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STUDY QUESTION Is temporary ovarian suspension following laparoscopic surgery for severe pelvic endometriosis an effective method for reducing the prevalence of postoperative ovarian adhesions? SUMMARY ANSWER Temporary ovarian suspension for 36–48 h following laparoscopic treatment of severe endometriosis does not result in a significant reduction of postoperative ovarian adhesions. WHAT IS KNOWN ALREADY Pelvic adhesions often develop following laparoscopic surgery for severe pelvic endometriosis. Adhesions can cause chronic pelvic pain and fertility problems compromising the success of treatment. Small observational studies suggested that temporary postoperative ovarian suspension to the abdominal wall may significantly reduce the prevalence of postoperative ovarian adhesions. STUDY DESIGN, SIZE, DURATION This was a prospective within group comparison double-blind RCT. We recruited premenopausal women with severe pelvic endometriosis who required extensive laparoscopic surgery with preservation of the uterus and ovaries. Severity of the disease and eligibility for inclusion were determined at surgery. A total of 55 women were randomized to unilateral ovarian suspension for 36–48 h, 52 of which were included in the final analysis. Both ovaries were routinely suspended to the anterior abdominal wall during surgery. At the end of the operation, each woman was randomized to having only one ovary suspended postoperatively. The suture suspending the contralateral ovary was cut and a new transabdominal suture was inserted to act as a placebo. Both sutures were removed 36–48 h after surgery prior to discharge. Three months after surgery, all women attended for a detailed transvaginal ultrasound scan to assess ovarian mobility. Both the women and the ultrasound operators were blinded as to the side of postoperative ovarian suspension. The primary outcome was the prevalence of ovarian adhesions as described on ultrasound examination. Secondary outcomes were the severity of adhesions and the presence and intensity of postoperative pain. PARTICIPANTS/MATERIALS, SETTING, METHODS All 55 participants had severe pelvic endometriosis confirmed at laparoscopy. As each participant had only one of their ovaries suspended at the end of surgery, they acted as their own control. MAIN RESULTS AND THE ROLE OF CHANCE The median interval between ovarian suspension and postoperative scan was 99 days (interquartile range 68–114). There was no significant difference (P = 0.23) in the prevalence of postoperative ovarian adhesions between the suspended (20/52) and unsuspended (27/52) side (38.5 versus 51.9%) [odds ratio 0.56 (95% confidence interval 0.22–1.35)]. LIMITATIONS, REASONS FOR CAUTION Ovaries were suspended postoperatively for 36–48 h. Longer suspension could result in lower prevalence of postoperative adhesions. WIDER IMPLICATIONS OF THE FINDINGS The value of temporary ovarian suspension in women having surgery for mild-to-moderate endometriosis should be investigated further. The potential benefits of other adhesion prevention strategies, such as surgical barrier agents, in women undergoing surgical treatment for severe pelvic endometriosis should also be explored. STUDY FUNDING/COMPETING INTERESTS E.S. received honoraria from Ethicon for provision of training to healthcare professionals and consultancy fees from Bayer. W.H. was supported by the research fund provided by the Gynaecology Ultrasound Centre, London UK. A.C. is on the advisory board for surgical innovations for which he receives an annual honorarium. A.C. also received support for courses and education from Storz and Johnson and Johnson and support for clinical nursing from Covidien and Lotus. The other authors declared no competing interests. TRIAL REGISTRATION NUMBER Current ... [ABSTRACT FROM AUTHOR]

Laparoscopic surgery has now replaced traditional open surgery as the preferred method of intervention for many procedures. Although there are advantages of laparoscopic surgery to the patient, the technology puts additional strain on the surgical team. There are three aspects to the theatre environment that need to be considered: staff safety, patient safety and cost efficiency. We have previously published on the effect of the laparoscopic theatre environment on staff safety. To our knowledge, there are no data on the effect of integrated theatres on surgical teamwork. We therefore wished to determine staff perception of the effect that the integrated theatre environment had on their working interactions and behaviour in the operating room. This was a cross-sectional questionnaire survey. Twenty-seven theatre staff (nurses, consultants and trainees) working in a laparoscopic theatre were asked to complete a questionnaire. This included general demographics and their perception regards the theatre environment and team interaction. Visual analogue scores were used to compare the integrated and non-integrated theatres. Non-parametric statistical analysis was used. Overall the theatre team members had a strong preference for working in an integrated theatre environment. They felt that it resulted in greater efficiency, better teamwork and reduced stress levels. Differences were highly significant ( p < 0.0001). This is the first paper ever to look at the impact of the theatre environment on comfort and behaviour of medical and nursing staff involved in carrying out laparoscopic surgery. It is only by assessing these factors and the quality of the operating theatre environment that the true benefits of integrated theatres will be appreciated. This investment not only protects staff and patients but these data suggest that the improved behaviours may further enhance safety and also create greater efficiency resulting in cost savings. [ABSTRACT FROM AUTHOR]

An employer has a legal requirement to offer a safe working environment to its employees. The risks and hazards should be reduced as far as practicably possible, and the set-up should be as ergonomic as possible. Modern laparoscopic surgery carried out in an old-fashioned theatre without the advantages that an integrated operating room has to offer results in increased risk of injury to the staff. We have assessed the relative risks and determined reasons why modernisation is essential to the safety of the theatre team. [ABSTRACT FROM AUTHOR]

Key content Mini laparotomy (suprapubic, transumbilical, ancillary port-site) and posterior colpotomy are methods that have been used for the removal of specimens excised laparoscopically, with the use of morcellators and endoscopic bags growing in popularity in recent years., The size, cystic versus solid component and the risk of malignancy are essential factors influencing the route of specimen retrieval. The risk of spillage (especially in suspected early malignancy) has to be considered during excision and retrieval., Natural orifice transluminal endoscopy ( NOTES) may be the operative and retrieval route of the future., Learning objectives To be aware of the different methods and routes of retrieving laparoscopically excised specimens., To be aware of the risks associated with each method and route., To review the factors that will influence the optimal choice of route and method., Ethical issues In the age of specialisation, a clinician who is not specially trained in operative laparoscopic surgery should not be practicing it. To minimise complications, the excision and retrieval of specimens via minimally invasive incisions should be limited to specially trained individuals. [ABSTRACT FROM AUTHOR]

We evaluated in a prospective observational study the use of a 'uterine sandwich' technique (uterine compression sutures in association with intrauterine tamponade) in women who had had unsuccessful medical treatment for postpartum hemorrhage. Ten of the 11 patients had cesarean sections (complicated by placenta previa and uterine atony) and one had a normal delivery. The median estimated blood loss and units of blood transfused were 1500ml (range 750-4000ml) and two units (range 0-9), respectively. B-Lynch sutures were placed in two patients and Hayman's modification was used in nine. Bakri balloon tamponade was in place for a median of 22hours (range 17-27hours), while the median volume infused in the balloon was 300ml (range 150-350ml). The combined technique was successful in avoiding hysterectomy in all cases, and there was no documented postpartum morbidity. This is a simple and quick surgical technique that can be used to treat atonic postpartum hemorrhage, particularly in conjunction with placenta previa. [ABSTRACT FROM AUTHOR]

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This paper aims to determine the correlation between the diagnosis of endometriosis on the basis of the visualisation at laparoscopy and the histological diagnosis. Histological confirmation rates vary in the current literature. We retrospectively reviewed 160 patients over 2 years, who had laparoscopy for pelvic pain or suspected endometriosis. Our results showed higher histological confirmation rate compared with other studies. In addition, the use of CD10 IHC may increase detection rates further when the diagnosis is suspected but not confirmed by routine histology. Diagnosis of endometriosis is essential as it can influence patients' management. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 36-year-old woman who underwent excision of the right Bartholin's gland which proved to be adenoid cystic carcinoma (ACC), one of the rarest neoplasms of the genital tract in women. Before surgery, she was treated with antibiotics due to the swelling at the Bartholin's gland but showed no improvement. The patient underwent hemivulvectomy and lymph node dissection without radiotherapy and was cured from the disease eight years after.

A letter to the editor is presented in response to the article about the essential way to undertake a hysterectom.

A letter to the editor is presented in response to the article "Uniforms and Workwear: An Evidence Base for Developing Local Policy" from Great Britain's Department of Health.