Introduction
Testing for COVID-19 is a cornerstone of pandemic control. If conducted inappropriately, nasopharyngeal swab collection can be painful and preanalytical sample collection errors may lead ...to false negative results. Our objective was to develop a realistic and easily available synthetic simulator for nasopharyngeal swab collection.
Materials and methods
The nasopharyngeal swab collection simulator was designed through different development steps: segmentation, computer-aided design (CAD), and 3D printing. The model was 3D printed using PolyJet technology, which allows multi-material printing using hard and soft materials.
Results
The simulator splits in the parasagittal plane close to the septum to allow better visualization and understanding of nasal cavity landmarks. The model is able to simulate the softness and texture of different structural elements. The simulator allows the user to conduct realistic nasopharyngeal swab collection. A colored pad on the posterior wall of the nasopharynx provides real-time feedback to the user. The simulator also permits incorrect swab insertion, which is of obvious benefit from a training perspective. Comprehensive 3D files for printing and full instructions for manufacturing the simulator is freely available online via an open access link.
Conclusion
In the context of the COVID-19 pandemic, we developed a nasopharyngeal swab collection simulator which can be produced by 3D printing via an open access link, which offers complete operating instructions.
Epithelial ovarian cancer is mostly discovered at the stage of peritoneal carcinosis. Complete cytoreductive surgery improves overall survival. The Fagotti score is a predictive score of ...resectability based on peritoneal laparoscopic exploratory. Our aim was to study the inter-observer concordance in an external validation of the Fagotti score. An observational, prospective, multicenter study was conducted using the Francogyn research network. The primary outcome was inter-observer concordance of the Fagotti score. 15 patients in which an ovarian mass was discovered were included. For each patient, the first exploratory laparoscopy before any treatment/chemotherapy was recorded. This bank of 15 videos was subject to blind review accompanied by a Fagotti score rating by 11 gynecological surgeons specializing in oncology. A total of 165 blind reviews were performed. Inter-observer concordance was very good for the Fagotti score with an intraclass correlation coefficient (ICC) of 0.83 95% CI 0.71; 0.93. Inter-observer concordance for the adjusted Fagotti score, which accounts for unexplorable areas with extensive carcinomatosis, resulted in an ICC of 0.64 95% CI 0.46; 0.82. According to the reviewers, the three least explorable parameters were mesentery involvement, stomach infiltration and liver damage. The ICC of the explorable Fagotti score, i.e. score with deletion of the parameters most often unexplored by laparoscopy, was 0.86 0.75-0.94. This study confirms the reproducibility of the Fagotti score during first assessment laparoscopies in cases of advanced ovarian cancer. The explorable Fagotti score has an equivalent or better inter-observer concordance than the Fagotti score.
Background Clinical assessment of fetal head station is difficult and subjective; it is mandatory before attempting operative vaginal delivery. Objective The principal objective of our study was to ...assess whether measurement of the perineum-to-skull ultrasound distance was predictive of a difficult operative vaginal delivery. Secondary objectives included evaluation of the interobserver reproducibility of perineum-to-skull ultrasound distance and comparison of this measurement and digital examination in predicting a difficult operative delivery. Study Design This was a prospective cohort study including all cases of operative vaginal deliveries in singleton pregnancies in cephalic presentation >34 weeks’ gestation, from 2012 through 2015. All data were entered prospectively in a medical record system specially devised to meet the requirements of this study. Results Of the 659 patients in whom perineum-to-skull ultrasound distance was measured prior to operative vaginal delivery, 120 (18%) met the composite criterion for a difficult extraction. Perineum-to-skull ultrasound distance measurement of ≥40 mm was significantly associated with the occurrence of a difficult extraction based on the composite criterion, after adjustment for parity, presentation type, and fetal macrosomia (odds ratio, 2.38; 95% confidence interval, 1.51–3.74; P = .0002). The intraclass correlation coefficient between the perineum-to-skull ultrasound distance measured by the first operator and that measured by the second operator was 0.96 (95% confidence interval, 0.95–0.97; P < .0001). Based on the receiver operating characteristic curve analyses, perineum-to-skull ultrasound distance was a more accurate predictor of difficult operative delivery than digital vaginal examination ( P = .036). Conclusion Measurement of the perineum-fetal skull ultrasound distance is a reproducible and predictive index of the difficulty of instrumental extraction. Ultrasound is a useful supplementary tool to the usual clinical findings.
Objective
To develop and evaluate a non-invasive surgical assistance based on augmented reality (AR) in the detection of ureters on animal model.
Method
After an experimental prototyping step on two ...pigs to determine the optimal conditions for visualization of the ureter in AR, three pigs were operated three times at 1 week intervals. The intervention consisted of an identification of the ureter, with and without the assistance of AR. At the end of the intervention, a clip was placed on the AR-proposed ureter to evaluate its accuracy. By doing a cone beam computed tomography, we measured the distance between the contrasted ureter and the clips in the acquired volume. Thirteen videos were recorded, allowing subsequent evaluation of the clinical relevance of the device.
Results
The feasibility of the technique has been confirmed. The margin of error was 1.77 mm (± 1.56 mm) for ureter localization accuracy. In order to evaluate the perceived relevance and accuracy in the detection of AR-assisted ureter, 58 gynecological surgeons were shown the videos then questioned. Of the 754 responses obtained (13 videos × 58 surgeons), the ureter was identified in direct vision in 31.2% of cases versus 81.7% in AR (
p
value 3.62 × 10
−7
). When looking at pigs that had already had one or two operations, the ureter was identified in only 16% of cases with direct vision compared to 76.1% with AR (
p
-value 5.48 × 10
−19
). In addition, 67% of surgeons felt that AR allowed them to better identify the ureters and 61% that AR reconstruction was accurate.
Conclusion
This first AR device showed a satisfactory precision in the detection of ureters with a favorable opinion of surgeons. This surgical assistance system could be helpful in the performance of difficult procedures, for example in the case of patients, which have undergone multiple surgeries in the past.
Objective
To describe the possible difficulties encountered in the event of laparoscopic sacrocolpopexy for vaginal vault prolapse and corresponding avoidance strategies.
Methods
Video recordings of ...different laparoscopic sacrocolpopexies for vaginal vault prolapse showing various situations and difficulties. University Teaching Hospital of Strasbourg.
Results
Although laparoscopic sacrocolpopexy for vaginal vault prolapse is becoming more common, achieving a good outcome remains challenging, especially with the vesicovaginal dissection. Bladder injuries are not rare and occur in about 2 to 6% of cases. Vaginal perforation is less common, but remains a risk. This video illustrates possible difficulties encountered and presents various strategies to avoid them. Several tips on exposing structures and following anatomical landmarks are described.
Conclusion
Knowing how to avoid these surgical traps will help trainee urogynecologic surgeons to perform laparoscopic sacrocolpopexy for vaginal vault prolapse.
Background
Borderline ovarian tumors (BOTs) are tumors with a favorable prognosis but whose management by consensus is essential to limit the risk of invasive recurrence. This study aimed to conduct ...an inventory of surgical practices for BOT in France and to evaluate the conformity of the treatment according to the current French guidelines.
Methods
This retrospective, multicenter cohort study included nine referral centers of France between January 2001 and December 2018. It analyzed all patients with serous and mucinous BOT who had undergone surgery. A peritoneal staging in accordance with the recommendations was defined by performance of a peritoneal cytology, an omentectomy, and at least one peritoneal biopsy.
Results
The study included 332 patients. A laparoscopy was performed in 79.5% of the cases. Treatment was conservative in 31.9% of the cases. The recurrence rate was significantly increased after conservative treatment (17.3% vs 3.1%;
p
< 0.001). Peritoneal cytology was performed for 95.5%, omentectomy for 83.1%, and at least one biopsy for 82.2% of the patients. The overall recurrence rate was 7.8%, and the recurrence was invasive in 1.2% of the cases. No link was found between the recurrence rate and the conformity of peritoneal staging. The overall rate of staging noncompliance was 22.9%.
Conclusion
The current standards for BOT management seem to be well applied.
Background Radio(chemo)therapy is often required in pelvic malignancies (cancer of the anus, rectum, cervix). Direct irradiation adversely affects ovarian and endometrial function, compromising the ...fertility of women. While ovarian transposition is an established method to move the ovaries away from the radiation field, surgical procedures to displace the uterus are investigational. This study demonstrates the surgical options for uterine displacement in relation to the radiation dose received. Methods The uterine displacement techniques were carried out sequentially in a human female cadaver to demonstrate each procedure step by step and assess the uterine positions with dosimetric CT scans in a hybrid operating room. Two treatment plans (anal and rectal cancer) were simulated on each of the four dosimetric scans (1. anatomical position, 2. uterine suspension of the round ligaments to the abdominal wall 3. ventrofixation of the uterine fundus at the umbilical level, 4. uterine transposition). Treatments were planned on EclipseR System (Varian Medical SystemsR,USA) using Volumetric Modulated Arc Therapy. Data about maximum (Dmax) and mean (Dmean) radiation dose received and the volume receiving 14 Gy (V14Gy) were collected. Results All procedures were completed without technical complications. In the rectal cancer simulation with delivery of 50 Gy to the tumor, Dmax, Dmean and V14Gy to the uterus were respectively 52,8 Gy, 34,3 Gy and 30,5cc (1), 31,8 Gy, 20,2 Gy and 22.0cc (2), 24,4 Gy, 6,8 Gy and 5,5cc (3), 1,8 Gy, 0,6 Gy and 0,0cc (4). For anal cancer, delivering 64 Gy to the tumor respectively 46,7 Gy, 34,8 Gy and 31,3cc (1), 34,3 Gy, 20,0 Gy and 21,5cc (2), 21,8 Gy, 5,9 Gy and 2,6cc (3), 1,4 Gy, 0,7 Gy and 0,0cc (4). Conclusions The feasibility of several uterine displacement procedures was safely demonstrated. Increasing distance to the radiation field requires more complex surgical interventions to minimize radiation exposure. Surgical strategy needs to be tailored to the multidisciplinary treatment plan, and uterine transposition is the most technically complex with the least dose received.
Objective The aim of this study was to develop a new diagnostic tool to predict lymph node metastasis (LNM) in patients with advanced epithelial ovarian cancer undergoing primary cytoreductive ...surgery. Materials and method The FRANCOGYN group's multicenter retrospective ovarian cancer cohort furnished the patient population on which we developed a logistic regression model. The prediction model equation enabled us to create LNM risk groups with simple lymphadenectomy decision rules associated with a user-friendly free interactive web application called shinyLNM. Results 277 patients from the FRANCOGYN cohort were included; 115 with no LNM and 162 with LNM. Three variables were independently and significantly (p<0.05) associated with LNM in multivariate analysis: pelvic and/or para-aortic LNM on CT and/or PET/CT (p<0.00), initial PCI greater than or equal to 10 and/or diaphragmatic carcinosis (p = 0.02), and initial CA125 greater than or equal to 500 (p = 0.02). The ROC-AUC of this prediction model after leave-one-out cross-validation was 0.72. There was no difference between the predicted and the observed probabilities of LNM (p = 0.09). Specificity for the group at high risk of LNM was 83.5%, the LR+ was 2.73, and the observed probability of LNM was 79.3%; sensitivity for the group at low-risk of LNM was 92.0%, the LR- was 0.24, and the observed probability of LNM was 25.0%. Conclusion This new tool may prove useful for improving surgical planning and provide useful information for patients.
•Pelvic radiotherapy results in a damage to ovarian and endometrial function in female patients in reproductive age.•Uterus displacement procedures in women with pelvic malignancies candidate to ...radiotherapy are currently experimental.•With this video we reported step-by-step surgical techniques for laparoscopic uterine displacement.
Preservation of fertility without compromising oncological outcomes is a major objective in young patients at the time of cancer treatment (Azaïs et al., 2018; Bizzarri et al., 2022). Radio(chemo)therapy is often required in pelvic malignancies (anus, rectum, sarcoma). Direct irradiation results in a damage to ovarian (Bizzarri et al., 2023) and endometrial function (Lohynska et al., 2021), compromising the fertility of female patients of reproductive age. While ovarian transposition is an established method to move the ovaries away from the radiation field (Morice et al., 2022; Pavone et al., 2023), corresponding surgical procedures displacing the uterus are investigational (Pavone et al., 2023; Querleu et al., 2010; Ribeiro et al., 2017, 2024). In a human female cadaver model, the reported laparoscopic techniques of uterine displacement were carried out to demonstrate their feasibility and the step-by-step surgical techniques. The surgeries were performed in a hybrid operating room which enables to perform CT-scan and evaluate the uterine positions according to anatomical landmarks. The following procedures were performed in the same cadaveric model and were described in the video: 1. Uterine suspension of the round ligaments to the abdominal wall 2. Uterine ventrofixation of the fundus at the level of the umbilical line 3. Uterine transposition according to the technique reported by Ribeiro et al. All procedures were completed without technical complications. All of these uterine displacement procedures are technically feasible. Uterine transposition is the most technically complex procedure, and its effectiveness in protecting the endometrium should be evaluated in comparison to the simpler techniques (Table 1). Future studies incorporating radiotherapy simulations are needed to define which technique represents the best compromise between surgical complexity and positioning the uterus at a level that receives the lowest possible radiation dose.
As regards ovarian cancer, the use of minimally invasive surgery has steadily increased over the years. Reluctance persists, however, about its oncological outcomes. The main objective of this ...meta-analysis was to compare the three and five-year mortality of patients operated by minimally invasive surgery (MIS) for ovarian cancer to those operated by conventional open surgery (OPS), as well as their respective perioperative outcomes. PubMed, Cochrane library and CinicalTrials.gov were systematically searched, using the terms laparoscopy, laparoscopic or minimally invasive in combination with ovarian cancer or ovarian carcinoma. We finally included 19 observational studies with a total of 7213 patients. We found no statistically significant difference for five-year (relative risk (RR) = 0.89, 95% CI 0.53-1.49,
= 0.62)) and three-year mortality (RR = 0.95, 95% CI 0.80-1.12,
= 0.52) between the patients undergoing MIS and those operated by OPS. When five and three-year recurrences were analyzed, no statistically significant differences were also observed. Analysis in early and advanced stages subgroups showed no significant difference for survival outcomes, suggesting oncological safety of MIS in all stages. Whether the surgery was primary or interval debulking surgery in advanced ovarian cancer, did not influence the comparative results on mortality or recurrence. Although the available studies are retrospective, and mostly carry a high risk for bias and confounding, an overwhelming consistency of the evidence suggests the likely effectiveness of MIS in selected cases of ovarian cancer, even in advanced stages. To validate the use of MIS, the development of future randomized interventional studies should be a priority.
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