ObjectiveTo estimate the effectiveness and safety of laparoscopic surgical excision of rectovaginal endometriosis.DesignA multicentre, prospective cohort study.Setting51 hospitals accredited as specialist endometriosis centres.Participants5162 women of reproductive age with rectovaginal endometriosis of which 4721 women had planned laparoscopic excision.InterventionsLaparoscopic surgical excision of rectovaginal endometriosis requiring dissection of the pararectal space.Main outcome measuresStandardised symptom questionnaires enquiring about chronic pelvic pain, bladder and bowel symptoms, analgesia use and quality of life (EuroQol) completed prior to surgery and at 6, 12 and 24 months postoperatively. Serious perioperative and postoperative complications including major haemorrhage, infection and visceral injury were recorded.ResultsAt 6 months postsurgery, there were significant reductions in premenstrual, menstrual and non-cyclical pelvic pain, deep dyspareunia, dyschezia, low back pain and bladder pain. In addition, there were significant reductions in voiding difficulty, bowel frequency, urgency, incomplete emptying, constipation and passing blood. These reductions were maintained at 2 years, with the exception of voiding difficulty. Global quality of life significantly improved from a median pretreatment score of 55/100 to 80/100 at 6 months. There was a significant improvement in quality of life in all measured domains and in quality-adjusted life years. These improvements were sustained at 2 years. All analgesia use was reduced and, in particular, opiate use fell from 28.1% prior to surgery to 16.1% at 6 months. The overall incidence of complications was 6.8% (321/4721). Gastrointestinal complications (enterotomy, anastomotic leak or fistula) occurred in 52 (1.1%) operations and of the urinary tract (ureteric/bladder injury or leak) in 49 (1.0%) procedures.ConclusionLaparoscopic surgical excision of rectovaginal endometriosis appears to be effective in treating pelvic pain and bowel symptoms and improving health-related quality of life and has a low rate of major complications when performed in specialist centres.

Objective To assess variation in the route of hysterectomy over 7 years and to assess regional variation in practice. Design Retrospective cohort study. Setting English NHS Hospitals 2011–2017. Population 230 876 patients having a hysterectomy for six diagnostic categories (endometrial cancer, endometriosis and pain, menstrual disorders, fibroids, benign adnexal masses, and ‘other’) identified from Hospital Episode Statistics. Methods The proportion of hysterectomies carried out by each route was calculated for each year overall and for each primary diagnosis by year. Comparisons between 2011 and 2017 were via chi‐square test. Rank correlation coefficients were calculated to assess trends over the study period. Analysis of regional variation in practice was restricted to 2017. A multivariable logistic regression was performed to obtain crude and adjusted odds of having a minimal access hysterectomy. Main outcome measures The proportion of abdominal, vaginal, laparoscopic, and failed laparoscopic procedures for each primary diagnosis by study year. Odds of a minimal access hysterectomy in 2017. Results The proportion of hysterectomies performed laparoscopically increased from 20.2% in 2011 to 47.2% in 2017, as did the proportion of failed laparoscopic procedures; 1.7% in 2011 to 2.8% in 2017. The proportion of abdominal hysterectomies decreased from 70.4% in 2011 to 46.5% in 2017. There was a smaller decrease in vaginal procedures from 7.8% in 2011 to 3.5% in 2017. Regional variation in the route of hysterectomy was demonstrated in 2017, which persisted when adjusted for confounding factors. Conclusions The proportion of laparoscopic procedures has increased, and it was the commonest route of hysterectomy for this cohort in 2017. There were significant regional differences in route of hysterectomy in 2017. Tweetable abstract Increasing laparoscopic hysterectomy and decreasing abdominal hysterectomy rates from 2011 to 2017 with regional variation in practice.

Both LSHP and VH are effective surgical options for uterovaginal prolapse. At 2 years, both procedures had similar improvement in symptom domains, overall scores, adverse events, recurrent prolapse, and new-onset SUI. Long-term randomized studies are needed.

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There are 8 cycle/ deg ripples or oscillations in performance as a function of location near Mach bands in experiments measuring Mach bands' masking effects on random polarity signal bars. The oscillations with increments are 180°out of phase with those for decrements. The oscillations, much larger than the measurement error, appear to relate to the weighting function of the spatial-frequency-tuned channel detecting the broadband signals. The ripples disappear with step maskers and become much smaller at durations below 25 ms, implying either that the site of masking has changed or that the weighting function and hence spatialfrequency tuning is slow to develop.