Gynaecological Endoscopy最新文献

To report a case of primary pelvic hydatid cyst presenting as an adnexal mass and having undergone a laparoscopic excision

The clinical records of the patient were reviewed.

The clinical and radiological findings demonstrated a right adnexal 5x6x5 cm unilocular cystic mass. Laparoscopic dissection of the dense adhesions between the mass, the right ovary and the omentum were performed. Laparoscopic excision of the mass was performed without rupturing the cyst and placing it in a bag. Histological examination confirmed the hydatid disease. Neither complications nor recurrence was observed during the follow up.

Laparoscopy is used safely for treatment of pelvic haydatid cysts after taking measures to prevent intra-abdominal spillage.

To define the role of routine cystoscopy following laparoscopically assisted hysterectomy in the early detection of ureteric injuries.

A retrospective observational study based on casenote review.

A consecutive series of 436 women who underwent routine video cystoscopy after intrafascial laparoscopically assisted hysterectomy, with or without bilateral salpingo-oöphorectomy.

In 436 cystoscope evaluations, six cases aroused suspicion of a ureteric injury. Subsequent evaluation confirmed injury in two of these cases. A further two cases were not suspected on cystoscopic grounds but were detected in the early postoperative period. One ureteric injury was associated with endoscopic staples, two with electrosurgery and one with the harmonic scalpel. The staple injury was suspected clinically during the operative procedure; the remainder were not.

Routine cystoscopy at intrafascial laparoscopically assisted hysterectomy has not contributed to the early diagnosis and treatment of ureteric injuries sustained with the authors' current technique. Thus cystoscopy ought to be done selectively according to clinical intraoperative concern. The distal pelvic ureter should be routinely inspected for dilatation, via peritoneal windows, at the end of the hysterectomy. Every endogynaecologist should review their data on cystoscopy and ureteric injuries associated with laparoscopically assisted hysterectomy to ascertain whether cystoscopy is justifiable in their practice, and whether surgical techniques need to be modified to enhance ureteric protection.

To report the case history of a patient who sustained delayed bowel trauma following uterine perforation, and endometrial ablation.

The clinical records of the patient were reviewed.

Dysfunctional uterine bleeding unresponsive to medication was diagnosed, and the patient was booked to undergo a Vesta system endometrial ablation procedure. Following insertion of the electrode-carrying balloon, the first warm-up phase was aborted because of an impedance error, and the second warm up failed to reach a temperature of 75 °C on all electrodes. Uterine perforation was suspected. Inspection of the uterus revealed a lateral perforation below the endocervical os. A rollerball ablation of the endometrium was then carried out under laparoscopic control. At 3 months later the patient was admitted with symptoms and signs of acute abdominal pathology. She underwent a laparotomy, and a small bowel perforation was oversewn. During the operation, malrotation of the bowel was diagnosed. The patient continued to experience menorrhagia, and subsequently underwent a hysterectomy.

This is an unusual case report of delayed bowel trauma following uterine perforation, and endometrial ablation in a patient with malrotation of the bowel.

Objective

To compare the efficacy, cost-effectiveness, and possible complications of operative laparoscopy with laparotomy for treating benign adnexal cystic tumours at a unit in a developing country.

Design

A prospective comparative study.

Setting

Gynaecologic Endoscopy Unit, Assiut University Hospital, Assiut, Egypt.

Subjects

91 women of childbearing age with a clinical, biochemical and transvaginal sonographic diagnosis of benign adnexal cystic tumour.

Interventions

71 patients were allocated to one of two groups according to management approach. The laparoscopy group (A) included 37 patients while the laparotomy group (B) included 34 patients.

Main outcome measures

For each patient, the operating time, intra- and postoperative complications, postoperative pain and duration of hospital stay were recorded.

Results

The operating time was significantly shorter in group A (47.8 ± 28.3 min) than in group B (64.9 ± 19.2 min). Intraoperative uncontrolled bleeding occurred in one patient in group A. Postoperative pain was significantly less in group A than in group B (P < 0.001). Postoperative febrile morbidity developed in 12.2% and 31.6% of patients in groups A and B, respectively. The duration of postoperative hospital stay was significantly shorter among patients in group A (49.5 ± 42.6 h) than in group B (124.8 ± 40.9 h) (P < 0.001). Postoperative complications included wound infections: one case in group A and three in group B.

Conclusions

Laparoscopic management of benign cystic adnexal masses is a fast and safe procedure with minimal intra- and postoperative complications compared with laparotomy. Its use in developing countries with limited resources is cost-effective, given appropriate selection of cases and experienced endoscopists.

Objective

To assess the role of ultrasound with respect to management decisions in premenopausal women with abnormal uterine bleeding attending an outpatient hysteroscopy clinic.

Design

Retrospective analysis of ultrasound and hysteroscopic findings, in 264 women referred with abnormal uterine bleeding.

Setting

Outpatient hysteroscopy clinic in a busy district general hospital.

Results

In situations where hysteroscopy findings were normal, additional information gained from a preliminary ultrasound did not affect management decisions. No malignant adnexal pathology was detected, and ultrasound assessment of the endometrium did not correlate well with either hysteroscopic or histological findings.

Conclusion

Ultrasound findings do not alter management decisions in this situation. The presence of irregular bleeding, and patients' prior expectations, are more significant determinants.

We report the laparoscopic finding of a pelvic schitosomiasis in a 29-year-old Saudi woman who had a diagnostic laparoscopy for primary infertility. We believe that this is the first report to show the natural nodular appearance of this disease, and may help in the differentiation from other pelvic lesions such as tuberculosis and malignancy. Histological examination of the biopsy of these nodules confirmed the diagnosis of schistosoma haematobium. Hence she referred to an assisted reproduction unit.

To describe an endoscopic technique which simplifies the transvaginal sacrospinous colpopexy operation for vault prolapse.

Insertion of polydioxanone sutures was carried out under direct endoscopic visualization.

The introduction of this new technique has changed the difficult blind step of the operation into a directly visualized endoscopic procedure and has decreased the likelihood of complications, especially injury to pudendal nerve and vessels and postoperative buttock pain. This could allow the majority of the gynaecologists to safely perform the operation.

Objective

To describe an interstitial pregnancy which occurred subsequent to and at the site of an hysteroscopic excision of an intrauterine septum.

Setting

University-affiliated reproductive medicine programme.

Subject

A 32-year-old woman undergoing IVF treatment for infertility.

Results

The patient underwent IVF treatment after hysteroscopic resection of an intrauterine septum. Ectopic pregnancy occurred interstitially in the uterine fundus, at the site of the previous septotomy. The pregnancy was excised at laparotomy.

Conclusions

Interstitial ectopic pregnancy may represent a complication of operative hysteroscopy.

To compare the weights of commonly used extracorporeal slip knots.

The weights of seven commonly used types of extracorporeal slip knots and an intracorporeally tied flat square knot were compared. In each arm of the study, 17 knots were tied around a 5-mm jig using a laparoscopic trainer. Knots were weighed using microscales.

A laboratory experiment.

Weight of knot loops in milligrams.

The heaviest ligature was the modified Roeder knot. The Western knot utilized less suture material than all the other knots studied. The flat square knot utilized less suture material than all the slip knots with the exception of the Western ligature.

As other studies have correlated suture mass with the incidence of wound infection, a ligature with a low weight should be chosen in preference to the modified Roeder knot where possible.