Trauma to the inferior epigastric artery during insertion of ports for laparoscopic surgery can be associated with major hemorrhage. Several techniques have been developed to deal with this ...emergency, but most require special and expensive instrumentation that may not be readily available. We describe a simple and quick method to deal with this complication using only standard sutures and a laparoscopic needle holder. Two sutures with straight needles are inserted below laterally and medially to the vessels and pulled out via a contralateral port. The sutures are tied together and pulled back into the abdominal cavity and tied to secure the vessels. The procedure is repeated above the vessels to produce complete hemostasis. The technique also can be applied easily to repair the rectus sheath after using large trocars and cannulas and thereby prevent herniation.
To facilitate extraction and avoid intra-abdominal spillage during laparoscopic removal of adnexal masses, various designs and sizes of endopouches (bags) have been used. We describe a simple ...technique using a special laparoscopic bag that requires no additional instruments to hold, open, or close the bag.
The laparoscopic bag can be prepared from the sterile wrapping of disposable surgical items (eg, suction tubing) and two long sutures. The bag is introduced through the cannula of the laparoscope and is unfurled. By manipulation of the two long sutures threaded through the neck of the bag, the surgeon can easily open and close it.
We have performed this procedure "in vitro" on many occasions to ensure that the drawstring technique works. The laparoscopic bag has been used successfully in three patients undergoing oophorectomy and salpingo-oophorectomy. Our experience shows that this type of laparoscopic bag is easy to use and safe, reduces operative time, and is cost effective. Because the bag can be large, operating inside the bag is also possible.
Our drawstring design allows easy manipulation of a laparoscopic bag to facilitate its opening and closure.
•Symptoms are often not specific and may include fever, abdominal pain, flank and back pain.•Treatment is controversial and there is no standard evidence – based protocol; anticoagulation therapy and ...antibiotics remain the main basic therapy.•The application of bipolar electrocautery and the pexy of the ovary are possible contributing mechanisms for the thrombus formation.
Ovarian vein thrombosis is a rare but potentially serious complication after surgical and gynecologic procedures such as oophorectomy and hysterectomy. The association of this event with laparoscopic hysterectomy in particular, is very rare. Only two cases have been described so far.
We present a case of ovarian vein thrombosis after laparoscopic hysterectomy in a 40-year-old with deep endometriosis and multiple intramural uterine myomas. Laparoscopic hysterectomy, left oophorectomy, right salpingectomy, and suspension (ovariopexy) of the right ovary on the ipsilateral round ligament of the uterus were performed, using bipolar electrocautery as a hemostatic tool.
The 7th postoperative day the patient presented to our hospital complaining of abdominal pain and fever. An abdominal CT scan demonstrated a filling defect and enlargement of the right ovarian vein, a finding compatible with ovarian vein thrombosis. She was treated with low molecular weight heparin (LMWH). On the 19th postoperative day, an MRI scan was performed and did not reveal any pathological findings of the right ovarian vein. The patient was discharged on LMWH for three months. Post treatment evaluation for thrombophilia was negative for pathological findings.
Our case is a very rare condition. Only two ‘similar’ cases have been described in the literature so far. Bipolar electrocautery and ovariopexy on the ipsilateral round ligament during laparoscopic hysterectomy should be evaluated further as possible contributing mechanisms for the thrombus formation.
We present a case report of a foetus with Prune-Belly syndrome (PBS) which was diagnosed sonographically during the 13th week of gestation and review of the literature. Sonographic diagnosis was ...based on abnormally distended urinary bladder and abdomen and absence of 'keyhole sign'. Termination was performed on parental request and post-mortem examination revealed absence of abdominal wall musculature and the distended urinary bladder in a male foetus. Prenatal diagnosis of PBS is based on ultrasound and is usually diagnosed in the second trimester. In the first trimester there are very few reports to date. Prognosis and possible treatment options are herein discussed as well as the underlying mechanisms that may explain the clinical presentation of the syndrome.
We conducted this prospective cohort study to standardize our laparoscopic technique of excision of posterior deep infiltrating endometriosis (DIE) nodules, according to their size, location, and ...geometry, including 36 patients who were grouped, according to principal pelvic expansion of the nodule, into groups with central (group 1) and lateral (group 2) lesions, and according to nodule size, into ≤2 cm (group A) and >2 cm (group B) lesions, respectively. In cases of group 1 the following operative steps were more frequently performed compared to those of group 2: suspension of the rectosigmoid, colpectomy, and placement of bowel wall reinforcement sutures. The opposite was true regarding suspension of the adnexa, systematic ureteric dissection, and removal of the diseased pelvic peritoneum. When grouping patients according to nodule size, almost all of the examined parameters were more frequently applied to patients of group B: adnexal suspension, suspension of the rectosigmoid, systematic ureteric dissection, division of uterine vein, colpectomy, and placement of bowel wall reinforcement sutures. Nodule size was the single most important determinant of duration of surgery. In conclusion, during the building-up of one’s learning curve of laparoscopic excision of posterior DIE nodules, technique standardization is very important to avoid complications.
Negative cone biopsies. A reappraisal Diakomanolis, Emmanuel; Haidopoulos, Dimitrios; Chatzipapas, Ioannis ...
Journal of reproductive medicine,
08/2003, Letnik:
48, Številka:
8
Journal Article
Recenzirano
To analyze the incidence of negative cone biopsies and evaluate the significance of the findings.
The study population consisted of women who underwent cervical conization at a university teaching ...hospital from February 1996 to December 2001. Three modalities were used for conization: CO2 laser, large loop excision of the transformation zone and needle excision of the transformation zone. Negative cones were defined as those not showing evidence of human papillomavirus infection, intraepithelial neoplasia of squamous or glandular origin, or invasive disease.
During the study period, 817 conizations were performed. Of these, 206 (25%) were negative. Less than half the patients (41.7%) had a punch biopsy that matched the subsequent cone biopsy specimen. The negative cone rate in women with a punch biopsy showing cervical intraepithelial neoplasia (CIN) 1 was 60% in contrast with those who had a biopsy indicating CIN 2-3; the latter percentage was 16.5%, and the difference was statistically significant.
Close adherence to international guidelines during workup of an abnormal smear, meticulous colposcopy performed by a certified colposcopist and careful evaluation of punch biopsies by pathologists might help to decrease the negative cone rate.
BACKGROUNDJuvenile cystic adenomyomas (JCAs) are rare uterine lesions. Differential diagnosis might be difficult. We present the case of an adolescent who was diagnosed with JCA and was managed with ...laparoscopic excision. CASEA 14-year-old patient with complaint of menarche with excruciating dysmenorrhea, was diagnosed using magnetic resonance imaging with a uterine anomaly consisting of a normal right hemiuterus, and a left cystic lesion with surrounding hypotense myometrium. She was managed with laparoscopic excision of the left side, and uterine reconstruction. Histology was suggestive of JCA, associated with diffuse adenomyosis. Dysmenorrhea improved considerably after surgery. SUMMARY AND CONCLUSIONDifferential diagnosis between cystic uterine lesions relies on clinical, imaging, and perioperative clues that might assist in their formal classification. Doubt might still remain in some cases.
Protopapas et al reviewed women presenting right-sided pelvic pain as their main complaint who underwent laprascopic appendicectomy as part of their management. Results revealed an abnormal appendix ...in most patients.
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