Confocal laser endomicroscopy distinguishing benign and malignant gallbladder polyps during choledochoscopic gallbladderpreserving polypectomy:A case report

BACKGROUND In the last decade, confocal laser endomicroscopy (CLE) has emerged as a newendoscopic imaging modality for real-time in vivo histological examination at themicroscopic level. CLE has been shown to be useful for distinguishing benign andmalignant lesions and has been widely used in many digestive diseases. In ourstudy, we used CLE for the first time to examine the morphology of cholesterolpolyps as well as the different parts of normal gallbladder mucosa.CASE SUMMARY A 57-year-old woman was diagnosed by ultrasound with a polyp of 21 mm in thegallbladder wall. She consented to polyp removal by laparoscopic choledochoscopy.During laparoscopic cholecystectomy combined with choledochoscopicpolyp resection, CLE was used to observe the morphology of the polyp surfacecells. The appearance of the mucosa and microvessels in various parts of thegallbladder were also observed under CLE. Through comparison betweenpostoperative pathology and intraoperative CLE diagnosis, the reliability ofintraoperative CLE diagnosis was confirmed. CLE is a reliable method to examineliving cell pathology during cholecystectomy. Based on our practice, CLE shouldbe prioritized in the diagnosis of gallbladder polyps.CONCLUSION Compared with traditional histological examination, CLE has several advantages.We believe that CLE has great potential in this field.

“Zero ischemia”laparoscopic partial nephrectomy by high-power GreenLight laser enucleation for renal carcinoma:A single-center experience

BACKGROUND Laparoscopic partial nephrectomy has been widely used in renal cell carcinoma treatment.The efficacy of GreenLight laser on Laparoscopic partial nephrectomy is still unknown.AIM To present the first series of laparoscopic partial nephrectomy(LPN)by GreenLight laser enucleation without renal artery clamping.Due to the excellent coagulation and hemostatic properties of the laser,laser-assisted LPN(LLPN)makes it possible to perform a“zero ischemia”resection.METHODS Fifteen patients with T1a exogenous renal tumors who received high-power GreenLight laser non-ischemic LPN in our hospital were retrospectively analyzed.All clinical information,surgical and post-operative data,complications,pathological and functional outcomes were analyzed.RESULTS Surgery was successfully completed in all patients,and no open or radical nephrectomy was performed.The renal artery was not clamped,leading to no ischemic time.No blood transfusions were required,the average hemoglobin level ranged from 96.0 to 132.0 g/L and no postoperative complications occurred.The mean operation time was 104.3±8.2 min.The postoperative removal of negative pressure drainage time ranged from 5.0 to 7.0 d,and the mean postoperative hospital stay was 6.5±0.7 d.No serious complications occurred.Postoperative pathological results showed clear cell carcinoma in 12 patients,papillary renal cell carcinoma in 2 patients,and hamartoma in 1 patient.The mean creatinine level was 75.0±0.8μmol/L(range 61.0-90.4μmol/L)at 1 mo after surgery,and there were no statistically significant differences compared with pre-operation(P>0.05).The glomerular filtration rate ranged from 45.1 to 60.8 mL/min,with an average of 54.0±5.0 mL/min,and these levels were not significantly different from those before surgery(P>0.05).CONCLUSION GreenLight laser has extraordinary cutting and sealing advantages when used for small renal tumors(exogenous tumors of stage T1a)during LPN.However,use of this technique can lead to the generation of excessive smoke.

Effect of surface-enhanced laser desorption/ionization time-of-flight mass spectrometry on identifing biomarkers of endometriosis

Background Endometriosis is a common gynecological disease. This study aimed to screen proteins that were expressed differently in patients with endometriosis versus normal controls using proteomic techniques, surface-enhanced laser desorption/ionization time-of-flight mass spectrometry （SELDI-TOF-MS）.Methods Protein chip SELDI-TOF-MS combines the advantages of microarray and mass spectrometry, and can screen latent markers in sera of patients with endometriosis. Serum samples from patients and normal volunteers were analyzed by SELDI-TOF-MS. Results After comparing the serum protein spectra of 36 patients with 24 normal controls, 24 differently expressed potential biomarkers （P 〈0.01） were identified. Using Biomarker Pattern software, we established a tree model of the 60 serum protein spectra. When using the three bJomarkers to classify the samples, the sensitivity for diagnosing endometriosis was 91.7%, specificity was 95.8%, and coincidence rate was 93.3%. Then we used serum samples from 12 patients and 8 normal controls to validate the tree model and report the sensitivity for diagnosing endometriosis was 91.7%, specificity was 75%, and coincidence rate was 85%. Conclusions SELDI-TOF-MS may be a useful tool in high-risk population screening for endometriosis. The identification and application of the biomarkers need to further study.

Diagnosis and treatment of tubal endometriosis in women undergoing laparoscopy:A case series from a single hospital

BACKGROUND Tubal endometriosis(TEM)is a category of pelvic endometriosis(EM)that is characterized by ectopic endometrial glands and/or stroma within any part of the fallopian tube.The fallopian tubes may be a partial source of ovarian endometriosis(OEM).TEM is difficult to diagnose during surgery and is usually detected by pathology after surgery.AIM To provide a clinical basis for the diagnosis and treatment of TEM.METHODS In this study,the data of 30 patients who underwent laparoscopic salpingectomy due to various gynecological diseases and had pathological confirmation of TEM at our hospital were retrospectively analyzed,and the clinical basis for the diagnosis and treatment of TEM was evaluated.RESULTS Among 1982 surgical patients,30 met the study criteria.Among those,6 patients had a history of infertility,12 patients had a history of artificial abortion,13 patients had a history of cesarean section,1 patient had a history of tubal ligation,4 patients had an intrauterine device,and 22 patients had hydrosalpinx.Sixteen patients(53.33%)conceived naturally and gave birth to healthy babies.Pathology showed that only 2 patients had TEM without any other gynecological diseases,while the others all had simultaneous diseases,including 26 patients with EM at other pelvic sites.CONCLUSION The final diagnosis of TEM depends on pathological examination since there are no specific clinical characteristics.The rate of TEM combined with EM(especially OEM)was higher than that of other gynecological diseases,which indicates that TEM is related to OEM.

Role of colonoscopy in the diagnostic work-up of bowel endometriosis

AIM:To evaluate the accuracy of colonoscopy for the prediction of intestinal involvement in deep pelvic endometriosis.METHODS:This prospective observational study was performed between September 2011 and July 2014.Only women with both a clinical and imaging diagnosis of deep pelvic endometriosis were included.The study was approved by the local ethics committee and written informed consent was obtained in all cases.Both colonoscopy and laparoscopy were performed by expert surgeons with a high level of expertise with these techniques.Laparoscopy was performed within4 wk of colonoscopic examination.All hypothetical colonoscopy findings(eccentric wall thickening with or without surface nodularities and polypoid lesions with or without surface nodularities of endometriosis)were compared with laparoscopic and histological findings.We calculated the sensitivity,specificity,positive predictive value and negative predictive value for the presence of colonoscopic findings of intestinal endometriosis.RESULTS:A total of 174 consecutive women aged between 21-42 years with a diagnosis of deep pelvic endometriosis who underwent colonoscopy andsurgical intervention were included in our analysis.In 76 of the women(43.6%),intestinal endometrial implants were found at surgery and histopathological examination.Specifically,38 of the 76 lesions(50%)were characterized by the presence of serosal bowel nodules;28 of the 76 lesions(36.8%)reached the muscularis layer;8 of the 76 lesions(10.5%)reached the submucosa;and 2 of the 76 lesions(2.6%)reached the mucosa.Colonoscopic findings suggestive of intestinal endometriosis were detected in 7 of the174(4%)examinations.Colonoscopy failed to diagnose intestinal endometriosis in 70 of the 76 women(92.1%).A colonoscopic diagnosis of endometriosis was obtained in all cases of mucosal involvement,in 3of 8 cases(37.5%)of submucosal involvement,in no cases of muscularis layer involvement and in 1 of 38cases(2.6%)of serosa involvement.The sensitivity,specificity,positive predictive and negative predictive values of colonoscopy for the diagnosis of intestinal endometriosis were 7%,98%,85%and 58%,respectively.CONCLUSION:Being an invasive procedure,colonoscopy should not be routinely performed in the diagnostic work-up of bowel endometriosis.

Bowel endometriosis:Recent insights and unsolved problems

Bowel endometriosis affects between 3.8% and 37% of women with endometriosis.The evaluation of symptoms and clinical examination are inadequate for an accurate diagnosis of intestinal endometriosis.Transvaginal ultrasonography is the first line investigation in patients with suspected bowel endometriosis and allows accurate determination of the presence of the disease.Radiological techniques (such as magnetic resonance imaging and multidetector computerized tomography enteroclysis) are useful for estimating the extent of bowel endometriosis.Hormonal therapies (progestins,gonadotropin releasing hormone analogues and aromatase inhibitors) significantly improve pain and intestinal symptoms in patients with bowel stenosis less than 60% and who do not wish to conceive.However,hormonal therapies may not prevent the progression of bowel endometriosis and,therefore,patients receiving long-term treatment should be periodically monitored.Surgical excision of bowel endometriosis should be offered to symptomatic patients with bowel stenosis greater than 60%.Intestinal endometriotic nodules may be excised by nodulectomy or segmental resection.Both surgical procedures improve pain,intestinal symptoms and fertility.Nodulectomy may be associated with a lower rate of complications.

Laparoscopic umbilical trocar port site endometriosis:A case report

BACKGROUND Abdominal wall endometriosis can occur secondary to gynecological and obstetric pelvic laparotomy;however,this is a rare clinical event.There are few cases of endometriosis involving the incision site of a laparoscopic surgery,especially for those of the endometrial nodule at the umbilical trocar port site where the camera is placed.CASE SUMMARY We describe the case of a 37-year-old woman who presented with a 2-year history of a tough swelling below the umbilicus,which presented periodical pain during menstruation.The patient had undergone laparoscopic ovarian cystectomy 4 years prior,and we theorized that the umbilical nodule was a complication of that laparoscopic surgery.Histological analysis confirmed the diagnosis of abdominal umbilical scar endometriosis secondary to previous laparoscopic surgery.Surgical removal of the nodule followed by three cycles of leuprorelin was curative.CONCLUSION Abdominal mass and pain in women of childbearing age with a previous history of pelvic surgery should support consideration of endometriosis at the surgical site.

Clinical Research on Efficacy of Cassia Twig Tuckahoe Capsule and Mifepristone Combined with Laparoscopic Surgery for the Treatment of Endometriosis

Objective: To compare the clinical efficacy of Cassia Twig Tuckahoe capsule (Chinese Medicine) and Mifepristone combined with laparoscopic surgery for the treatment of endometriosis. Designs: Prospective cohort study. Setting: Gynecology and Obstetrics Department, Jingzhou Central Hospital, affiliated to Yangtze University. Methods: We selected 67 patients suspected with endometriosis and divided randomly into 2 groups on patient choice. Outcome Measures: Treatment efficacy, side effects, recurrence rate and pregnancy rate. Results: Comparing the effect of treatment between the two groups, the success rate was almost same (P > 0.5). However, the disappearance of pain was faster in Cassia twig Tuckahoe group (P Conclusion: After analysis of the result, Cassia twig Tuckahoe capsule combined with Laparoscopy is superior to the Mifepristone combined with Laparoscopy. Cassia twig Tuckahoe capsule is a very propitious medicine for treating endometriosis for long term benefits.

Experience with Diagnostic Laparoscopy in the Evaluation of Tubal Factor Infertility

Context and Objectives: Tubal factor infertility accounts for a large portion of female factor infertility. Tubal disease is responsible for 25% - 35% of female infertility. The most prevalent cause of tubal factor infertility is pelvic inflammatory disease and acute salpingitis. The incidence of tubal damage after one episode of pelvic infection is approximately 12%, 23% after two episodes and 54% after three episodes. Various modalities for investigating tubal factor infertility exist including: saline Infusion sonography (SIS), Hystero-contrast sonography (HyCoSy), hysterosalpingography (HSG) and laparoscopy with chromopertubation, the latter being the gold standard. The aim of this study was to determine the role of diagnostic laparoscopy in the evaluation of tubal factor in infertile women. Settings and Design: A retrospective descriptive study on all diagnostic laparoscopic procedures carried out to evaluate tubal factor infertility in the endoscopic gynecology unit of a tertiary-level hospital from 2010 to 2019. Methods: A retrospective descriptive study was conducted in the Department of Obstetrics and Gynaecology of a tertiary-level hospital in Ghana. A total of three hundred and ninety-one (391) records of all diagnostic laparoscopy procedures performed because of infertility in the endoscopic gynecology unit of a tertiary-level hospital between 2010 and 2019 were analyzed. Clients who underwent diagnostic laparoscopy to assess tubal factor infertility in the Obstetrics and Gynaecology Directorate of Komfo Anokye Teaching Hospital (KATH), Kumasi, from 2010 to 2019 were included in the study. Tubal patency was tested by laparoscopy and chromopertubation using methylene blue dye. The clinical characteristics of these women (age, parity, type of infertility), the intra-operative findings and complications were evaluated. Data on age, parity, type of infertility and intra operative findings were extracted using a proforma. Cases in which the bio-data or other clinical and laparoscopic findings were missing were excluded from the study. Ethical approval for the study was obtained from the Institutional Review Board (IRB) for Research and Development (R & D). A simple percentage method was used for statistical analysis. Results: A total of 391 women underwent diagnostic laparoscopy for investigation of tubal factor infertility between 2010 and 2019. The women’s mean age was 33.16 years. The youngest patient was 20 years and the oldest was 46 years. 232 (59.3%) patients were in primary infertility group while 159 (40.7%) patients were in secondary infertility group. 265 (66.8%) of the women were in the age group 20 - 35 years. The main laparoscopic findings for tubal factor were: 57.28% with bilateral tubal occlusion, 16.39% with unilateral tubal occlusion and 7.92% with hydrosalpinx. 18.41% had bilateral tubal patency. Other findings were identified during the laparoscopic procedure. For peritoneal abnormalities, 200 (51.15%) had normal findings, 184 (47.06%) had adhesions and 7 (1.79%) had peritoneal endometriosis. For uterine factor, 185 (47.31%) had normal uterus with no fibroids or adenomyosis, 202 (51.67%) had uterine fibroids, 2 (0.51%) had uterine anomaly and 2 (0.51%) had adenomyosis. For ovarian pathology, 13 (3.32%) had simple cyst, 2 (0.51%) had endometrioma, 184 (47.07%) had the ovaries involved in adhesions. 192 (49.10%) of patients had normal looking ovaries. There was no mortality or conversion to open laparotomy in this series. Conclusions: Unilateral and bilateral tubal blockade was detected in 73.67% of cases of infertile women. Diagnostic laparoscopy is a safe procedure.

Bowel endometriosis: Colorectal surgeon's perspective in a multidisciplinary surgical team

Endometriosis is a gynecological condition that presents as endometrial-like tissue outside the uterus and induces a chronic inflammatory reaction. Up to 15% of women in their reproductive period are affected by this condition. Deep endometriosis is defined as endometriosis located more than 5 mm beneath the peritoneal surface. This type of endometriosis is mostly found on the uterosacral ligaments, inside the rectovaginal septum or vagina, in the rectosigmoid area, ovarian fossa, pelvic peritoneum, ureters, and bladder, causing a distortion of the pelvic anatomy. The frequency of bowel endometriosis is unknown, but in cases of bowel infiltration, about 90% are localized on the sigmoid colon or the rectum. Colorectal involvement results in alterations of bowel habits such as constipation, diarrhea, tenesmus, dyschezia, and, rarely, rectal bleeding.Differential diagnosis must be made in case of irritable bowel syndrome,solitary rectal ulcer syndrome,and a rectal tumor.A precise diagnosis about the presence,location,and extent of endometriosis is necessary to plan surgical treatment.Multidisciplinary laparoscopic treatment has become the standard of care.Depending on the size of the lesion and site of involvement,fullthickness disc excision or bowel resection needs to be performed by an experienced colorectal surgeon.Longterm outcomes,following bowel resection for severe endometriosis,regarding pain and recurrence rate are good with a pregnancy rate of 50%.

Colorectal resection in deep pelvic endometriosis: Surgical technique and post-operative complications

AIM: To investigate the impact of different surgical techniques on post-operative complications after colorectal resection for endometriosis.METHODS: A multicenter case-controlled study using the prospectively collected data of 90 women(22 with and 68 without post-operative complications) who underwent laparoscopic colorectal resection for endometriosis was designed to evaluate any risk factors of post-operative complications. The prospectively collected data included: gender, age, body mass index, American Society of Anesthesiologists risk class, endometriosis localization(from anal verge), operative time, conversion, intraoperative complications, and post-operative surgical complications such as anastomotic dehiscence, bleeding, infection, and bowel dysfunction.RESULTS: A similar number of complicated cases have been registered for the different surgical techniques evaluated(laparoscopy, single access, flexure mobilization, mesenteric artery ligation, and transvaginal specimen extraction). A multivariate regression analysis showed that, after adjusting for major clinical, demographic, and surgical characteristics, complicated cases were only associated withendometriosis localization from the anal verge(OR = 0.8, 95%CI: 0.74-0.98, P = 0.03). After analyzing the association of post-operative complications and each different surgical technique, we found that only bowel dysfunction after surgery was associated with mesenteric artery ligation(11 out of 44 dysfunctions in the mesenteric artery ligation group vs 2 out of 36 cases in the no mesenteric artery ligation group; P = 0.03).CONCLUSION: Although further randomized clinical trials are needed to give a definitive conclusion, laparoscopic colorectal resection for deep infiltrating endometriosis appears to be both feasible and safe. Surgical technique cannot be considered a risk factor of post-operative complications.

ENDOMETRIOSIS IN ADOLESCENTS──ANALYSIS OF 6 CASES

Objective.To study the characteristics, diagnosis and treatment of endometriosis in adolescent patients. Method.Six cases of adolescent endometriosis in our hospital were reviewed retrospectively. Result. Endometriosis is the most common cause of chronic pelvic pain in adolescents. There may be a natural progression of endometriosis from atypical lesions in adolescents to classic lesions in adults. Congenital abnormalities of the reproductive tract are the main reasons for the adolescent endometriosis. Conclusion. Endometriosis should be strongly suspected in adolescent girls with chronic pelvic pain,especially unresponsive to oral contraceptives and nonsteroidal anti-inflammatory drugs. The treatment involves the operations and medicines.

Laparoscopy in the Diagnosis and the Treatment of Infertility（Analysis of 340 consecutive cases）

Three hundred and jorty patients suffering from primary and secondary infertility were investigated by laparoscopy with the following results. 1. The substantial and most common causes of infertility were related to chronic pelvic inflammatory disease and pelvic endometriosis. 2. Comparison of the result of chromopertubation under direct vision during loparoscy with the preoperative results with hysterosalpingography and phenolphthaline tubal instillation test showed significant difference (P<0.01). In the tubal patent group the compatibility of the results was 90.2% and 79% respectively whereas in the obstructed tubal group the discrepancy between the results was 50.5% and 59% respectively. 3. With the aid of laparoscopic investigation, the underlying cause of infertility could be verified in 97.6% of the patients. In 53.2% of the cases 14 different kinds of operations were performed directly under the laparoscope, while 12.9% of the cases required loparotomy. In 58.5% of the patients laparoscopy was performed in combination with hysteroscopy and 26 operations,consisting of uterine septum resection and intrauterine adhesiolysis were completed undder the monitoring of the loparoscope.

Systematic Review of Prevalence of Endometriosis among Indigenous Africans

Introduction: Although the prevalence of endometriosis is to a certain extent documented in women living in high resource countries, its prevalence in black Africa is unknown. Since the current view is that endometriosis hardly affects indigenous Africans, we aim to provide a systematic review of prevalence of endometriosis among the indigenous Africans. Objective: To determine the prevalence and clinical presentation of endometriosis in the indigenous African women. Methodology: A systematic literature search was carried out for relevant articles on all citations on PubMed, based on the key words “Endometriosis” and “Africa”. An additional search was done on African journal Online. Outcome Measures: The primary outcome measure was the prevalence of endometriosis among indigenous Africans. Results: Out of 58 identified paper’s, only 4 were eligible for the systematic review. The prevalence of endometriosis was 4.3% (Osefo et al. [1] and 8.2% (Ekwempu et al. [2]) in the laparotomy and hysterectomy specimen respectively. In the paper by Fawole et al. [3], where endometriosis was diagnosed on the basis of laparoscopic visualization alone without histological confirmation, the prevalence was 48.1%. Somigliana et al. [4] estimated endometriosis to be 0.2% based on clinical history, clinical examination and imaging, without surgical procedure to confirm this estimation. Due to differences in study populations, methodology and diagnostic criteria, it was not possible to have pooled prevalence of endometriosis. Conclusion: Although existing evidence suggests that the prevalence of endometriosis in indigenous Africans is 0.2% - 48.1%, the study analyzed had limitations. Prospective multi-centered studies with laparoscopic diagnosis and histological confirmation of endometriosis are required to establish the prevalence of endometriosis among the general population in the indigenous Africans. Endometriosis in Africa needs to receive more research attention. This paper is expected to stimulate and sensitize the clinicians and researchers in Africa about this condition.

Endometriosis: An “Unexplored”, “Neglected” or “Forgotten” Condition in Africa?

Endometriosis is a condition that is commonly encountered in gynaecological practice. Endometriosis has varied, non-specific clinical presentations and its diagnosis sometimes poses a challenge to the clinician. We have encountered various women with clinical presentation highly suggestive of endometriosis. Further diagnosis using imaging and biopsy confirmed endometriosis. This paper presents our experience of endometriosis in our care of African women and a review of the literature on endometriosis. We want to highlight the various clinical presentations of endometriosis, appraise the various methods for diagnosis, discuss the treatment modalities available and evaluate the impact of this condition on women. We want to emphasize the fact that African women also suffer from this condition, and impress upon clinicians, the necessity for closer look for the condition, stimulate discussion and research into endometriosis in Africa as it seems this condition is “neglected or forgotten” in Africa.

Laparoscopic diagnosis of endometriosis—Clinical study

Objective: To examine the laparoscopic findings in patients with suspicion of endometriosis. Study Design: Retrospective study. Setting: Department of Obstetrics and Gynecology, University of Oulu, Finland. Sample: First-time laparoscopy, without any known surgical diagnosis, was made in 53 consecutive patients between January 2006 and November 2011. Main Outcome Measures: The laparoscopic findings, staging of endometriosis, the percentages of different symptoms linked with endometriosis. Results: Laparoscopy revealed endometriosis in 40% of cases. Most frequent symptoms were dysmenorrhea (86%) and dyspareunia (81%) followed with vibration pain (71%), urinary symptoms (29%) and lowered fertility (24%). Only 5% of patients with endometriosis complained of bowel symptoms, which were significantly more common in patients without endometriosis (28%) (p = 0.034). The median interval between the onset of symptoms and laparoscopic diagnosis was 1.9 years (SD 3.2, range 0.6 - 11). Conclusions: The interval between the onset of symptoms and laparoscopic diagnosis is short reflecting the prompt availability of the necessary facilities in specialist health care. Finally laparoscopy seems to be safe in cases of endometriosis suspicion.

Association of endometrioma with ovarian teratoma and mucinous cystadenoma in a patient diagnosed with endometriosis: A case report

BACKGROUND Co-occurrence of different tumor types in a same patient’s ovaries diagnosed with endometriosis is a rare phenomenon.CASE SUMMARY In this article we present an uncommon association of three distinct ovarian pathologies in a same woman presenting with adnexal mass.A 31-year-old nulliparous woman with a large persistent adnexal mass underwent laparoscopic surgery.Imaging demonstrated a multi-cystic mass with internal echoes.Tumor markers were within normal range.Based on histopathologic assessment,benign mucinous cystadenoma and mature cystic teratoma of the right ovary together with endometrioma of left ovary were revealed.CONCLUSION In cases of large adnexal mass,the of existence of more than one tumor type and the involvement of the contralateral ovary is possible.Also,the possibility of concurrent underlying malignancy or diminished ovarian reserve should be kept in mind.

Robotic Assisted Surgery for Endometriosis—“Is the Way Forward?”

Endometriosis is a chronic and progressive gynecologic disorder that affects 10% - 50% of women of reproductive age worldwide. Chronic pain and infertility are the most debilitating problems associated with it requiring both medical and surgical treatment. Laparoscopy is considered the gold standard for diagnosis and treatment. However, a 10% rate of conversion to laparotomy has been reported when performed by skilled laparoscopic surgeons and much higher in low volume less skilled surgeons. To improve surgical outcomes, robotic assistance is the logical next step in performing minimally invasive gynecological surgeries, especially in complex endometriosis cases. Enhanced 3D visualization and 10× magnification along with Endowrist instruments with seven degrees of freedom facilitates precise and careful dissection. Firefly technology using ICG green dye can improve detection of small and invisible lesions. Robotics is useful in deep infiltrating disease manifesting as lesions deeper than the superficial tissues of rectovaginal septum, vaginal fornix, pelvic sidewalls, parametrium, bowel or ureter and bladder. Trials show no increase in surgical time, blood loss, or intra- or postoperative complications and similar clinical outcome when robotics is compared with laparoscopy. At present, it is more appropriate to compare it with laparotomy rather than laparoscopy. Robotics can be used to manage recurrence of endometriosis after hysterectomy. Surgeons experienced in conventional laparoscopy can utilize robotic platform for deep infiltrating endometriosis for performing complex surgical dissection and achieving the surgical goals in mind and reduce conversions to open surgery. Robotic assistance can bridge the gap in performance of laparoscopic surgery in advanced endometriosis.

Epidemiological Profile and Location of Lesions According to #ENZIAN of Patients Operated on for Endometriosis in a Public Endoscopic Surgery Centre, Yaounde, Cameroon

Introduction: Endometriosis is a chronic disease affecting approximately 10% of women. Our aim was to describe the epidemiological profile, clinical presentation and location of lesions in patients operated on for endometriosis. Methodology: We conducted an analytical cross-sectional study with retrospective data collection over a period of 05 years from 1 January 2017 to 31 March 2022. Our study population consisted of women who had undergone laparoscopy for endometriosis. Data analysis was performed using SPSS software version 23.0. Results: In total we included 159 patients who had undergone laparoscopy for endometriosis. The mean age was 32.9 ± 5.9 years, most of whom were nuligravida 61.6% (n = 99). Infertility was the most frequent reason for consultation, accounting for 72.3% (n = 115), followed by dysmenorrhoea in 60.8% (n = 96) of cases and chronic pelvic pain in 37.7% (n = 60). In addition, 46 (28.9%) patients complained of deep dyspareunia, 17 (10.7%) of dyschezia and nine (5.7%) of dysuria. Magnetic Resonance Imaging (MRI) was used in one patient. Diagnostic laparoscopy was performed directly in 77 (48.4%) patients. The lesions were multifocal, according to the #ENZIAN classification nomenclature. Tubal lesions were most frequently found 107 (67.3%) on the left, followed by compartment B (uterosacral ligaments, cardinal ligaments and lateral pelvic wall) 49.7% (n = 79), and endometriomas 40.9% (n = 65). Conclusion: Women operated on for endometriosis were of a more advanced age, and predominantly nulliparous. Infertility was the most frequent reason for consultation and tubal location most frequently encountered for superficial lesions and compartiment B for deep lesions according to #ENZIA.

Endometriosis Diagnosis Correlation of Laparoscopic Visualization and Histopathology Confirmation in Low Resource Setting

Background: Endometriosis is enigmatic clinical entity which is described as the location of the endometrial tissue external of the uterine cavity. Endometriosis constitutes a serious health issue due to its high affliction of 10% of reproductive women. With limited resources in Africa, it is essential to assess whether diagnosis of endometriosis by laparoscopic visualization can be used as a substitute for histology. Objective: To correlate the diagnosis of endometriosis by laparoscopic visualization and the histological confirmation of the biopsy taken. Methods: A prospective cross sectional study with a sample size of 443 was undertaken in the diagnosis of endometriosis among Africans in Nairobi, Kenya from March 2019 to March 2021. Women undergoing laparoscopy were screened for endometriosis by visualization and a biopsy was taken for histopathology. Diagnosis of endometriosis by visualization was correlated with histological confirmed endometriosis. Results: Women with a diagnosis of endometriosis through laparoscopic visualization were found to be 77 (17.4%) and 30 (6.8%) had positive histology for endometriosis. Laparoscopic visualization diagnosis had a low positive predictive value of 39%. Conclusion: Laparoscopic visualization diagnosis had a low positive predictive value of 39% and this did not correlate with histopathologic diagnosis. It is essential to perform biopsy with histopathology for the confirmation of endometriosis.