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Résumé Objectif La chirurgie de l’endométriose pelvienne profonde est associée à une morbidité importante. L’objectif de cette étude est d’évaluer l’intérêt de la cœlioscopie robot-assistée dans le cadre de l’endométriose pelvienne profonde et de caractériser les résultats périopératoires. Patientes et méthodes De novembre 2008 à avril 2012, 164 patientes ayant une endométriose de stade IV et opérées par cœlioscopie robot-assistée (DA VINCI ® ) ont été incluses par 8 centres internationaux. Les patientes ont été séparées en 4 groupes, en fonction de la localisation du ou des nodule(s) : rectum ( n = 88), vessie ( n = 23), ligaments utéro-sacrés ( n = 115) et hystérectomie ( n = 28). Nous avons ensuite évalué les procédures effectuées, les complications, les récidives et l’impact sur la fertilité. Résultats Dans le groupe rectum, il y a eu 1 laparoconversion, 1 transfusion de culots globulaires et 2 plaies rectales suturées (1,2 %). Dans le groupe vessie, un hématome vésico-vaginal et 1 cas d’auto-sondages prolongés. Dans le groupe ligaments utéro-sacrés, 2 fistules urétérales, et dans le groupe hystérectomie, aucune complication. Discussion et conclusion Il s’agit de la plus grande série publiée dans la littérature sur la cœlioscopie robot-assistée dans le cadre de l’endométriose pelvienne profonde. La cœlioscopie robot-assistée semble prometteuse dans cette indication, sans augmentation de la durée de la chirurgie, des pertes sanguines, et des complications per- et postopératoires. Objectives To assess the interest of robotic-assisted laparoscopy in the context of deep infiltrating endometriosis and to investigate perioperative results. Patients and methods From November 2008 to April 2012, 164 women with stage IV endometriosis who underwent robotic-assisted laparoscopy (DA VINCI Intuitive Surgical System ® ) were included by eight international participating clinical centers. Patients were divided in 4 groups according to the localization of the nodule(s): rectum ( n = 88), bladder ( n = 23), ureter and uterosacral ligaments ( n = 115) et hysterectomy ( n = 28). We evaluated the procedures performed, the duration of intervention, the complications, the recurrence and the impact on fertility. Results In the rectum group, there was a laparotomy conversion, 2 sutured rectal injuries and a red cells blood transfusion. In the bladder group, there was a vesicovaginal hematoma and a prolongated intermittent self-catheterization. In the ureter and uterosacral ligaments group, there was 2 ureteral fistulas and there was no complication in the hysterectomy group. Discussion and conclusion This study is the largest series published in the literature on robotic-assisted laparoscopy for deep infiltrating endometriosis. The interest of robotic-assisted laparoscopy in deep infiltrating endometriosis seems to be promising while no increase in surgical time, blood loss, and intra- and postoperative complications were observed. [ABSTRACT FROM AUTHOR]

Abstract: Endometriosis, defined by the development of endometrial tisue outside the uterus, is a benign disease responsible for infertility and pelvic pain. The diagnosis based on a detailed gynecological history and a careful clinical examination should be done as early as possible in order to treat patients correctly. Medical treatment is not appropriate in all cases and surgical treatment should be proposed but morbidity is related to the severity of the lesion. Ectopic implantation of endometrial cells needs complex interactions between host tissue and epithelial endometrial cells. The conditions for the development of endometriosis are estrogeno-dependent growth of endometrial cells, induction of angiogenesis and lymphangiogenesis. Principal cellular and molecular factors of angiogenesis, lymphangiogenesis and fibrosis should be identified in order to develop new therapeutic strategies of endometriosis. [Copyright &y& Elsevier]

The aim of our study is to test a combination of biological markers differentially expressed in samples from women with or without endometriosis. Methods ENDOSEARCH is a prospective multicentric international clinical trial registered with Clinical Trial.gov. 20 renowned specialized centers in Europe, USA, Canada, and the Indian Ocean, granted by the European Union aiming to validate a cluster of biomarkers. 1000 patients. The Patient Group includes women between 18 and 45 with suspected endometriosis undergoing laparoscopy. Patients with predominant adenomyosis and/or fibroids diagnosed by imaging, chronic, malignant, infectious, metabolic or endocrine diseases are excluded. The Control Group includes patients of same age group without any endometriosis-related clinical sign, with planned laparoscopic surgery for other indications. Samples of endometriosis lesions and endometrial biopsies for both groups are sent to a unique center (Endodiag, Paris, France) to be tested with the cluster of biomarkers. Laparoscopy for endometriosis or benign conditions (Control group). 40% of the patients recruited in the Endometriosis group have already had at least one and up to 4 previous laparoscopies for endometriosis. Almost 50% of the patients had an AFS score of III or IV. 14% of the patients suspected of endometriosis had negative pathology while 2% of the patients in the control group had severe endometriosis at laparoscopy and were excluded. We present the first large prospective multicentric international clinical trial aiming to test a cluster of biomarkers to diagnose endometriosis by recruiting over 1000 patients all around Europe, the US and Canada. Even in major referral centers almost 14% of the pre-op diagnosis were negative at pathology while 2% of the control group had severe endometriosis. Those preliminary results with others show the necessity of development of accurate biological tests to diagnose endometriosis and avoid unnecessary laparoscopies. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The objective of the study was to characterize the vascular architecture at the placental-maternal interface in pregnancies complicated by placenta increta and normal pregnancies. STUDY DESIGN: Vessel numbers and cross-section area density and spatial and area distributions in 13 placenta-increta placental beds were compared with 9 normal placental beds using computer-assisted image analysis of whole-slide CD31 immunolabeled sections. RESULTS: The total areas occupied by vessels in normal and placenta-increta placental beds were comparable, but vessels were significantly sparser and larger in the latter. Moreover, placenta-increta-vessel distributions (area and distance from the placental-myometrial junction) were more heterogeneous. CONCLUSION: Size and spatial organization of the placenta-increta vascular architecture at the placental-maternal interface differed from normal and might partially explain the severe hemorrhage observed during placenta-increta deliveries. [ABSTRACT FROM AUTHOR]