Gynaecological Endoscopy最新文献

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.

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 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.

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 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.

To review the complications of hysteroscopy.

A retrospective review of the literature on hysteroscopy, to focus on some of the problems that the surgeon may face following this easy and usually safe procedure.

Complications both from large series and isolated reports are included. They can be immediate, varying from an innocuous perforation of the uterus to injury to the bladder, bowel or vascular structures. Haemorrhage may be arrested by simple techniques or may require a laparotomy and hysterectomy. Problems include infection; complications of the distending medium, including CO₂ and air embolism; anaesthetic complications, and thermal injuries. Delayed complications, such as haematometra, rupture of the uterus in a subsequent pregnancy and the need for a repeat procedure including hysterectomy, are other possibilities.

Though hysteroscopy is a safe and easily executed procedure, it may be associated with mild or severe morbidity and even mortality.

Objective

This is a case report showing an association between c-erbB2 over-expression in the endometrium and lack of response to progesterone.

Patients and methods

Determinations of oestrogen and progesterone receptors by immunohistochemistry were carried out in four patients with endometrial lesions that did not respond to the administration of progestins, and results were correlated with the presence of c-erbB2 over-expression.

Results

The presence of c-erbB2 over-expression in the endometrium was associated with a lack of response to progesterone even in the presence of receptors for this hormone.

Conclusion

The presence of c-erbB2 over-expression in the endometrium may be an early event in the development of some forms of atypical complex hyperplasia or carcinoma that may not regress with progesterone treatment.

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.