Leuven Institute for Fertility and Embryology LIFE

Leuven, Belgium

Leuven Institute for Fertility and Embryology LIFE

Leuven, Belgium

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De Wilde R.L.,University of Oldenburg | Alvarez J.,Hospital Universitario Infanta Sofia | Brolmann H.,VU University Amsterdam | Campo R.,Leuven Institute for Fertility and Embryology LIFE | And 6 more authors.
Archives of Gynecology and Obstetrics | Year: 2016

There is molecular evidence that endometriosis has a negative impact on the ovaries, although the exact pathophysiology concerning endometriosis-associated subfertility is not known. The negative impact on the tubo-ovarian unit can be directly by distorting the anatomy, indirectly by invoking inflammation or by oxidative damage with poorer-quality oocytes. Endometriosis even seems to have a negative effect on pregnancy outcome after in vitro fertilization. © 2016, Springer-Verlag Berlin Heidelberg.


Di Spiezio Sardo A.,University of Naples Federico II | Calagna G.,University of Palermo | Scognamiglio M.,University of Naples Federico II | O'Donovan P.,Royal Infirmary | And 2 more authors.
European Journal of Obstetrics Gynecology and Reproductive Biology | Year: 2016

Objective The purpose of the present review is to provide a survey of the various measures of preventing adhesions used in hysteroscopic surgery. Study Design A systematic computerized literature search was conducted to provide a survey of the various measures used in hysteroscopic surgery to prevent adhesions. Finally, 29 studies were included in the analysis, showing a wide variety of methods and agents advocated in international literature. They are explained in various sections, based on the IUA prevention approach adopted (surgical technique, early second-look hysteroscopy, barrier method, pharmacological therapy). Results The results of our review show that (i) use of surgical techniques which reduce the use of electrosurgery should be preferred whenever possible (Level of evidence: 4); (ii) an early second-look hysteroscopy would appear to be an effective preventive, as well as therapeutic, strategy regarding IUA but studies on the topic are too few for relevant evidence; (iii) barriers methods are the most widely used and, among these, gel barriers have been proven to have a significant clinical effect on IUA prevention, because of higher adhesiveness and prolonged residence time on the injured surface (Level of evidence: 1b); (iv) the role of hormonal and antibiotic therapy in the prevention of post-operative IUA is difficult to evaluate as it has been used in association with other prevention strategies in most studies included in our review. Conclusions Robust and high quality randomized trials to assess the effectiveness of different anti-adhesion therapies are still needed before one or more of these strategies may be strongly recommended for improving clinical outcomes in women treated by operative hysteroscopy. © 2016 Elsevier Ireland Ltd.


Brolmann H.,VU University Amsterdam | Tanos V.,University of Nicosia | Grimbizis G.,Aristotle University of Thessaloniki | Ind T.,Royal Marsden Hospital | And 12 more authors.
Gynecological Surgery | Year: 2015

In laparoscopy, specimens have to be removed from the abdominal cavity. If the trocar opening or the vaginal outlet is insufficient to pass the specimen, the specimen needs to be reduced. The power morcellator is an instrument with a fast rotating cylindrical knife which aims to divide the tissue into smaller pieces or fragments. The Food and Drug Administration (FDA) issued a press release in April 2014 that discouraged the use of these power morcellators. This article has the objective to review the literature related to complications by power morcellation of uterine fibroids in laparoscopy and offer recommendations to laparoscopic surgeons in gynaecology. This project was initiated by the executive board of the European Society of Gynaecological Endoscopy. A steering committee on fibroid morcellation was installed and experienced ESGE members requested to chair an action group to address distinct clinical questions. Clinical questions were formulated with regards to the sarcoma risk in presumed uterine fibroids, diagnosis of sarcoma, complications of morcellation and future research. A literature review on the different subjects was conducted, systematic if appropriate and feasible. It was concluded that the true prevalence of uterine sarcoma in presumed fibroids is not known given the wide range of prevalences (0.45–0.014 %) from meta-analyses mainly based on retrospective trials. Age and certain imaging characteristics such as ‘lacunes’ suggesting necrosis and increased central vascularisation of the tumour are associated with a higher risk of uterine sarcoma, although the risks remain low. There is not enough evidence to estimate this risk in individual patients. Complications of morcellation are rare. Reported are direct morcellation injuries to vessels and bowel, the development of so-called parasitic fibroids requiring reintervention and the spread of sarcoma cells in the abdominal cavity, which may possibly or even likely upstaging the disease. Momentarily in-bag morcellation is investigated as it may possibly prevent morcellation complications. Because of lack of evidence, this literature review cannot give strong recommendations but offers only options which are condensed in a flow chart. Prospective data collection may clarify the issue on sarcoma risk in presumed fibroids and technology to extract tissue laparoscopically from the abdominal cavity should be perfected. © 2015, The Author(s).


PubMed | Donauisar Klinikum Deggendorf Dingolfing Landau, University Hospital of Tuebingen, Elisabeth twee steden Hospital, Spire Hull and East Riding Hospital and 10 more.
Type: Review | Journal: Gynecological surgery | Year: 2015

In laparoscopy, specimens have to be removed from the abdominal cavity. If the trocar opening or the vaginal outlet is insufficient to pass the specimen, the specimen needs to be reduced. The power morcellator is an instrument with a fast rotating cylindrical knife which aims to divide the tissue into smaller pieces or fragments. The Food and Drug Administration (FDA) issued a press release in April 2014 that discouraged the use of these power morcellators. This article has the objective to review the literature related to complications by power morcellation of uterine fibroids in laparoscopy and offer recommendations to laparoscopic surgeons in gynaecology. This project was initiated by the executive board of the European Society of Gynaecological Endoscopy. A steering committee on fibroid morcellation was installed and experienced ESGE members requested to chair an action group to address distinct clinical questions. Clinical questions were formulated with regards to the sarcoma risk in presumed uterine fibroids, diagnosis of sarcoma, complications of morcellation and future research. A literature review on the different subjects was conducted, systematic if appropriate and feasible. It was concluded that the true prevalence of uterine sarcoma in presumed fibroids is not known given the wide range of prevalences (0.45-0.014%) from meta-analyses mainly based on retrospective trials. Age and certain imaging characteristics such as lacunes suggesting necrosis and increased central vascularisation of the tumour are associated with a higher risk of uterine sarcoma, although the risks remain low. There is not enough evidence to estimate this risk in individual patients. Complications of morcellation are rare. Reported are direct morcellation injuries to vessels and bowel, the development of so-called parasitic fibroids requiring reintervention and the spread of sarcoma cells in the abdominal cavity, which may possibly or even likely upstaging the disease. Momentarily in-bag morcellation is investigated as it may possibly prevent morcellation complications. Because of lack of evidence, this literature review cannot give strong recommendations but offers only options which are condensed in a flow chart. Prospective data collection may clarify the issue on sarcoma risk in presumed fibroids and technology to extract tissue laparoscopically from the abdominal cavity should be perfected.


PubMed | Poznan University of Medical Sciences, University of Heidelberg, University of Southampton, VU University Amsterdam and 6 more.
Type: Journal Article | Journal: Archives of gynecology and obstetrics | Year: 2016

There is molecular evidence that endometriosis has a negative impact on the ovaries, although the exact pathophysiology concerning endometriosis-associated subfertility is not known. The negative impact on the tubo-ovarian unit can be directly by distorting the anatomy, indirectly by invoking inflammation or by oxidative damage with poorer-quality oocytes. Endometriosis even seems to have a negative effect on pregnancy outcome after in vitro fertilization.


Campo R.,Surgery Academy | Campo R.,Leuven Institute for Fertility and Embryology LIFE | Reising C.,Surgery Academy | Reising C.,The Surgical Center | And 7 more authors.
Gynecological Surgery | Year: 2010

This study aims to evaluate the face and construct validity of the Laparoscopic Skills Testing and Training (LASTT) model, developed by the European Academy of Gynaecological Surgery (EAGS) for assessing laparoscopic psychomotor skills (LPS). This study is designed based on the Canadian Task Force II-1. This study was conducted in workshops organised by the EAGS in 2008 and 2009. One hundred ninety-nine gynaecologists were classified in three groups according to their exposure to laparoscopy (G1: no/little, G2: intermediate, G3: important). Participants performed three repetitions of three exercises (E1: camera navigation, E2: hands-eyes coordination, E3: bimanual coordination) with measurable objectives to accomplish within a limited time frame. The face validity of the model was assessed by an 11-item questionnaire using a 10-cm visual analogue scale. Q1- Q8 evaluated its capacity for testing and training LPS and Q9-Q11 its relevance for actual laparoscopic surgery. The score of each exercise was obtained by dividing the time to correct performed exercise by the number of objectives effectively accomplished. The correlation between E1-E3 scores and the level of exposure to laparoscopy was evaluated, and the scores of the different groups were compared to assess the construct validity. Participants gave a favourable opinion about the model without inter-group differences. In E1-E3, the scores correlated with the level of previous exposure to laparoscopic procedures, moreexperienced participants achieving better results than lessexperienced participants. The data demonstrate the face and construct validity of the LASTT model, suggesting that it can be a useful tool for training and evaluation of LPS in surgical disciplines that perform laparoscopic procedures. © Springer-Verlag 2010.

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