António Setubal - Academia.edu (original) (raw)

Papers by António Setubal

Journal of Minimally Invasive Gynecology, Jul 1, 2023

Poster: "ECR 2016 / C-1192 / Adenomyosis and MRI: What you need to know and be aware of &quo... more Poster: "ECR 2016 / C-1192 / Adenomyosis and MRI: What you need to know and be aware of " by: "L. I. R. Agostinho1, R. Cruz2, A. Guerra3, M. J. M. Barata3, A. Setubal1; 1Lisbon/PT, 2Loures/PT, 3Lisboa/PT"

Diagnostic and Interventional Imaging, 2019

Endometriosis is a chronic gynecological condition that affects primarily young women. Imaging pl... more Endometriosis is a chronic gynecological condition that affects primarily young women. Imaging plays a pivotal role for the diagnosis and pre-surgical mapping of the disease. By comparison, the role of imaging in the identification of disease recurrence and postoperative complications are not well established. The goal of this review is to report the postoperative findings, including normal postoperative findings, initial disease recurrence and complications, with a special emphasis on magnetic resonance imaging (MRI), in women who have undergone surgery for pelvic endometriosis. This review is based on a literature search of manuscripts published between 2000 and 2018. Meta-analyses, systematic reviews and original scientific articles published in English language were included.

Journal of Minimally Invasive Gynecology, 2017

The local IRB was consulted and declared this manuscript for IRB exemption. Conclusion: Mini lapa... more The local IRB was consulted and declared this manuscript for IRB exemption. Conclusion: Mini laparoscopy is an alternative to classic laparoscopy associated with higher patient satisfaction. The prophylactic salpingectomy has proven to reduce the risk of ovary, peritoneal and tubal epithelial carcinoma, tubal benign diseases and does not increase significantly the operative time or postoperative complications.

Poster: "ECR 2013 / C-2024 / Multidisciplinary approach of endometriosis: do’s and dont’s&qu... more Poster: "ECR 2013 / C-2024 / Multidisciplinary approach of endometriosis: do’s and dont’s" by: "A. Guerra, A. Setubal, F. Osorio, F. Faustino, D. Vilarinho, V. Mascarenhas, A. Gaspar, H. M. R. Marques; Lisbon/PT"

The Internet Journal of Surgery, 2009

The urinary tract constitutes one of the rare localizations of endometriosis, accounting for 1-2%... more The urinary tract constitutes one of the rare localizations of endometriosis, accounting for 1-2%, even rarer when it is the unique localization of the disease.In the present paper the authors present two cases of bladder endometriosis, the second one being the more peculiar, as the classic intra-abdominal foci were absent.The treatment is still controversial; exact diagnosis, patient age, desire for reproduction, severity of symptoms, location and extent of the disease should be taken into consideration in order to determine the appropriate therapy.In our opinion, laparoscopic segmental cystectomy will be the first option to be considered.

Evidence-based data for endometriosis management are limited. Experiments are excluded without ad... more Evidence-based data for endometriosis management are limited. Experiments are excluded without adequate animal models. Data are limited to symptomatic women and occasional observations. Hormonal medical therapy cannot be blinded if recognised by the patient. Randomised controlled trials are not realistic for surgery since a variable disease with low numbers. Each diagnosis and treatment is an experiment with an outcome and experience is Bayesian updating from the past. If the experience of many is similar, this has more value than an opinion. The combined experience of a group of endometriosis surgeons was used to discuss problems in the management of endometriosis. Considering endometriosis as several genetically/epigenetically different diseases is important for medical therapy. Imaging cannot exclude endometriosis and diagnostic accuracy is limited for superficial lesions, deep lesions, and cystic corpora lutea. Surgery should not be avoided for emotional reasons. Shifting infert...

Journal of minimally invasive gynecology, Jan 9, 2017

Isthmocele appears as a fluid pouch-like defect in the anterior uterine wall at the site of a pri... more Isthmocele appears as a fluid pouch-like defect in the anterior uterine wall at the site of a prior Cesarean section and ranges in prevalence from 19% to 84%, a direct relation to the increase in Cesarean sections performed worldwide. Many definitions have been suggested for the dehiscence resulting from Cesarean section, and we propose standardization with a single term for all cases: isthmocele. Patients are not always symptomatic, but symptoms typically include intermittent abnormal bleeding, pain, and infertility. Pregnancy complications that result from isthmocele include ectopic pregnancy, low implantation, and uterine rupture. Magnetic resonance imaging and transvaginal ultrasound are the gold standard imaging techniques for diagnosis. Surgical treatment of isthmocele is still a controversial issue but should be offered to symptomatic women or the asymptomatic patient who desires future pregnancy. When surgery is the treatment choice, laparoscopy guided by hysteroscopy, hyste...

Journal of minimally invasive gynecology, Jan 28, 2017

To describe our surgical approach in a rare case of deep infiltrating endometriosis of the obtura... more To describe our surgical approach in a rare case of deep infiltrating endometriosis of the obturator internus muscle with obturator nerve involvement. A step-by-step surgical explanation using video and literature review (Canadian Task Force Classification III). Endometriosis can be pelvic or rarely extrapelvic and is classically defined as the presence of endometrial glands and stroma outside the uterine cavity [1,2]. Pain along the sensitive area of the obturator nerve, thigh adduction weakness and difficulty in ambulation are extremely rare presenting symptoms [2-4]. We report a case of a 32-year-old patient who presented with cyclic leg pain in the inner right thigh radiating to the knee caused by a cystic endometriotic mass in the obturator internus muscle with nerve retraction. The patient provided informed consent to use the surgical video. Institutional review board approval was obtained. Pelvic magnetic resonance imaging was performed and confirmed a nodular lesion of about...

Journal of Minimally Invasive Gynecology, 2015

Deep endometriosis presenting with ascites and preserved fertility is an unusual combination. Thi... more Deep endometriosis presenting with ascites and preserved fertility is an unusual combination. This report describes a unique case of deep endometriosis and primary infertility, with successful pregnancy after optimal surgical approach and personalized ovarian stimulation protocol for IVF, showing the importance of a multidisciplinary approach in these patients.

World Journal of Clinical Cases, 2014

In the last years, operative laparoscopy became a standard approach in gynaecology and general su... more In the last years, operative laparoscopy became a standard approach in gynaecology and general surgery. Even in pregnancy its use is becoming more widely accepted. In fact, it offers advantages similar to those in no pregnant women, associated with good maternal and fetal outcomes. Around 0.2% of pregnant women require abdominal surgery. The most common indications of laparoscopy in pregnancy are cholelithiasis complications, appendicitis, persistent ovarian cyst and adnexal torsion. Authors describe a very rare case of acute abdomen due to isolated Fallopian tube torsion in a 24(th) weeks pregnant woman, managed by laparoscopic salpingectomy.

Journal of Minimally Invasive Gynecology, 2013

How do we communicate new information to the clinical community?What is the article of the future... more How do we communicate new information to the clinical community?What is the article of the future? There is a transition to digital, but we are still involved in a process that is part of the print world. The introduction of the video article in this issue of JMIG is part of the transition. Although JMIG has previously accepted videos, they were seen as additional material to a conventional manuscript; this video research article is different. The videos that we are introducing in this issue are not adjunct material but the focal point of the research. These video articles represent a unique way to present scholarly material. This work should not be viewed as another ‘‘social media’’ presentation but a visual presentation of research. We follow the rules of the history of surgery. Old movies were invented back in 1895. The Lumi ere Brothers presented their first surgical films on December 28, 1895 in Paris, France. A very well-known surgeon at the time immediately realized that film was a very important tool that could be used to teach surgery and improve scholarly work. He took the Lumi ere Brother’s idea, modified the camera and created a new form of film. Eug ene-Louis Doyen was the surgeon that in 1898 became the pioneer of surgical films. He stated, ‘‘In less than a minute, you will make a thousand people understand what each of you has only been able to teach to a few in the operating theatre’’. At the present time, we are able to teach laparoscopy and hysteroscopy through live events to millions of people around the world. JMIG wants to be a part of this pioneer process. Films are not films anymore, videos are not videos either. For the moment we will call it ‘‘videos’’ and in the near future we believe that we will have to change the name. Submit your video material online through EES. The process is similar to a conventional manuscript. The requirements for an acceptable video are listed online. These include the size of the file, time limits, and appropriate narration in English. Music soundtracks should not be included. Previously copyrighted material should not be submitted and a structured abstract is required. The video will be assessed first by the video editor, Dr. Setubal, and then assigned to reviewers from the editorial board who are experts in the content of the video. Reviewers will follow a format that is standardized and include not only an assessment of visual quality, but more importantly, the content. These videos are not case reports or surgical anecdotes. A novel surgical approach is acceptable, but mostly these videos are a visual presentation of surgical outcomes.

Gynecological Surgery, 2011

Although laparoscopy continues to be the gold standard in the diagnosis of deep endometriosis, no... more Although laparoscopy continues to be the gold standard in the diagnosis of deep endometriosis, non-invasive imaging methods are important for an adequate staging of the disease, as they may determine the site, size, and severity of the lesions and thus contribute to planning the surgical treatment better. An observational study was carried out between April 2008 and June 2009 during which time nine consecutive patients underwent preoperative PET scan examination for clinical suspicion of deep endometriosis. PET scans provide a functional assessment of cellular activity; but in our study, it did not exhibit consistent results.

Fertility and Sterility, 2014

Objective: To review bowel complications caused by deep endometriosis during pregnancy or in vitr... more Objective: To review bowel complications caused by deep endometriosis during pregnancy or in vitro fertilization (IVF). Design: Three case reports and a systematic review. Setting: A tertiary referral center for deep endometriosis surgery. Patient(s): Three case reports of bowel perforation or occlusion during pregnancy caused by deep endometriosis. Intervention(s): A PubMed search was conducted to identify complications of deep endometriosis during pregnancy or IVF. The literature search identified 13 articles. According to these, 12 articles described 12 bowel complications caused by progression of deep endometriosis during pregnancy, and 1 article described six cases of bowel occlusion during IVF. Result(s): In 12 of 15 women, complications occurred during the third trimester of pregnancy, whereas 3 of 15 women presented with complications in the postpartum period. All complications during IVF occurred during stimulation. No specific factors that could predict these complications were identified, leading to the conclusion that endometriosis complications that occur in pregnancy or in IVF patients are probably underreported. Conclusion(s): Bowel complications during pregnancy or IVF stimulation may occur in women with deep endometriosis. This suggests that the endocrine environment of pregnancy does not prevent progression, at least in some women. These complications are rare, although probably underreported.

European Journal of Obstetrics & Gynecology and Reproductive Biology, 1999

Vesicouterine fistula is one of the less common acquired urogenital fistula and a rare event in o... more Vesicouterine fistula is one of the less common acquired urogenital fistula and a rare event in obstetrics. We report a case which occurred after a vaginal delivery followed by manual removal of placenta in a woman who had a previous cesarean section. The fistula was successfully repaired 5 weeks after delivery.

Cases Journal, 2009

Vaginal endometriosis is characterized by the presence of endometrial tissue in the vagina. In th... more Vaginal endometriosis is characterized by the presence of endometrial tissue in the vagina. In this paper the authors present an unusual case of post-hysterectomy vaginal cuff endometriosis.

Insights into imaging, Jan 4, 2017

Adenomyosis is defined as the presence of ectopic endometrial glands and stroma within the myomet... more Adenomyosis is defined as the presence of ectopic endometrial glands and stroma within the myometrium. It is a disease of the inner myometrium and results from infiltration of the basal endometrium into the underlying myometrium. Transvaginal ultrasonography (TVUS) and magnetic resonance imaging (MRI) are the main radiologic tools for this condition. A thickness of the junctional zone of at least 12 mm is the most frequent MRI criterion in establishing the presence of adenomyosis. Adenomyosis can appear as a diffuse or focal form. Adenomyosis is often associated with hormone-dependent lesions such as leiomyoma, deep pelvic endometriosis and endometrial hyperplasia/polyps. Herein, we illustrate the MRI findings of adenomyosis and associated conditions, focusing on their imaging pitfalls. • Adenomyosis is defined as the presence of ectopic endometrium within the myometrium. • MRI is an accurate tool for the diagnosis of adenomyosis and associated conditions. • Adenomyosis can be diffu...

Journal of Minimally Invasive Gynecology, 2020

To describe the surgical treatment of a uterine isthmocele. Design: Demonstration of the laparosc... more To describe the surgical treatment of a uterine isthmocele. Design: Demonstration of the laparoscopic technique with narrated video footage. Setting: Cesarean section rate has been increasing despite the World Health Organization's recommendation of a maximum 15%, with some countries reaching rates as high as 50%. The choice of delivery method is a complex topic based on physical and psychologic health, social and cultural context, and quality of maternity care. With the increasing number of cesarean sections, a new entity was recognized, the isthmocele [1]. A uterine isthmocele is a dilatation of the uterine cesarean scar and functions as a reservoir collecting blood during menstruation. Isthmocele prevalence ranges from 19% to 84%[2]. The most frequent complaint relates to intermittent postmenstrual bleeding (30%). Isthmocele can be a cause of infertility and pelvic pain [3]. Interstitial pregnancy is a known complication with a mortality rate up to 2.5%. The diagnosis can be made by transvaginal ultrasound and/or magnetic resonance imaging but also by hysteroscopy or hysterosalpingography. Treatment can be done by controlling the symptoms with oral combined contraceptive (decreasing metrorrhagia) or with surgical correction improving symptoms and/or fertility [4-7]. Isthmocele correction seems to improve secondary infertility in patients in whom a fertility workup did not find other cause [8,9]. Surgical approach can be done by vaginal route with hysteroscopy; abdominal route with laparoscopy, robotic or laparotomy; or through a combine procedure with both routes. Hysterectomy is the definitive treatment, but for those who want to preserve fertility, isthmocele correction can be offered. For laparoscopic surgery, several ways have been described to detect the isthmocele such as Foley catheter, hysteroscopy, methylene blue, and Hegar probe. When we do laparoscopy, we prefer concomitant use of hysteroscopy. There is a trending opinion that patients with a smaller isthmocele could be treated hysteroscopically (2.5 mm according to Jeremy et al [10] and 3.0 mm described by Marotta et al [11]). The goal of hysteroscopy correction is to remove the inflammatory infiltration in the endocervix, cutting the superior and inferior edges of the defect enabling normal blood evacuation of the uterus. By contrast, those with a larger isthmocele (with <2.5−3.0-mm residual myometrium) and a risk of perforation during hysteroscopy could be better treated by laparoscopy. This is especially important in patients interested in pregnancy because of the risk of uterine perforation [12]. There is still no strong evidence that hysteroscopic correction leads to an increased number of uterine ruptures compared with laparoscopy, but myometrium thickness seems to be greater after laparoscopic correction. Myometrium thickness is an independent risk factor for uterine rupture [13], and therefore, laparoscopic correction is preferred over hysteroscopic in women with a pregnancy desire. Finally, after surgical correction of an isthmocele, we recommend a 6-month interval before attempting pregnancy. Interventions: Laparoscopic treatment is important in women who are symptomatic, have thin endometrium, and desire a pregnancy. Key strategies are (1) dissection of the vesicouterine pouch laterally to avoid entering the bladder wall; (2) transillumination with hysteroscopy; (3) cut with cold scissors avoiding thermal damage of remaining myometrium; and (4) suture with figure 8 in multiple layers. No evidence of using a specific suture is available. Conclusion: Surgical treatment of a uterine isthmocele is a good option in women who are symptomatic and infertile. Laparoscopic treatment guided by hysteroscopy is a good option if residual myometrium is <3 mm. Journal of Minimally Invasive Gynecology (2020) 00, 1−2.