Search

Introduction: Endometriosis is a common, often-debilitating disease, affecting women of reproductive age. Pain is a common symptom of the disease and is commonly treated by surgery, medical therapy, or a combination of the two. This study aimed to evaluate the rates of ongoing pain post laparoscopic excision and the risk factors for ongoing pain symptoms. Method(s): This retrospective cohort study analyzed the medical records of all patients who underwent laparoscopic surgery for endometriosis in a large tertiary healthcare service in Australia between January 2009 and September 2016. Results were analyzed using SPSS statistics version 11. Result(s): A total of 972 patients met the inclusion criteria; of these, 398 had follow-up at our hospital network and were included in the final analysis. The median age was 34.5 years, 69.6% were of Caucasian ethnicity, and the median body mass index was 25.9; 70.6% of our patients reported decreased pain after surgery. Patients who suffered from chronic pain were twice as likely to experience ongoing pain, while patients with stage 3-4 endometriosis were found to have 65% reduced odds of pain at follow-up (95% confidence interval = 0.22-0.61, p < 0.001). In univariate analysis of non-Caucasian patients, those who had a specialist endometriosis surgeon perform the surgery had significantly higher incidence of symptom improvement (58% reduced odds of recurrent pain and 40% reduced odds, p < 0.05, accordingly). Conclusion(s): The prevalence and severity of pain associated with endometriosis mandates a thorough understanding of the effectiveness of current management. Our article highlights the utility of laparoscopic surgery in treating endometriosis-associated pain.Copyright © The Author(s) 2020.

Introduction Endometriosis is a debilitating chronic inflammatory condition highly burdensome to the healthcare system. The present trial will establish the efficacy of (1) yoga and (2) cognitive-behavioural therapy (CBT), above (3) education, on quality of life, biopsychosocial outcomes and cost-effectiveness. Methods and analysis This study is a parallel randomised controlled trial. Participants will be randomly allocated to yoga, CBT or education. Participants will be English-speaking adults, have a diagnosis of endometriosis by a qualified physician, with pain for at least 6 months, and access to internet. Participants will attend 8 weekly group CBT sessions of 120 min; or 8 weekly group yoga sessions of 60 min; or receive weekly educational handouts on endometriosis. The primary outcome measure is quality of life. The analysis will include mixed-effects analysis of variance and linear models, cost-utility analysis from a societal and health system perspective and qualitative thematic analysis. Ethics and dissemination Enrolment in the study is voluntary and participants can withdraw at any time. Participants will be given the option to discuss the study with their next of kin/treating physician. Findings will be disseminated via publications, conferences and briefs to professional organisations. The University's media team will also be used to further disseminate via lay person articles and media releases. Trial registration number ACTRN12620000756921p; Pre-results. Copyright © 2021 BMJ Publishing Group. All rights reserved.

IntroductionEndometriosis is a debilitating chronic inflammatory condition highly burdensome to the healthcare system. The present trial will establish the efficacy of (1) yoga and (2) cognitive–behavioural therapy (CBT), above (3) education, on quality of life, biopsychosocial outcomes and cost-effectiveness.Methods and analysisThis study is a parallel randomised controlled trial. Participants will be randomly allocated to yoga, CBT or education. Participants will be English-speaking adults, have a diagnosis of endometriosis by a qualified physician, with pain for at least 6 months, and access to internet. Participants will attend 8 weekly group CBT sessions of 120 min; or 8 weekly group yoga sessions of 60 min; or receive weekly educational handouts on endometriosis. The primary outcome measure is quality of life. The analysis will include mixed-effects analysis of variance and linear models, cost–utility analysis from a societal and health system perspective and qualitative thematic analysis.Ethics and disseminationEnrolment in the study is voluntary and participants can withdraw at any time. Participants will be given the option to discuss the study with their next of kin/treating physician. Findings will be disseminated via publications, conferences and briefs to professional organisations. The University’s media team will also be used to further disseminate via lay person articles and media releases.Trial registration numberACTRN12620000756921p; Pre-results.

Hysteroscopy is one of the most frequent procedures that a gynecologist will perform over their career. It is also one of the safest procedures. Operative hysteroscopy has an increased risk profile due to the nature of the surgery. The following review will address the issue of gas embolism in hysteroscopy. This review will look at the evidence regarding the likely causation, rates, and potential methods of minimizing risk to patients as well as treatment options available should this complication arise.Copyright © The Author(s) 2019.

Objective: To evaluate the prevalence of unsuspected uterine sarcomas undergoing morcellation at the time of hysterectomy or myomectomy. Design(s): A retrospective cohort study. Setting(s): A teaching health service in Melbourne, Australia, consisting of four hospitals which provide gynecology and gynecology oncology services including one tertiary referral center. Population: All women undergoing any form of hysterectomy or myomectomy from 1998 to 2016. Method(s): Patient demographics and the presence of morcellation were collected. All cases of confirmed uterine sarcomas were further examined and their histological subtype, patient demographics, preoperative investigations, and surgical indication were also identified. Result(s): A total of 7584 cases were studied. Overall, 33 uterine sarcomas were identified. Of these, seven cases were unsuspected malignancies. All seven cases were leiomyosarcomas. None of the malignant specimens underwent morcellation. The overall prevalence of uterine sarcomas in the total study population was 0.44%. The rate of unsuspected uterine sarcomas in women undergoing hysterectomy or myomectomy for presumed benign indications was 0.13% or 1 in 769. The rate of unintended morcellation of a uterine sarcoma in our center was 0%. The diagnosis of endometrial sarcoma was prompted by endometrial sampling in 58% of the cases when performed. Conclusion(s): The risk of inadvertent morcellation of unsuspected uterine sarcomas is low. Patients should be appropriately selected with adequate investigations and a detailed history and examination prior to surgery. Further studies are needed to identify effective preoperative screening methods for uterine sarcomas.Copyright © The Author(s) 2018.

The presence of fibroids and endometrial polyps is associated with reduced endometrial receptivity and subsequent fertility outcomes. The following review explores the molecular mechanisms behind reduced endometrial receptivity, with a focus upon homebox genes, basic transcription element binding proteins, transforming growth factor beta-3, and bone morphogenetic protein 2. A better understanding of these processes is essential for future targeted therapy.Copyright © 2017 Wichtig Publishing.

Introduction: Colorectal involvement occurs in up to 12% of cases of endometriosis. Various surgical options for its management have been described, including segmental resection and disc excision, with debate surrounding indications for surgery and the impact of such procedures. The current study aimed to describe the experiences of three Australian gynaecologists regarding laparoscopic bowel surgery for colorectal endometriosis. Method(s): The records of three gynaecological surgeons were analysed for patients who underwent surgical removal of colorectal endometriosis by way of appendicectomy, bowel disc excision and/or segmental resection, between 1999 and 2012. Result(s): A total of 307 patients were identified. Sixteen (5.2%) underwent appendicectomy, 146 (47.6%) underwent disc excision, 126 (41.0%) underwent segmental resection and 19 (6.2%) underwent simultaneous procedures. The majority of procedures were performed laparoscopically (265 of 307; 86.3%). Nineteen procedures (6.2%) were planned laparotomies due to the known extent of disease. Twenty-three procedures were converted from laparoscopy to laparotomy (conversion rate of 7.5%). Complications occurred in 35 of the 307 cases (11.4%). Sixty-seven women amongst the 122 wishing to conceive post-operatively achieved at least one pregnancy (pregnancy rate of 54.9%). Of the 84 pregnancies achieved amongst the 67 women who conceived, 49 (58.3%) were achieved through assisted reproductive technologies, and 31 pregnancies (36.9%) were conceived spontaneously. This information was unavailable for 4 pregnancies (4.8%). Conclusion(s): The current series demonstrates that laparoscopic surgery for severe disease is feasible in specialised centres. Furthermore, such surgery may have a positive impact upon post-operative fertility.Copyright © 2017 Wichtig Publishing.

In this presentation I will present the evidence for surgery in women infertility and endometriosis. I will cover the evidence for surgery relating to AFS stage 1 & 2, Endometriomas and AFS stage 3 & 4. Currently there is varied data on the place of surgery in the above groups. There are obviously advocates for and against surgery worldwide. This lecture will present a balanced approach and emphasize the value of individualisation of treatment in these varied patient groups, in particular the more complex patient group with stage 3&4 DIE. Surgery and IVF should not be seen as conflicting management modalities but rather complimentary and often vital together in the management of the more complex endometriosis situations. Not only is surgery a critical component of management but correct application of skills and training to minimize complications and maximise fertility outcomes are vital. I will also present our most recent data in our patient cohort with colorectal endometriosis and infertility. To facilitate surgical training and management into future AGES is proud to announce the adaptation of its two year fellowship in advanced gynaecological endoscopy. I will briefly touch on the development of this programme and the vital role it will play in the development of our future leaders in gynaecological endoscopy in Australia.

Study Objective: To evaluate the incidence and severity of recurrent endometriosis, success rate of surgery, medical treatment and associated risk factors for recurrence. Design(s):Aretrospective review of patients diagnosed with endometriosis from July 2009 to June 2016. Setting(s):AMulti-centre medical centre with a tertiary level endometriosis unit Patients: Patients who underwent surgery for endometriosis-associated pain, were followed-up in our unit and had complete computerized medical records available. A total of 385 patients were included in the assessment. Intervention(s): N/A Measurements and Main Results: The demographic characteristics, stage of endometriosis, associated medical conditions; type of surgery and other medical treatments were evaluated. Student T-Test and Chi Square Test were used to compare variables. The number of patients diagnosed with stage 1 and 2 endometriosis was 223 (57.9%) and 162(42.1%) stages 3& 4. Pain was an indication for surgery in 330 (85.7%) patients, endometrioma in 136(35.3%) and infertility+/-pain in 63 (16.4%). In patients with preoperative pain, 99 (30%) had complete resolution, 143 (43.3%) had improvement in their symptoms & 71 (21.5%) had no change at the 6-8 week post-operative review. On further follow-up, recurrent pain symptoms were reported in 73 of 242 (30.1%). The average time for symptom recurrence was 14.7 months (range 1-72 months, SD 14.9). Of those patients, 39 (53.4 %) were diagnosed as having stage 1&2 and 34 (46.6%) stages 3&4. All patients were offered post-operative hormonal treatment, 139 (42.1%) chose not to have any. Conclusion(s): Our study confirms the high rate of symptom improvement after laparoscopic excision of endometriosis. However, in accordance with previous studies, the risk of recurrence is high. Our results show no correlation of endometriosis stage and recurrence of pain. Medical treatment did not affect chance of pain recurrence, however, this could be due to the relatively small

Study Objective: The aim of the current study was to evaluate the effect that high BMI (>=30) had on the surgical outcomes of patients undergoing operative laparoscopy for endometriosis. Design(s): Retrospective Cohort Study. Setting(s): Monash Health hospitals in Melbourne, Australia. Patient(s): All patients who underwent surgical treatment of endometriosis between July 1st 2009 and June 31st 2016. Intervention(s): None. Measurements and Main Results: 831 patients were included. The median age of the patients was 33 years (15-64, SD 8.6). The average BMI in our patient population was 25.8 (13.1-52.1, SD 6). 163 patients had a BMI >=30 (19.6%). 668 patients had a BMI <30 (80.4%). We did not find a significant impact of BMI on the stage of endometriosis in our study population. The main indication for surgery in both groups was pain (BMI >=30: 83.4%, BMI <30: 82.9%). Obese patients had more chronic pain (13.5% vs 8.4%, p = .04). Low BMI patients had infertility as a more frequent indication for surgery than obese patients (20.98% vs 14.11%, p = .04). Both groups had similar complication rates (4.9% for obese patients vs 3.14%). Obese patients had an increased conversion to laparotomy rate (3.06% vs 1.6%), however, this was not statistically significant (p = .1). We also did not find a difference in operating time between the two groups. Length of stay was not significantly longer for patients with BMI >=30 compared to BMI <30 (1.4 vs 1.5 days, p = .2). Conclusion(s): In this study we found that there was no difference in operating time or complication rates in women with BMI >=30. These findings suggest that when advanced laparoscopic surgery for endometriosis is performed in a unit with a high volume of obese patients, the complication rate is comparable to those with a BMI <30.

Endometriosis is one of the most common gynaecological conditions affecting 6% to 12% of women in the reproductive age group. It can be found in 35% to 45% of women who are trying to conceive and are infertile. Infertility is one of the most common problems associated with endometriosis. This review will look at the evidence that endometriosis may lead to infertility and the data looking at whether surgical correction of endometriosis may improve fertility outcomes.Copyright © 2017 Wichtig Publishing.

STUDY QUESTION Which essential items should be recorded before, during and after endometriosis surgery and in clinical outcome based surgical trials in patients with deep endometriosis (DE)? SUMMARY ANSWER A DE surgical sheet (DESS) was developed for standardized reporting of the surgical treatment of DE and an international expert consensus proposal on relevant items that should be recorded in surgical outcome trials in women with DE. WHAT IS KNOWN ALREADY Surgery is an important treatment for symptomatic DE. So far, data have been reported in such a way that comparison of different surgical techniques is impossible. Therefore, we present an international expert proposal for standardized reporting of surgical treatment and surgical outcome trials in women with DE. STUDY DESIGN, SIZE, DURATION International expert consensus based on a systematic review of literature. PARTICIPANTS/MATERIALS, SETTING, METHODS Taking into account recommendations from Consolidated Standards of Reporting Trials (CONSORT), the Innovation Development Exploration Assessment and Long-term Study (IDEAL), the Initiative on Methods, Measurement and Pain Assessment in Clinical trials (IMMPACT) and the World Endometriosis Research Foundation Phenome and Biobanking Harmonisation Project (WERF EPHect), a systematic literature review on surgical treatment of DE was performed and resulted in a proposal for standardized reporting, adapted by contributions from eight members of the multidisciplinary Leuven University Hospitals Endometriosis Care Program, from 18 international experts and from audience feedback during three international meetings. MAIN RESULTS AND THE ROLE OF CHANCE We have developed the DESS to record in detail the surgical procedures for DE, and an international consensus on pre-, intra- and post-operative data that should be recorded in surgical outcome trials on DE. LIMITATIONS, REASONS FOR CAUTION The recommendations in this paper represent a consensus among international experts b