Combined Surgical and Hormone Therapy for Endometriosis is the Most Effective Treatment: Prospective, Randomized, Controlled Trial

Alkatout, İbrahim; Mettler, Liselotte; Beteta, Carmen; Hedderich, Jürgen; Jonat, W.; Schollmeyer, Thoralf; Salmassi, Ali

doi:10.1016/j.jmig.2013.01.019

Cited by 83 publications

(85 citation statements)

References 22 publications

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“…endometriosis and improved pregnancy rate. 33 Because progestin formulary may not uncommonly be prescribed in women without endometriosis/adenomyosis for other medical purpose, we included this aspect into the covariate analysis in the Cox models.…”

Section: Discussionmentioning

confidence: 99%

The Risks for Ovarian, Endometrial, Breast, Colorectal, and Other Cancers in Women With Newly Diagnosed Endometriosis or Adenomyosis: A Population-Based Study

Kok¹,

Tsai

et al. 2015

Int J Gynecol Cancer

105

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Section: Discussionmentioning

confidence: 99%

The Risks for Ovarian, Endometrial, Breast, Colorectal, and Other Cancers in Women With Newly Diagnosed Endometriosis or Adenomyosis: A Population-Based Study

Kok¹,

Tsai

et al. 2015

Int J Gynecol Cancer

105

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“…2 Combined surgical and medical treatment is often the most effective plan for improving the incidence of recurrence and the improvement of pregnancy rate in patients with endometriosis. 3 The high recurrence rate of ovarian endometrioma and its concurrent symptoms represents one of the less satisfactory aspects of the surgical treatment of endometriosis. 4 …”

Section: Introductionmentioning

confidence: 99%

Surgical Therapy of Ovarian Endometrioma: Recurrence and Pregnancy Rates

Maul

Morrision

Schollmeyer

et al. 2014

JSLS

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Background and Objectives:The study was designed to analyze preoperative clinical and surgical findings at enucleation of ovarian endometrioma with their impact on recurrence and pregnancy rates.Methods:This is a retrospective study of 550 histologically verified ovarian endometriomas operated on at the Department of Obstetrics and Gynecology, University Hospital Kiel, Germany, between 1995 and 2004. Preoperative data, surgical findings, and postoperative outcomes of 289 cases were analyzed. The average follow-up period was 12.9 years.Results:Ovarian endometriomas recurred in 23.9% of patients. Risk factors identified for recurrence of endometriomas were preoperative pain (P = .013), dysmenorrhea (P = .013), larger cyst size (>8 cm), younger age (<25 years), and preoperative cyst rupture. Factors associated with postoperative dysmenorrhea were younger age <25 years (P < .001), nulliparity (P = .020), and lager cyst size >8 cm (P = .048). Recurrence of pain was influenced by previous surgery of endometrioma (P < .05). Laparoscopy had a higher percentage of symptom-free patients than laparotomy did (49.0% vs 33.3%). Additional postoperative hormonal treatment resulted in a higher spontaneous pregnancy rate (41.4% vs 12.6%; P < .001) but a lower recurrence-free interval rate (70.5% vs 82.6%; P = .050) when compared with surgery only.Conclusions:We identified preoperative and intraoperative findings associated with higher risk of recurrence of endometrioma, pain, and dysmenorrhea. Patients desiring pregnancy benefited from postoperative hormone treatment, but no favorable results from combined therapy were observed with regard to recurrence rate.

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“…In economic terms, reusable trocars seem to be more costeffective than disposable instruments. However, the disadvantages of reusables are the time required for cleaning and sterilizing and the necessity of frequent sharpening and technical service (4,5).…”

Section: Reusable Trocarsmentioning

confidence: 99%

Abdominal anatomy in the context of port placement and trocars

Alkatout¹,

Mettler²,

Maass³

et al. 2015

J Turkish German Gynecol Assoc

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Review 241Introduction Extra-abdominal relevant anatomy Anatomical basis: The anterior abdominal wall has four muscles that are penetrated at all entries: rectus abdominis, external obliquus abdominis, internal obliquus abdominis, and transversus abdominis. Although the penetrating areas are variable in laparoscopy, the usual trocar placement uses similar inserting areas. Therefore, it is obligatory for any surgeon to be experienced in the anatomy of the abdominal wall and its consecutive relevant anatomical structures. There are no significant vascular structures that need to be respected upon insertion of the subumbilical trocar. Solely, strict attention has to be given to holding to the median line to avoid any accidental damage to paramedian structures. There are two arteries in the superficial abdominal wall that should be visualized. Damage to these arteries should be avoided because even superficial incisions can lead to severe bleeding that requires the conversion from laparoscopy to laparotomy. Both vessels can be visualized by diaphanoscopy (Figures 1-4). Trocar placement is performed, dependent on the corresponding internal site, at a 90° angle to the abdominal wall once the aiming point has been located. The superficial epigastric artery arises from the femoral artery approximately 1 cm below the inguinal ligament through the fascia cribrosa, turns upward in front of the inguinal ligament, and then ascends while spreading out between the two layers of the superficial fascia of the abdominal wall, nearly as far as the umbilicus. The circumflex iliac superficial artery originates from the femoral artery close to the superficial epigastric artery. After perforating the fascia lata, it runs parallel to the inguinal ligament and laterally to the iliac crist while spreading into smaller branches (1). Places for trocar insertionThe laparoscope and optic trocar should be inserted, whenever possible, in the subumbilical region using a semilunar or straight incision (Figure 1). Only if trocar placement is not possible, e.g., due to severe adhesions or large intra-abdominal tumors, are alternative entry sites negotiated, e.g., above the umbilicus or Palmer's point (Figure 5), as a precursor entry site.The placement for the working trocars depends on the operation. If the operative focus is located in the pelvis and no large tumor is expected to be touching the umbilical region, the two working trocars can be inserted in the lower abdominal wall in a vessel-free area, as confirmed by diaphanoscopy. Any auxiliary trocar can be placed in the midline suprasymphysically or left of the midline. A maximum distance between the optic trocar and the working trocars should be Although the anatomy of the human being has not changed, technical developments in operating materials and methods demand a simultaneous development in operative management. Developments in electronic and optical technologies permit many gynecological operations to be performed laparoscopically. One fundamental distinction between any other operating...

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Combined Surgical and Hormone Therapy for Endometriosis is the Most Effective Treatment: Prospective, Randomized, Controlled Trial

Cited by 83 publications

References 22 publications

The Risks for Ovarian, Endometrial, Breast, Colorectal, and Other Cancers in Women With Newly Diagnosed Endometriosis or Adenomyosis: A Population-Based Study

The Risks for Ovarian, Endometrial, Breast, Colorectal, and Other Cancers in Women With Newly Diagnosed Endometriosis or Adenomyosis: A Population-Based Study

Surgical Therapy of Ovarian Endometrioma: Recurrence and Pregnancy Rates

Abdominal anatomy in the context of port placement and trocars

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