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STUDY OBJECTIVE To investigate the postoperative morbidity of laparoscopic hysterectomy (LH) for endometriosis/adenomyosis in terms of operative outcomes and complications. DESIGN Retrospective multicentric cohort study. SETTING Eight European minimally invasive referral centers. PATIENTS Data from 995 patients with pathologically confirmed endometriosis and/or adenomyosis who underwent LH without concomitant urological and/or gastroenterological procedures from January 2010 to December 2020. INTERVENTIONS Total laparoscopic hysterectomy. MEASUREMENTS AND MAIN RESULTS Demographic patients' characteristics, surgical outcomes, and intraoperative and postoperative complications were evaluated. We considered major postoperative surgical-related complications any grade 2 or more events (Clavien-Dindo score) that occurred within 30 days from surgery. Univariate analysis and multivariable models fit with logistic regression were used to estimate the adjusted odds ratio (OR) and corresponding 95% CI for major complications. Median age at surgery was 44 years (28-54) and about half of them (505, 50.7%) were on medical treatment (estro-progestins, progestin or GnRh-analogues) at the time of surgery. In association with LH, posterior adhesiolysis was performed in 387 (38,9%) cases and deep nodule resection in 302 (30,0%). Intraoperative complications occurred in 3% of the patients and major postoperative complications were registered in 93 (9.3%). The multivariable analysis showed an inverse correlation between the occurrence of Clavien-Dindo >2 complications and age (OR 0.94, 95%CI 0.90-0.99), while previous surgery for endometriosis (OR 1.62, 95%CI 1.01-2.60) and intraoperative complications (OR 6.49, 95%CI 2.65-16.87) were found as predictors of major events. Medical treatment at the time of surgery has emerged as a protective factor (OR 0.50, 95%CI 0.31-0.81). CONCLUSION LH for endometriosis/adenomyosis is associated with non-negligible morbidity. Knowing the factors associated with higher risks of complications might be used for risk stratification and could help clinicians during preoperative counseling. The administration of estro-progestin or progesterone preoperatively might reduce the risks of postoperative complications following surgery.

We report a case of an adnexal torsion in a 27-year-old woman in her 12th week of gestation. She presented with hypogastric and lumbar pain with biliary vomiting and nausea. Upon physical examination, tenderness in the right lower quadrant with rebound tenderness was apparent, and gynecological examination revealed right adnexal tenderness with absence of abnormal cervical discharge. The transvaginal ultrasonography demonstrated an enlarged cystic right ovary with no flow detected on color and power Doppler mode. We performed a laparoscopy and the diagnosis of adnexal torsion was confirmed. Detorsion of the right adnexa and cystectomy of the ovary was achieved without surgical or anesthetic complications. The patient was supplemented with progesterone during pregnancy and gave birth to a healthy child at term. Adnexal torsion is an unusual cause of abdominal pain in gestation with an incidence of 1-5:10.000, and it is more often observed during the first and early second trimesters of gestation. The clinical signs are often unspecific, and an ultrasound is the most commonly used imaging method for this diagnosis. The laparoscopy is the preferred method of diagnosis and treatment can be safely used in pregnancy if the guidelines are respected.

The workshop discussed the possibilities of innovative technologies to increase food production. Most of the concepts discussed are based on rainfall management, conservation and recycling. Simple technologies, adopted to local circumstances, can increase farm yields in small-scale agriculture. Small-scale rainfed agriculture is viable with intelligent utilisation of harvested rainfall. These small-scale technologies need however to be complemented with educational programs, incentives and trade to be broadly adopted and effective. The need for better documentation of results was also raised in the discussion.

Distributed hydrologic models describe both hillslope and channel processes. The presence of a large number of hillslopes requires that flood routing through a channel network be computationally efficient and able to account for hillslope or lateral inflow. This paper presents an analytical solution to the linearized Saint-Venant equation with lateral inflow uniformly distributed along the channel. The solution is given as the sum of two functions. The first function, obtained by several earlier authors, represents the response to the upstream inflow; the second function, derived in this study, represents the contribution from lateral or hillslope inflow. We test the latter on a simple channel, and the results compare well with those of a detailed numerical model for channels with steep to fairly gentle bed slopes. The errors due to linearization are presented, and the effects of channel-bed slope and the reference velocity are discussed. A run time comparison between the numerical and the analytical solutions shows that the latter is more efficient computationally and hence is ideal as an element of a distributed rainfall-runoff model.