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Compared to median sternotomy, the potential benefits of minimally invasive single aortic or mitral valve surgery include reduction of blood loss, lower morbidity, and shorter intensive care unit and hospital length of stay. However, there are few reports regarding concomitant aortic and mitral valves minimally invasive surgery via mini-thoracotomy. To the authors knowledge, this is the first report in the Liege area, of a successful minimally invasive right latero-thoracic approach for aortic and mitral valve surgery in a 78-year old woman who presented severe and symptomatic aortic stenosis and mitral insufficiency. In addition to the description of the surgical approach, the authors will summarize the current literature on this approach, as well as the clinical evolution of the patient.La chirurgie valvulaire isolée, aortique ou mitrale par voie mini-invasive offre de nombreux avantages par rapport à la sternotomie médiane en termes de réduction des pertes sanguines, de diminution de la morbidité et de réduction des durées de séjour aux soins intensifs et hospitalier global. Toutefois, il existe très peu de données dans la littérature sur la chirurgie combinée mitrale et aortique par mini-thoracotomie. à notre connaissance, nous présentons le premier cas de double chirurgie mitrale et aortique réalisée avec succès par abord latéral thoracique droit dans la région liégeoise chez une patiente de 78 ans qui présentait une sténose aortique et une insuffisance mitrale sévères et symptomatiques. En plus d’une description de notre technique chirurgicale, nous résumerons les grandes séries cliniques publiées dans la littérature sur le sujet, ainsi que l’évolution clinique de notre patiente.

New glaucoma surgery procedures. The treatment of glaucoma aims to lower intraocular pressure in order to stop the evolution of the optic neuropathy. Surgery is indicated if medical and/or laser treatments are not sufficient and/or not well tolerated. The new minimally Invasive glaucoma surgery (migs) procedures allow faster visual recovery and reduce the risk of complications.Fragilité et Précarité des personnes. Vivant avec le vih Vivre avec le vih en 2021 signifie être Atteint d’une maladie chronique qui n’est Toujours pas « comme les autres ». La Stigmatisation et les discriminations persistent, Et le pronostic reste incertain dans Les pays du sud, où l’accès aux soins reste Aléatoire et l’apparition de résistances Préoccupante. Être soigné pendant la pandémie de Covid-19 a représenté un défi de santé Publique, mais les personnes vivant Avec le vih (pvvih), plus précaires et Fragiles psychologiquement que la population Générale, ont été davantage Affectées par les difficultés d’accès Aux soins. La population des pvvih comprend en Particulier deux groupes principaux : les Migrants et les hommes qui ont des rapports Sexuels avec des hommes (hsh), Comme l’indiquent, en 2020, les chiffres Des nouvelles contaminations. La population migrante atteinte est hétérogène, Avec des personnes résidant sur Le sol français depuis des décennies mais Aussi des primo-arrivants, au parcours de Migration souvent semé d’événements Traumatiques. Outre le poids de l’atteinte Par le vih lui-même, les agressions fréquentes Et les préoccupations pour les Proches restés au pays, tout comme le Poids de l’exil, aboutissent à une prévalence Elevée des troubles psychiques. Aujourd’hui encore, être homosexuel ne va Pas toujours de soi, que la stigmatisation Provienne des autres ou qu’elle soit intégrée Par la personne elle-même (autostigmatisation). Le vieillissement est globalement Déprécié dans notre société et Particulièrement dans la communauté gay. Celle-ci est également atteinte par la pratique Du chemsex et du slam, des usages De substances psychoactives préoccupants. De tous ces éléments découlent de fortes Prévalences des troubles psychiques et Une éventuelle précarité sociale. La prise En charge des pvvih doit être globale, elle Nécessite de prendre en compte tous ces Aspects, médicaux, psychiques, sociaux, Et d’y associer les patients.

Several minimally invasive surgical therapies have been developed for the treatment of Lower Urinary Tract Symptoms (LUTS) associated with Benign Prostate Hyperplasia (BPH). The objective was to report an update on these new office-based therapies.This simple review is based on the data available in the literature on office-based minimally invasive surgical techniques for treating BPH. A PubMed search and narrative review of the data were performed in July 2021. Only articles in French or English were reviewed.The most studied office-based minimally invasive treatments for BPH are water vapor thermal therapy (Rezum® system, Boston Scientific Corporation, Marlborough, MA), prostatic urethral lift (UroLift® system, NeoTract, Inc., Pleasanton, California, USA) and the Temporarily Implanted Nitinol Device (iTind®, Medi-Tate Ltd, Hadera, Israel). Each treatment appears to provide rapid and lasting improvement in LUTS and quality of life, preservation of sexual and ejaculatory functions, rapid postoperative recovery with a minimal adverse event profile, thus allowing outpatient care. Compared to conventional BPH surgeries, these benefits would be offset by higher retreatment rates and less overall improvement in LUTS.New minimally invasive therapies are promising options that are well tolerated and preserve sexual and ejaculatory functions in men with BPH. Although standard surgical approaches may be more effective, these benefits are valuable for certain patient populations.

Head and neck cancer surgery often has functional and aesthetic consequences. De-escalation surgery is a major concern for surgeons with a constant desire to develop surgical techniques with less invasive approaches and to preserve anatomical structures as much as possible. This was made possible by the appearance of minimally transoral and endonasal surgery as well as by the limitation of the surgical procedure by neoadjuvant treatments or by the limitation of surgical excision without compromising the oncological outcome and patient survival. This evolution continues with the arrival of new technologies such as virtual reality or artificial intelligence.

Different surgical and non-surgical techniques have been developed in order to reduce the duration of orthodontic treatment. Regarding surgical techniques, corticotomies are widely used. The micro-osteoperforation technique (MOP), in addition to the piezocision technique, have been developed to provide minimally invasive surgery as an alternative to conventional corticotomies, without the elevation of a mucoperiosteal flap. Regarding non-surgical techniques, the approach is radically different in terms of physical stimuli or chemical techniques. Corticotomy and piezocision techniques have been found to be effective in accelerating orthodontic tooth movement, although the corticotomy technique presents a significant risk of postoperative treatment. These two techniques also offer the possibility of adding a bone graft using a tunneling surgical approach. Regarding non-surgical techniques, physical stimuli techniques such as with a laser are easy to perform, non-invasive and seem to be promising. However, their effectiveness has not yet been demonstrated, as is the case for chemical techniques. While at first glance these techniques are reassuringly non-invasive, do they not give the sensation of playing the sorcerer's apprentice ? Although surgical techniques seem to have demonstrated their significant efficacy in accelerating orthodontic tooth movement, non-surgical techniques do not yet provide a sufficient level of evidence and / or safety to be performed in our routine clinical practice as orthodontists. As these topics are innovative, new and future scientific evidence should be able to lead to the development of all these concepts.

Advanced epithelial ovarian cancer (EOC) is associated with high mortality and often managed first with neoadjuvant chemotherapy (NACT) followed by debulking surgery. Laparoscopic surgery with or without robotic assistance (Minimally Invasive Surgery (MIS)) may represent a beneficial option for these patients. The objective of this literature review is to clarify the place of MIS in the management of advanced EOC for selected patients.Pubmed, Cochrane and Clinicaltrials.gov online databases were used for this review, to select English or French published articles.We selected 11 original articles published between 2015 and 2020, 6 of which compared MIS and laparotomy. Among these 11 studies, 8 were retrospective cohorts, 2 were phase II trials, and one was a case-control study. In total, there were 3721 patients, of which 854 (23%) were treated with MIS. The robotic assistance was used with 224 patients (26%) of those MIS patients. Looking specifically at MIS patients, the laparoconversion rate was 9.5%, the rate of complete resection (CC-0) was 83.4%. Finally, the MIS complication rate was 1% intraoperatively and 12% postoperatively. The rate of complete resection, postoperative complication, as well as overall survival (OS) were comparable between patients treated with MIS or laparotomy. One study found an improved disease-free survival (DFS) in MIS versus laparotomy (18 months versus 12 months; P=0.027).MIS seems feasible, effective, and reliable in comparison to laparotomy for the completion of cytoreductive surgery after NACT without compromising oncological safety. Prospective randomized controlled trials are needed to confirm the role of MIS in advanced EOC.

The treatment of the early-stage cervical cancer is surgical. In the last ten years we have seen a surgical de-escalation and the development of new techniques such as the sentinel node biopsy. In 2018, absolutely against the trend, the study published in the New England Journal of Medicine by Pedro Ramirez upset the world of gynecologic-oncologists by demonstrating that the open approach is superior to the minimally invasive technique in the surgical management of these cancers. A long debate arose after the publication of this article, which remains the only prospective randomized study published to date on the subject. We therefore must take a step back and return to open surgery in the treatment of early-stage cervical cancer.Le traitement du cancer débutant du col de l’utérus est la chirurgie. Ces dix dernières années, on a assisté à une désescalade chirurgicale et au développement de nouvelles techniques comme celle du ganglion sentinelle. En 2018, en opposition avec l’évolution actuelle, l’étude publiée dans

The treatment of the early-stage cervical cancer is surgical. In the last ten years we have seen a surgical de-escalation and the development of new techniques such as the sentinel node biopsy. In 2018, absolutely against the trend, the study published in the New England Journal of Medicine by Pedro Ramirez upset the world of gynecologic-oncologists by demonstrating that the open approach is superior to the minimally invasive technique in the surgical management of these cancers. A long debate arose after the publication of this article, which remains the only prospective randomized study published to date on the subject. We therefore must take a step back and return to open surgery in the treatment of early-stage cervical cancer.

New surgical techniques for the treatment of benign prostatic obstruction (BPO) have emerged in recent years. We sought to give an overview on each of these technologies.A comprehensive review of the literature between 2013 and 2020 was carried out by a panel of national experts already practicing these interventions. All the data were then discussed among all the co-authors in order to obtain a consensus with regard to the selected articles and their analysis. Finally, an inventory was drawn to provide an overview of these technological advances and their availability in France.The treatment benign prostatic obstruction has diversified greatly over the past 5 years. 5 new technologies have emerged, allowing today a transurethral non-ablative treatment (UROLIFT®, ITIND®), a transurethral ablative treatment (REZUM®), a transurethral ablative treatment with robotic assistance (AQUABEAM®) or an endovascular management by embolization of the prostatic arteries. Only UROLIFT® is considered an established technology in the latest EAU-Guidelines. The other four are under evaluation and recommendations have only been issued for two of them, AQUABEAM® and the embolization of the prostatic arteries.These new minimally invasive techniques aim to increase the therapeutic options for the management of BPO in order to offer a management more suited to the wishes of the patient. Some are positioned as an alternative to surgical or medical treatment, others between medical and surgical treatment. These technologies are not all at the same level of development, evaluation and level of proof, but have in common a limited distribution in France, in particular given their cost. Validated studies will allow them to position their subsequent use more precisely.

There is a continuous growth in the incidence of cardiovascular and thoracic diseases, especially related to the increased life expectancy. Moreover, the quality and efficacy of care for these pathologies are progressing constantly. The evolution of surgery prompts us to develop less aggressive (minimally invasive), although technically more complex, treatment or diagnostic techniques. Pathologies, which until now required heavy surgeries, are managed today in a less invasive way and become therefore accessible to patients even if they are older or in a poor general condition. In this article, we present our experience in the development of the minimal invasive procedures in cardiovascular and thoracic surgery.Les pathologies cardiovasculaires et thoraciques, au sens large, sont de plus en plus fréquentes, vu l’augmentation de l’espérance de vie, mais elles sont aussi de mieux en mieux prises en charge. En effet, l’évolution de la chirurgie nous incite à développer des techniques de traitement ou de diagnostic moins agressives (mini-invasives) quoique techniquement plus complexes. Des pathologies qui nécessitaient, jusqu’à présent, des chirurgies lourdes se prennent en charge, aujourd’hui, de manière moins invasive et deviennent donc accessibles à des patients en moins bon état général ou de plus en plus âgés. Nous présentons ici notre expérience dans le développement de l’approche mini-invasive en chirurgie cardiovasculaire et thoracique.

Advances in the reconstructive surgery and minimally invasive endonasal endoscopic surgery of head and neck is poorly evaluated in terms of their impact on radiotherapy planning and outcomes. These surgical advances have resulted in reduced morbidity with equivalent or better tumor control. In the absence of a recommendation on how to delineate target volumes in patients with flaps or to consider margins after endoscopic endonasal surgery, radiotherapy practices are inevitably heterogeneous. Efforts are needed to increase the therapeutic index of postoperative radiotherapy in these situations. We analysed the rare existing literature and outlined a preliminary basis for a recommendation. Strengthening of multidisciplinarity to accurately define target volumes in these complex and relatively new situations, and "delineation concertation meetings" between radiologists, surgeons and radiation oncologists could probably contribute to improved outcomes.

Recommendations for the management of patients with gynecological cancer during the COVID-19 pandemic period.Recommendations based on the consensus conference model.In the case of a COVID-19 positive patient, surgical management should be postponed for at least 15 days. For cervical cancer, the place of surgery must be re-evaluated in relation to radiotherapy and Radio-Chemotherapy-Concomitant and the value of lymph node staging surgeries must be reviewed on a case-by-case basis. For advanced ovarian cancers, neo-adjuvant chemotherapy should be favored even if primary cytoreduction surgery could be envisaged. It is lawful not to offer hyperthermic intraperitoneal chemotherapy during a COVID-19 pandemic. In the case of patients who must undergo interval surgery, it is possible to continue the chemotherapy and to offer surgery after 6 cycles of chemotherapy. For early stage endometrial cancer, in case of low and intermediate preoperative ESMO risk, hysterectomy with bilateral annexectomy associated with a sentinel lymph node procedure should be favored. It is possible to consider postponing surgery for 1 to 2 months in low-risk endometrial cancers (FIGO Ia stage on MRI and grade 1-2 endometrioid cancer on endometrial biopsy). For high ESMO risk, it ispossible to favor the MSKCC algorithm (combining PET-CT and sentinel lymph node biopsy) in order to omit pelvic and lumbar-aortic lymphadenectomies.During COVID-19 pandemic, patients suffering from cancer should not lose life chance, while limiting the risks associated with the virus.

Penile erection implants are considered to be the « Gold Standard » for the treatment of erectile dysfunction with an organic component that escapes pharmacological and mechanical treatment. The place of preoperative information is fundamental. It is a simple and minimally invasive surgery. Penile Erection Implants are becoming more and more a full-fledged treatment line, which can be offered at the same time as other Erectile Dysfunction treatments. In this article, we will discuss the presentation of the different implants available, the elements underlying their indication, the place of preoperative information, the mains steps of the surgical procedure, the outcomes and satisfaction rates.Les implants péniens d’érection (IPE) sont considérés comme le gold standard du traitement de la dysfonction érectile (DE) à composante organique échappant aux traitements pharmacologiques et au traitement mécanique. Ils sont très largement associés à des taux de satisfaction élevés, des taux de complication bas et à une fiabilité élevée. La place de l’information préopératoire est fondamentale. Il s’agit d’une chirurgie simple et peu invasive. Les IPE s’imposent de plus en plus comme une ligne de traitement à part entière. Dans cet article seront abordés la présentation des différents implants disponibles, les éléments sous-tendant leur indication, la place de l’information préopératoire, les grands principes de la chirurgie, les résultats postopératoires et les taux de satisfaction.

Midurethral slings are the main surgical treatment of stress urinary incontinence. Altis is a minimally invasive single-incision sling system. The aim of this study is to report the safety and efficacity results during a year of follow up.This single-centre and retrospective study has been performed in a university hospital, between February 2015 and May 2018. We included women aged more than 18, complaining a stress urinary incontinence with a urethral hypermobility and positive support maneuvers, who had failed from non surgical treatment. A prospective data collection has been done at the moment of inclusion, peroperative time, at 6 weeks, 6 months and a year after the procedure. The main evaluation criteria was the cure rate at twelve months.Thirty patients were included in our study. The mean age was 45,4±12,9 years old, the mean ICIQ-UI score was 13,5±4,06 and the median pad test was at 12g. Ninety three percent of the procedures were done as ambulatory surgery. The average operating time was at 22,2minutes. Overall, 75% of our patients were objectively cured and 14,2% were in fail of this treatment.The short term results show a good efficacity and safety of this procedure. But its place remains to be defined in relation to other techniques, TVT, TOT and non-prosthetic techniques.3.

Aortic valve replacement is nowadays a safe procedure with low morbidity and mortality. However, the evolution of surgery requires the development of less invasive techniques. Aortic valve replacement through a right mini-thoracotomy, technically more complicated, offers a lower rate of complications including less postoperative pain and less blood loss and transfusion, with a faster recovery. We report our early experience of aortic valve replacement through a right anterior mini-thoracotomy.La chirurgie de remplacement valvulaire aortique offre toujours d’excellents résultats avec une morbidité et une mortalité faibles. Cependant, l’évolution de la chirurgie nous incite à développer des techniques mini-invasives. La mini-thoracotomie antérieure droite, pour la chirurgie de remplacement de la valve aortique, techniquement plus complexe, offre de nombreux avantages. Cette technique assure une réduction des pertes sanguines et des douleurs postopératoires, une meilleure fonction respiratoire, un rétablissement plus rapide (durée de séjour hospitalier plus court) et un bénéfice esthétique. Nous rapportons ici notre expérience initiale de remplacement valvulaire aortique par mini-thoracotomie antérieure droite.

Minimally invasive surgery has recently gained popularity. This paradigm shift involves a series of potential difficulties from the surgeon's perspective. With recent developments these obstacles are gradually being overcomed. Recent navigation systems offer major improvements in the way information is acquired, displayed, and integrated into the surgical workflow through augmented reality. Finally, the progress of robotics has helped to improve the minimally invasive dexterity and competence of the surgeon. This article sumarizes the main and most recent developments in the areas mentionned above, analyzes the current limits that still need to be addressed, and suggests possible future directions.La réalité augmentée en urologie a gagné en popularité ces dernières années. Des systèmes de navigation récents offrent des améliorations majeures en termes d’information acquise, qui est affichée et intégrée dans le flux de travail chirurgical, grâce à la réalité augmentée. De même, le progrès de la robotique a contribué à améliorer la dextérité et la compétence mini-invasives du chirurgien. Cet article résume les principaux et les plus récents développements dans les domaines susmentionnés, analyse les limites actuelles qui doivent encore être abordées et suggère des orientations futures possibles.

The volume of ambulatory surgery in urology increases every year. Successful ambulatory care is defined by low hospital (re)admission rates, insuring optimal oncologic and functional outcomes. New medical techniques such as minimally invasive surgical approaches and less side effects of anesthesia have helped the development of ambulatory surgery. Additionally, it is essential to lower the burden of healthcare systems financially, without compromising quality of care. Ambulatory surgery needs a multidisciplinary team involvement, where the general practitioner has a key role.La pratique ambulatoire en urologie augmente chaque année. Les avancées médicochirurgicales ont permis de diminuer les gestes invasifs et les effets secondaires des anesthésiques. Sur le plan financier, il est essentiel de contrôler les dépenses de santé publique, tout en maintenant comme premier objectif la sécurité du patient. Les critères de succès d’une prise en charge ambulatoire se mesurent au faible taux d’hospitalisation et de réadmission, sans compromission quant aux résultats de la chirurgie. La prise en charge ambulatoire exige une équipe pluridisciplinaire et le médecin traitant joue un rôle essentiel dans l’itinéraire clinique de son patient.

The duration of orthodontic treatment in adults remains a barrier for some patients. Some surgical techniques have been developed in order to accelerate orthodontic tooth movement. The technique of corticotomies is effective in decreasing the orthodontic treatment time but remains invasive, leading to significant postoperative consequences.Minimally invasive techniques without muco-periosteal flap elevation have been developed: corticision, micro-osteoperforations, piezopuncture and piezocision.The piezocision procedure seems to be the best compromise to accelerate orthodontic tooth movement while respecting a specific surgical and orthodontic protocol. The piezocision surgery allows the addition of biomaterials in cases of dehiscence and/or fenestration on the alveolar bone associated with moderate to severe overcrowding.According to current publications, minimally invasive corticotomy techniques can be viewed as a new therapeutic tool in the acceleration of orthodontic tooth movement.

Endobronchial ultrasound (EBUS) is a minimally invasive investigation method that permits transbronchial needle aspiration (TBNA) of mediastinal and hilar lymphadenopathies in order to determine their etiology. Its indications are notably lung cancer staging and lymphadenopathy exploration in case of sarcoidosis and malignant lymphomas. The employment of EBUS-TBNA has grown over the past few years and has become an alternative to mediastinoscopy due to a lower complication rate. However, in rare cases, complications can occur as hemorrhage, infections (mediastinitis, pneumonia, pericarditis, cyst infection, sepsis) or other (pneumothorax, pneumomediastinitis). We report herein a case of a mediastinitis after endobronchial ultrasound-guided transbronchial needle aspiration which occurred in a 63-year-old patient treated by methotrexate and methylprednisolone for a rheumatoid arthritis. The symptoms appeared as fever and progressive dyspnea some days after the endoscopic procedure.L’échographie endobronchique (EBUS : EndoBronchial UltraSound) est une technique d’investigation mini-invasive permettant la cyto-ponction transbronchique à l’aiguille fine (TBNA-TransBronchial Needle Aspiration) d’adénopathies médiastinales et hilaires afin d’en déterminer l’étiologie. Son recours est notamment indiqué dans la stadification des adénopathies lors du bilan d’extension de cancers broncho-pulmonaires et dans l’exploration d’adénopathies, par exemple en cas de sarcoïdose et de lymphomes. L’utilisation de l’EBUS-TBNA s’est répandue ces dernières années et est devenue une alternative intéressante à la médiastinoscopie, notamment en raison d’un taux de complications moindre. Néanmoins, le risque zéro n’existant pas, il se peut que surviennent, dans de rares cas, des complications de type hémorragiques, infectieuses (médiastinite, pneumonie, péricardite, infection de kyste, sepsis) ou autres (pneumothorax et pneumomédiastin). Nous rapportons le cas d’une médiastinite post-EBUS survenue chez un patient de 63 ans, traité par méthotrexate et méthylprednisolone pour une polyarthrite rhumatoïde, et se manifestant par l’apparition d’une fièvre et d’une dyspnée progressive quelques jours après le geste endoscopique.

L’endométriose est une pathologie chronique qui provoque des douleurs pelviennes et une infertilité. On décrit trois phénotypes d’endométriose :l’endométriose péritonéale superficielle, les kystes ovariens d’endométriose (endométriomes) et l’endométriose profonde.L’examen standard pour le diagnostic de l’endométriose est, encore aujourd’hui, la laparoscopie. Nous avons étudié, de façon prospective, l’utilité d’un examen non invasif, la tomographie par émission de positrons (PET), chez les patientes avec suspicion d’endométriose. Nous n’avons pas mis en évidence d’hyperactivité métabolique sur les images de PET pré opératoires, après injection de déoxyglucose marqué au 18F (18FDG), des lésions d’endométriose ayant été confirmées par laparoscopie. Nous avons réalisé, dans un second temps, la même étude après injection d’un analogue de la somatostatine, le DOTATATE, marqué au 68Ga, qui montre une avidité pour les récepteurs à la somatostatine (SSTR) de type 2. Dans cette dernière étude, seules les lésions d’endométriose profonde se sont révélées hyperactives sur les images pré opératoires de PET. Nous avons ensuite réalisé une étude immunohistochimique rétrospective sur différents échantillons d’endométriose superficielle, d’endométriomes et d’endométriose profonde. Nos résultats ont confirmé l’expression de SSTR de type 1 et 5 par les cellules épithéliales des trois phénotypes d’endométriose. Par contre, seules les lésions d’endométriose profonde exprimaient les SSTR de type 2.Le traitement chirurgical des endométriomes et de l’endométriose superficielle est bien codifié. Par contre, la chirurgie de l’endométriose profonde reste au cœur des débats dans la littérature. Nous avons évalué notre aptitude à appliquer les techniques de chirurgie mini-invasive aux procédures complexes telles que la résection des nodules d’endométriose profonde du septum recto-vaginal (NEPSRV). Nous avons évalué la faisabilité de la laparoscopie avec assistance robotique pour une autre procédure complexe :la dissection des ganglions para-aortiques dans le cadre des cancers du col utérin localement avancés. Nous l’avons jugée faisable et sûre pour les patientes. En l’absence de bénéfice démontré de la laparoscopie avec assistance robotique sur la laparoscopie conventionnelle pour le traitement des NEPSRV, nous avons décidé d’évaluer une nouvelle stratégie opératoire mini-invasive de résection des NEPSRV. Nous avons réalisé une analyse des 10 premières patientes opérées selon cette stratégie et avons montré une amélioration significative des symptômes et de la qualité de vie des patientes. Nous avons également étudié la morbidité post opératoire. Nous avons finalement étudié l’apport de la laparoscopie guidée par la fluorescence au traitement des NEPSRV et observé des résultats prometteurs.A l’avenir, les lésions symptomatiques d’endométriose profonde exprimant les SSTR2 pourraient être sélectionnées à l’aide d’un PET au 68Ga-DOTATATE afin d’être traitées, dans le cadre d’essais cliniques, par des analogues de la somatostatine. Ces thérapies ciblées permettaient, dans ces cas, d’éviter la chirurgie. Notre stratégie opératoire mini-invasive pourraient dès lors être appliquée aux lésions n’exprimant pas les SSTR2., Doctorat en Sciences médicales (Médecine), info:eu-repo/semantics/nonPublished

Minimally invasive aortic valve surgery aims at reducing surgical invasiveness whilst preserving the high efficacy of surgical aortic valve replacement. As such it increases the value of the overall procedure. The surgical experience at the ULg is reported and replaced in the context of the pertinent related litterature.La réalisation de la chirurgie de la valve aortique par une voie d’abord réduite atténue le traumatisme chirurgical subi par le patient, mais doit garantir un geste de qualité équivalente. Au travers de la présentation d’une histoire clinique inscrite dans la routine, nous rapportons l’expérience du service dans ce domaine et nous la confrontons aux données de la littérature. L’approche mini-invasive apporte des avantages supplémentaires par rapport à la chirurgie conventionnelle et s’inscrit dans l’évolution actuelle des procédures interventionnelles.

The feasibility of minimally invasive hysterectomy for ambulatory benign pathology has been demonstrated in many international studies. France has a considerable delay of multifactorial origin in this field. The objective of this study is to identify the limiting factors related to health professionals to the realization of minimally invasive ambulatory hysterectomy and to determine possible strategies to increase its rate.This is a cross-sectional survey conducted over 2 months using a self-administered questionnaire sent by email to 180 gynecological surgeons in 2 French regions (Grand Est and Bourgogne-Franche Comté).A total of 22% of health professionals responded to the survey. The vast majority of practitioners (60%) said they did not carry out ambulatory care by habit. The apprehension of the reaction of the patients (47.5%), the fear of delayed diagnosis of complications (12.5%), the management of pain in the postoperative period (42.5%) also participated in brake of the promotion of ambulatory care.Improvement of the organisation of city and hospital management allowing a better continuity of care (70%), the economic valuation (37.5%) and the increase in the hourly amplitude of the ambulatory surgery unit (5%) would improve the rate of ambulatory care of minimally invasive hysterectomies, according to the gynecologist surgeons surveyed. In addition, a prospective study evaluating the quality of life of patients after ambulatory care of minimally invasive hysterectomy would allow better adherence of health professionals and patients to the ambulatory care project in 70% of cases.The change of mentality of health professionals remains a priority for the promotion of ambulatory surgery in gynecology. Information and communication are therefore essential to the expansion of the ambulatory.

Hallux valgus is a frequent disorder of the foot and decision-making about the best treatment provokes many questions among patients and specialists. These include the need for surgery, which surgical technique is the best choice, and is minimally invasive surgery going to replace open techniques? While the modern media provides patients with easy access to details concerning surgical techniques, they rarely include means for the patient to distinguish between objective information and publicity. The general practitioner is a person of trust for the patient and should help him or her consider treatment proposals. With these factors in mind, the aim of this paper is to share the evidence-based information regarding the treatment of hallux valgus with the general practitioner.L’hallux valgus est une pathologie du pied fréquente et sa prise en charge suscite actuellement beaucoup de questions tant parmi les patients que parmi les experts. La chirurgie est-elle indispensable ? A quel moment faut-il opérer ? Quelle technique utiliser ? La chirurgie mini-invasive va-t-elle remplacer les techniques ouvertes ? Les médias modernes permettent aux patients un accès facile aux détails concernant les techniques chirurgicales existant sur le marché, sans pour autant leur donner des moyens de distinction entre l’information objective et la promotion. Le médecin traitant est un spécialiste de confiance vers lequel le patient doit pouvoir se tourner avant d’accepter une proposition thérapeutique. C’est pourquoi, et c’est le but de cet article, il nous paraît essentiel de partager la connaissance du traitement de l’hallux valgus basée sur l’évidence avec le médecin traitant.

The management of endometrial carcinoma is constantly evolving. The SFOG and the CNGOF decided to jointly update the previous French recommendations (Institut national du cancer 2011) and to adapt to the French practice the 2015 recommendations elaborated at the time of joint European consensus conference with the participation of the three concerned European societies (ESGO, ESTRO, ESMO).A strict methodology was used. A steering committee was put together. A systematic review of the literature since 2011 has been carried out. A first draft of the recommendations has been elaborated, with emphasis on high level of evidence. An external review by users representing all the concerned discipines and all kinds of practice was completed. Three hundred and four comments were sent by 54 reviewers.The management of endometrial carcinoma requires a precise preoperative workup. A provisional estimate of the final stage is provided. This estimation impact the level of surgical staging. Surgery should use a minimal invasive approach. The final pathology is the key of the decision concerning adjuvant therapy, which involves surveillance, radiation therapy, brachytherapy, or chemotherapy.The management algorithms allow a fast, state of the art based, answer to the clinical questions raised by the management of endometrial cancer. They must be used only in the setting of a multidisciplinary team at all stages of the management.

Minimally invasive surgery is a technique frequently used in gynecologic surgery. The robot-assisted surgery is a recent approach, and the benefits are not yet proven. The objective of this study was to evaluate the feasibility to use robot-assisted surgery for obese patient with endometrial cancer.All patients undergoing a robotic surgery for uterus malignant indication between March 2013 and May 2016 in our center were retrospectively included. Patients were divided in two groups, according to their body mass index (BMI). The group with BMI30kg/mSeventy-seven patients met inclusion criteria for analysis. The median robot operative time was 110minutes for all patients [21-341], without difference between the five groups (P=0.60). There was no difference for the total operative time (P=0.50). The median hospital stay was 3 days (P=0.92). There were ten intraoperative complications. One patient had a conversion (1.3%). There was no statistical difference for postoperative complications (P=1).Our study found few differences in the surgical management by laparoscopic robot-assisted between obese and non obese women. Robot-assisted surgery seems to be feasible for uterine cancer treatment of obese patients. Prospective and randomized studies are needed to assess the benefit of the robotic surgery.

This article summarizes recent advances in the field of urinary infections, bladder function, minimal invasive surgery and genitourinary cancers.Cet article résume les progrès récents dans le domaine des infections urinaires, de la fonction de la vessie, de la chirurgie mini–invasive et des cancers génito-urinaires.

International audience; Forward thinking does not seek to predict the future, to unveil it as if it were already in existence, rather, its aim is to help us to construct it. Although today's epidemiological and therapeutic situations for urogenital tumours can evolve over the next 10~years, diagnostic and therapeutic methods, as well as the treatment and implementation of innovations, are already rapidly changing. Rather than reducing our prospective thinking to the therapeutic treatment of cancer only, we will aim at proposing a global sanitary vision that includes diagnosis, therapies, prevention, routine utilisation of technomedicine, genomics and even nanomedicine. This journey into the near future of tomorrow's cancerology holds the promise of being better adapted to the evolution of the medical thinking process. Imagining the way we will be treating renal, prostatic and urothelial tumours in 10~years' time is as much an introspection into our present day treatment system as a projection into its hoped for future evolution.; La prospective n’a pas pour objet de prédire l’avenir, de nous le dévoiler, comme s’il s’agissait d’une chose déjà faite, mais de nous aider à le construire. Si le contexte épidémiologique et thérapeutique actuel de ces tumeurs urogénitales peut évoluer en 10 ans, les méthodes diagnostiques et thérapeutiques d’aujourd’hui, ainsi que les concepts de prise en charge et l’implémentation des innovations sont déjà en pleine mutation. Plutôt que de focaliser la prospective à 10 ans uniquement sur la thérapeutique des cancers, nous chercherons à proposer une vision globale sanitaire incluant diagnostics, thérapeutiques, préventions, et l’utilisation en routine de la technomédecine, la génômique ou encore la nanomédecine. Ce voyage, dans un futur proche dans la cancérologie de demain, promet d’être plus adapté à l’évolution du mode de penser la médecine. L’exercice d’imagination de la manière dont nous traiterons les tumeurs rénales, prostatiques et urothéliales dans 10 ans, est autant une introspection au sein de notre actuel système de soins, que la manière dont nous souhaitons et pouvons le voir évoluer.

Mitral regurgitation (MR) is the most frequent valvular disease in industrialised countries. MR is classified as primary (mostly degenerative with valve prolapse) or secondary (mainly due to underlying ischemic heart disease resulting in deformation of the valve structure). Surgical repair represents the optimal treatment for severe primary MR, whereas the benefits of surgical correction of secondary MR are controversial. Over the past few years, transcatheter techniques have been developed to treat MR, such as the percutaneous edge-to-edge procedure (MitraClip). These approaches represent a novel therapeutic choice for patients judged inoperable by the "heart team". This review article aims to summarize the principles of MR assessment and discuss current therapeutic options for severe MR, taking into account the latest advances in the field.

Anterior chest wall deformity are mostly represented by pectus excavatum, which is a depression of the chondrosternal plastron from the 3rd to the 7th pairs of the costal cartilages, then by pectus carinatum which conversely represents a protrusion of this plastron. The major esthetic and psychosocial impact is not to be demonstrated anymore whereas the cardiopulmonary functional impact remains still highly debated. Regarding the management, curative surgical techniques such as Wurtz's sub-perichondrial simplified sternochondroplasty or Nuss' minimaly invasive technique are opposed to palliative filling technique such as customized silicone implant, lipostructure and flaps. In addition to these there are non-surgical techniques like suction bells (Vacuum Bell

Primary open-angle glaucoma is a progressive ocular disease affecting adults and associated with visual field defect. The aim of its treatment is to lower the ocular pressure by means of ocular drops, laser or surgery. To date, traditional surgical techniques still remain quite invasive, but recent research efforts have been made with a view to develop minimally invasive techniques. The Xen Gel Stent is one of them. It allows a safe and efficient lowering of ocular pressure by creating a sub-conjunctival flow, following an ab interno procedure that highly preserves the architecture of the treated eye.

In this year 2015, the developments of new technologies as well as multidisciplinary management remained successfully. The implementation of enhanced rehabilitation after surgery pathways continued to expand both geographically and in various surgical specialties. The use of the vaporized intraperitoneal chemotherapy (PIPAC) showed promising results. Minimally invasive surgery was further implemented in various fields of rectal, endocrine and oesophageal surgery.

We describe a supraorbital approach through an upper eyebrow skin incision to treat a fronto-orbital fracture with pneumocephaly in a 84-year-old cardiac patient. The clinical and cosmetic results are excellent. This case is illustrated by pre- and postoperative CT-scan and MRI as well as pictures showing the minimal invasive technique.

In the early twentieth century, the understanding of spine biomechanics and the advent of surgical techniques of the lumbar spine, led to the currently emerging concept of minimal invasive spine surgery, By reducing surgical access, blood loss, infection rate and general morbidity, functional prognosis of patients is improved. This is a real challenge for the spine surgeon, who has to maintain a good operative result by significantly reducing surgical collateral damages due to the relatively traumatic conventional access.