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ObjectiveTo estimate the effectiveness and safety of laparoscopic surgical excision of rectovaginal endometriosis.DesignA multicentre, prospective cohort study.Setting51 hospitals accredited as specialist endometriosis centres.Participants5162 women of reproductive age with rectovaginal endometriosis of which 4721 women had planned laparoscopic excision.InterventionsLaparoscopic surgical excision of rectovaginal endometriosis requiring dissection of the pararectal space.Main outcome measuresStandardised symptom questionnaires enquiring about chronic pelvic pain, bladder and bowel symptoms, analgesia use and quality of life (EuroQol) completed prior to surgery and at 6, 12 and 24 months postoperatively. Serious perioperative and postoperative complications including major haemorrhage, infection and visceral injury were recorded.ResultsAt 6 months postsurgery, there were significant reductions in premenstrual, menstrual and non-cyclical pelvic pain, deep dyspareunia, dyschezia, low back pain and bladder pain. In addition, there were significant reductions in voiding difficulty, bowel frequency, urgency, incomplete emptying, constipation and passing blood. These reductions were maintained at 2 years, with the exception of voiding difficulty. Global quality of life significantly improved from a median pretreatment score of 55/100 to 80/100 at 6 months. There was a significant improvement in quality of life in all measured domains and in quality-adjusted life years. These improvements were sustained at 2 years. All analgesia use was reduced and, in particular, opiate use fell from 28.1% prior to surgery to 16.1% at 6 months. The overall incidence of complications was 6.8% (321/4721). Gastrointestinal complications (enterotomy, anastomotic leak or fistula) occurred in 52 (1.1%) operations and of the urinary tract (ureteric/bladder injury or leak) in 49 (1.0%) procedures.ConclusionLaparoscopic surgical excision of rectovaginal endometriosis appears to be effective in treating pelvic pain and bowel symptoms and improving health-related quality of life and has a low rate of major complications when performed in specialist centres.

Background This study aimed to compare the outcomes of two distinct patient populations treated within two neighboring UK cancer centers (A and B) for advanced epithelial ovarian cancer (EOC). Methods A retrospective analysis of all new stages 3 and 4 EOC patients treated between January 2013 and December 2014 was performed. The Mayo Clinic surgical complexity score (SCS) was applied. Cox regression analysis identified the impact of treatment methods on survival. Results The study identified 249 patients (127 at center A and 122 in centre B) without significant differences in International Federation of Gynecology and Obstetrics (FIGO) stage (FIGO 4, 29.7% at centers A and B), Eastern Cooperative Oncology Group (ECOG) performance status (ECOG < 2, 89.9% at centers A and B), or histology (serous type in 84.1% at centers A and B). The patients at center A were more likely to undergo surgery (87% vs 59.8%; p  < 0.001). The types of chemotherapy and the patients receiving palliative treatment alone were equivalent between the two centers (3.6%). The median SCS was significantly higher at center A (9 vs 2; p  < 0.001) with greater tumor burden (9 vs 6 abdominal fields involved; p  < 0.001), longer median operation times (285 vs 155 min; p  < 0.001), and longer hospital stays (9 vs 6 days; p  < 0.001), but surgical morbidity and mortality were equivalent. The independent predictors of reduced overall survival (OS) were non-serous histology (hazard ratio [HR], 1.6; 95% confidence interval [CI] 1.04–2.61), ECOG higher than 2 (HR, 1.9; 95% CI 1.15–3.13), and palliation alone (HR, 3.43; 95% CI 1.51–7.81). Cytoreduction, of any timing, had an independent protective impact on OS compared with chemotherapy alone (HR, 0.31 for interval surgery and 0.39 for primary surgery), even after adjustment for other prognostic factors. Conclusions Incorporating surgery into the initial EOC management, even for those patients with a greater tumor burden and more disseminated disease, may require more complex procedures and more resources in terms of theater time and hospital stay, but seems to be associated with a significant prolongation of the patients overall survival compared with chemotherapy alone.

To explore current practice in fertility-sparing surgery for cervical cancer in the UK. A web-based structured questionnaire was designed and circulated to all members of the British Gynaecological Cancer Society. From 111 recipients, a total of 49 responses were collected. The majority of centres treated between 20-29 cases of invasive cervical cancer surgically (21/49, 42.9%) and performed between 0-5 cases of radical trachelectomy annually (29/49, 59.2%). The vaginal approach was the one most commonly used and was offered by almost half of the centres (21/49, 42.9%); laparoscopic techniques were offered in 13 (13/49, 26.6%). The responses were divided as to whether these cases should have been referred to supra-regional centres (25/49, 51.0%). With the use of Human Papillomavirus vaccination leading to a projected decrease in the number of cervical cancer incidence, patients may need to be referred to supraregional centres in the future.

Objective To assess surgical morbidity and mortality of maximal effort cytoreductive surgery for disseminated epithelial ovarian cancer (EOC) in a UK tertiary center. Methods/materials A monocentric prospective analysis of surgical morbidity and mortality was performed for all consecutive EOC patients who underwent extensive cytoreductive surgery between 01/2013 and 12/2014. Surgical complexity was assessed by the Mayo clinic surgical complexity score (SCS). Only patients with high SCS ≥5 were included in the analysis. Results We evaluated 118 stage IIIC/IV patients, with a median age of 63 years (range 19–91); 47.5 % had ascites and 29 % a pleural effusion. Median duration of surgery was 247 min (range 100–540 min). Median surgical complexity score was 10 (range 5–15) consisting of bowel resection (71 %), stoma formation (13.6 %), diaphragmatic stripping/resection (67 %), liver/liver capsule resection (39 %), splenectomy (20 %), resection stomach/lesser sac (26.3 %), pleurectomy (17 %), coeliac trunk/subdiaphragmatic lymphadenectomy (8 %). Total macroscopic tumor clearance rate was 89 %. Major surgical complication rate was 18.6 % ( n  = 22), with a 28-day and 3-month mortality of 1.7 and 3.4 %, respectively. The anastomotic leak rate was 0.8 %; fistula/bowel perforation 3.4 %; thromboembolism 3.4 % and reoperation 4.2 %. Median intensive care unit and hospital stay were 1.7 (range 0–104) and 8 days (range 4–118), respectively. Four patients (3.3 %) failed to receive chemotherapy within the first 8 postoperative weeks. Conclusions Maximal effort cytoreductive surgery for EOC is feasible within a UK setting with acceptable morbidity, low intestinal stoma rates and without clinically relevant delays to postoperative chemotherapy. Careful patient selection, and coordinated multidisciplinary effort appear to be the key for good outcome. Future evaluations should include quality of life analyses.

This chapter summarizes important aspects of the anatomy of the abdomen and the pelvis that should be known to the obstetric or gynaecological specialist. Many of the investigations and treatments discussed on a daily basis require good anatomical knowledge in order to be properly understood. The anterior abdominal wall including the vulva, vagina and perineal areas are lined with squamous epithelium. The epithelium lining the endocervix and uterine cavity is columnar and the squamocolumnar junction usually arises at the ectocervix in women of reproductive age. This is an important site as it is the area from which cervical intraepithelial neoplasia (CIN) and eventually cervical malignancy arises. The peritoneum is a thin serous membrane that lines the inside of the pelvic and abdominal cavities. It is probably best to imagine the pelvis containing the bladder, uterus and rectum.

This chapter contains sections titled: Surface anatomy The anterior abdominal wall The umbilicus Epithelium of the genital tract The peritoneum Vulva The clitoris Bony pelvis Pelvic floor Pelvic organs (Fig. 33.11) Conclusion Further reading

This chapter contains section titled: Introduction Surface anatomy Bony pelvis Pelvic floor Pelvic organs Conclusion

Councillor Dave Batten, on behalf of Cultural and Leisure Services Cabinet said: \"I am delighted that the City Council are able to support and promote basketball in the city, particularly with the excellent facilities we now have in the Skydome Arena.Our aim is to work with our partners in this venture to ensure that Coventry and England Basketball enjoy a successful relationship for these internationals and for the local development of basketball in the city.\" Simon Kirkland, Chief Executive for English Basketball said: \"We're delighted to be bringing international basketball to Coventry and to such a great venue. The Council's support has been vital to funding the deal with the Skydome and together we'reconfident that we can now secure the commercial sponsorship we need.\"