4%). Para a análise estatística foi empregado o teste do χ 2 , corrigido por Yates. Correlacionou-se a histologia dos pólipos com a presença ou não de sangramento genital (p=0,0056), o número de pólipos encontrados por mulher (p=0,921), e o tempo decorrido após a menopausa (p=0,720). Conclusões: pólipos endometriais são entidades freqüentemente encontradas após a menopausa, associando-se com baixa freqüência a hiperplasias e carcinomas endometriais e apenas o estudo histológico de todo espécime nos permite afastar malignidade. PALAVRAS-CHAVE:Pólipos; Endométrio, patologia; Menopausa; Neoplasias do endométrio; Hiperplasia endometrial ABSTRACT Purpose: to characterize postmenopausal endometrial polyps and to determine risk for concomitant premalignant and malignant pathology. Methods: a retrospective study including 82 postmenopausal women with a histological diagnosis of endometrial polyps who underwent hysteroscopic polypectomy, after a diagnosis of endometrial thickening made by transvaginal ultrasound, was performed. Medical reports provided clinical and gynecological history, data related to the operative hysteroscopy and definitive histological findings. Results: among the 82 patients who underwent hysteroscopic polypectomy, 10.9% were receiving some type of hormonal therapy. Twenty-eight women (34.1%) reported abnormal vaginal bleeding. Single polyp was encountered in 56 women (68.3%), two polyps were found in 19 cases (23.2%) and in 7 cases (3.6%), three or more polyps were found. The definitive histopathologic analysis revealed 63 (76.8%) benign polyps, 17 (20.8%) hyperplastic polyps (10 cases -12.2% -of simple endometrial hyperplasia without cytologic atypia and 7 cases -8.6% -of complex endometrial hyperplasia without cytologic atypia). Two polyps (2.4%) were diagnosed as harboring neoplasia. For the statistical analysis we employed χ 2 test improv...