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Résumé Objectifs Évaluer l’apport du bloc du nerf pudendal sur la qualité de l’analgésie en chirurgie gynécologique périnéale ou vulvaire. Patientes et méthodes Étude monocentrique prospective randomisée incluant toutes les patientes devant subir une chirurgie périnéo-vulvaire sous anesthésie générale. Les patientes ont été randomisées en 2 groupes : anesthésie générale seule (groupe AG, 41 patientes) ou associée à un bloc pudendal bilatéral guidé par neurostimulation (groupe BP, 42 patientes). L’évaluation de la douleur et la prescription d’hypnotiques et d’antalgiques en per- et en postopératoire était notée. Le critère de jugement principal était la moyenne des scores d’EVA de la douleur les 24 premières heures postopératoires. Résultats Il n’y avait pas de différence entre les moyennes des EVA les 24 premières heures, mais il semblait y avoir une réduction de l’EVA de la douleur à la deuxième heure dans le groupe BP. La consommation d’antalgiques en peropératoire était diminuée dans ce même groupe. Aucune complication à la réalisation du bloc pudendal n’a été à déplorer. Discussion et conclusion Le bloc pudendal guidé par neurostimulation est une technique simple et utile permettant, en association avec l’anesthésie générale, de diminuer la consommation d’antalgiques en peropératoires et une réduction de la douleur postopératoire immédiate dans les chirurgies vagino-périnéales, sans complication ni allongement de la durée opératoire. Des études de plus grande ampleur sont nécessaires pour confirmer l’efficacité de cette technique et évaluer les coûts et complications éventuelles. Objectives Evaluation of pudendal nerve block on the quality of analgesia in perineal or vulvar surgery. Patients and methods We realised a monocentered, prospective and randomised study of all patients undergoing perineo-vulvar surgery. Two groups of patients were evaluated: general anaesthesia alone (GA group, 41 patients) and both general anaesthesia and bilateral nerve stimulator-guided pudendal nerve block (15 mL of Ropivacaïne 5 mg.mL −1 + 0,5 μg.kg −1 of Clonidine) (PB group, 42 patients). Evaluation of pain was realised with per- and post-surgical prescription of hypnotics and antalgics was noted. The primary outcome measure was the Visual Analogic Scale (VAS) pain means scores in the first postoperative 24 hours. Results There was no difference in the VAS pain means scores in the first 24 hours, but it seemed to have a decrease in VAS pain at 2 hours in the PB group. Analgesic consumption during surgery was decreased in the same group. No complication of the pudendal block has been reported. Discussion and conclusion The nerve stimulator-guided pudendal nerve block is a simple and useful method which can, when associated with general anesthesia, reduce per-operative antalgics consumption and a decrease in the immediate postoperative pain in perineal or vulvar surgery, without complication or lengthening operating time. Further studies are needed to confirm the effectiveness of this technique and evaluate the costs and potential complications. [ABSTRACT FROM AUTHOR]

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]

Background: Almost 20% of parvovirus B19 foetal infections require intrauterine transfusions. In addition, myocardial dysfunction has been observed in severe parvovirus B19 infections. One objective of an intrauterine exchange transfusion (IUET) is to avoid an overload during the transfusion. Our aim was to study the obstetrical and neonatal outcomes in cases of IUETs performed for foetal parvovirus infections and to compare our survival rate to those studies in which simple in utero transfusions were chosen.Study Design and Methods: This was a retrospective monocentre study of all patients followed up for parvovirus B19 infections in which IUETs were performed. An IUET was indicated when foetal hydrops was observed and/or when severe foetal anaemia was diagnosed though an elevation in the middle cerebral artery peak systolic velocity. The characteristics of each pregnancy and the neonatal outcomes were studied until hospital discharge.Results: Thirty-five IUETs were performed in 26 foetuses. The median gestational age of the first IUET was 22.6 weeks. Only one foetal bradycardia incidence was recorded during the procedure. Three medical pregnancy terminations were observed in our series, secondary to severe cerebral anomalies confirmed in the magnetic resonance imaging. Five in utero deaths occurred, in which 2 of the foetuses underwent multiple IUETs. All the neonates had normal haemoglobin levels at birth, and none were transferred to the neonatal intensive care unit. The overall survival rate was 70%.Conclusion: IUETs exhibit a survival rate similar to that of simple intrauterine transfusions in foetal parvovirus infection cases. [ABSTRACT FROM AUTHOR]

BACKGROUND: Almost 20% of parvovirus B19 foetal infections require intrauterine transfusions. In addition, myocardial dysfunction has been observed in severe parvovirus B19 infections. One objective of an intrauterine exchange transfusion (IUET) is to avoid an overload during the transfusion. Our aim was to study the obstetrical and neonatal outcomes in cases of IUETs performed for foetal parvovirus infections and to compare our survival rate to those studies in which simple in utero transfusions were chosen. STUDY DESIGN AND METHODS: This was a retrospective monocentre study of all patients followed up for parvovirus B19 infections in which IUETs were performed. An IUET was indicated when foetal hydrops was observed and/or when severe foetal anaemia was diagnosed though an elevation in the middle cerebral artery peak systolic velocity. The characteristics of each pregnancy and the neonatal outcomes were studied until hospital discharge. RESULTS: Thirty‐five IUETs were performed in 26 foetuses. The median gestational age of the first IUET was 22.6 weeks. Only one foetal bradycardia incidence was recorded during the procedure. Three medical pregnancy terminations were observed in our series, secondary to severe cerebral anomalies confirmed in the magnetic resonance imaging. Five in utero deaths occurred, in which 2 of the foetuses underwent multiple IUETs. All the neonates had normal haemoglobin levels at birth, and none were transferred to the neonatal intensive care unit. The overall survival rate was 70%. CONCLUSION: IUETs exhibit a survival rate similar to that of simple intrauterine transfusions in foetal parvovirus infection cases. [ABSTRACT FROM AUTHOR]