In a referral center the global rate of reinterventions for mesh-related complications after POP repair is 2.8%. The surgical treatment of mesh complications appears to be a safe and effective procedure with cure of the symptoms in most cases.

Objective: To evaluate fertility after robot-assisted laparoscopic myomectomy (RALM) in terms of pregnancy rates, and obstetrical outcomes.Patients: This is a retrospective cohort of RALM performed for symptomatic leiomyomas among women who want to conceive. Medical data were retrospectively reviewed. An office hysteroscopy was prescribed 3 months after the surgery.Results: Fifty-three patients were included. The mean number of myomas was 2 ± 1.5 with a mean size of 69 ± 17.7 mm. A breach of the cavity was noticed in 15.1% of the cases. Two cases of intrauterine adhesions were diagnosed and treated during the post-operative office hysteroscopy (5.7%).Clinical pregnancy rates were 52.8% with a live birth rate of 41.5% in patients desiring pregnancy. A caesarean section was performed in 17 cases (70.8%). No case of uterine rupture was reported.Conclusion: More than half of the patients became pregnant after RALM. A low rate of obstetrical complications was reported, with no uterine ruptures, highlighting the promise of this technique for infertile patients.infertility, miscarriage, myoma, robot-assisted myomectomy, synechiae imaging, strict and appropriate patient selection, and appropriate training in the safe practices of contained morcellation. 36 Although the number of subjects is higher than in some other studies, the present study is limited by its observational and retrospective nature. A randomized study, comparing standard laparoscopy vs robot-assisted myomectomy, would clarify the benefits of robot assistance on pregnancy rates, obstetrical complications, and intrauterine adherences more accurately (Table 7). | CONCLUSIONIn this retrospective series, we report 52.8% pregnancy rates after robot-assisted myomectomy in patients desiring pregnancy, and 47% pregnancy rates in infertile patients (half undergoing ART). In all, 78% of pregnancies gave way to a live birth, the majority through programmed caesarean sections. A low rate of obstetrical complications was reported, with no uterine ruptures, and no abnormal placentation. After systematic post-operative hysteroscopy in patients desiring pregnancy, a 5.7% intrauterine adhesion rate was found, a lower rate than those after laparoscopy or laparotomy published in the literature. This low synechiae rate probably contributes to fertility preservation.These results are encouraging for improving fertility after robotassisted myomectomy. A comparative, prospective, multicentre study, comparing standard laparoscopy vs robot-assisted laparoscopy in patients operated for myomectomy, with a longer follow-up, is highly encouraged.

Intrauterine adhesions lead to partial or complete obliteration of the uterine cavity and have life-changing consequences for women. The leading cause of adhesions is believed to be loss of stroma resulting from trauma to the endometrium after surgery. Adhesions are formed when lost stroma is replaced by fibrous tissue that join the uterine walls. Few effective intrauterine anti-adhesion barriers for gynecological surgery exist. We designed a degradable anti-adhesion medical device prototype to prevent adhesion formation and recurrence and restore uterine morphology. We focused on ideal degradation time for complete uterine re-epithelialization for optimal anti-adhesion effect and clinical usability. We developed a triblock copolymer prototype [poly(lactide) combined with high molecular mass poly(ethylene oxide)]. Comparative pre-clinical studies demonstrated in vivo anti-adhesion efficacy. Ease of introduction and optimal deployment in a human uterus confirmed clinical usability. This article provides preliminary data to develop an intrauterine medical device and conduct a clinical trial.